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研究生(外文):Chiao-Yi Kuo
論文名稱(外文):Health Care Utilization and Determinants among Doctor-Shoppers in Taiwan
指導教授(外文):Cheng-Hua Lee
外文關鍵詞:Doctor-ShoppersHealth Care Utilization
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民眾藉由醫療服務之利用以達健康之完善。台灣現行之健保制度,並未限制消費者就醫選擇、就醫次數,即消費者擁有充分之就醫選擇的自由(freedom of choice)。然此制度下是否會造成消費者多醫就診行為?國內外研究顯示多醫就診(Doctor Shopping)其會造成(1)醫療費用上升(Demers 1995 , White-Means 1989);(2)醫療資源浪費(Klienschmidt 1995);(3)醫療持續性照護品質下降(張苙雲 1998 , Lo 2003)。然因目前台灣相關研究甚少,所以本研究首先定義多醫就診者(Doctor Shopper),並進一步探討其影響因素。
本研究運用國家衛生研究院「全民健保學術研究資料庫」之次級資料進行分析,包含 2000 年之承保資料檔、門診處方及治療明細檔、住院醫療費用清單明細檔、重大傷病證明明細檔等,另再串聯醫療資源資料、戶籍資料檔後,去除新生兒、年中死亡者、投保中斷者,尚餘151,480人為本研究之樣本。觀察樣本於2000年之醫療利用狀況。並依Demers(1995年) 運用加拿大魁北克省之資料庫定義多醫就診定義,採用一年內,看診醫師數分佈大於95百分位者,即看診醫師數大於20位醫師者。而本國採用此定義為看診醫師數大於12位以上者為多醫就診者。本研究並以小於11位者為對照組進行比較分析。分析內容含(1)描述型分析;(2)雙變項分析;(3)多變項分析等。
With the use of medical care, the health will reach perfection. Consumers has not been limited in selecting medical advice and the number of times of medical advice from the present Heath Insurance System in Taiwan; that is, consumer has completely freedom of choice in medical advise. Weather this system will cause more consumer seeking medical advice? The literature shows that Doctor Shopping have caused the increases of hospitalization cost (Demers 1995, White-Mean 1989), the wastes of medical recourses ((Klienschmidt 1995), and decline of continuous medical care (Chang, 1998, Lo 2003). The relevant research is rare in Taiwan, therefore, this research defines the Doctor Shopper first, and than explore its influence factors.
This research defines the Doctor Shopping first, and then the distribution of medical advice in Taiwan is divided into four groups, by (1) population characters: sex, age and aboriginals; (2) social status: including insurance amounts and types; (3) health: including disability, serious sick, chronic diseases, whether stay in hospital or not in that year; (4) residential area: including urbanization degree, western doctors per thousand people, and medial district. The next step is to explore the influence factors of Doctor Shopping and it is focused on the analysis of social status and healthy situation.
The second data of “National Health Insurance Research Database” provided by the National Health Research Institutes is applied in this research. The samples include insurant data, clinic prescription and treatment details, medical statement expenses, serious disease prove details in 2000 and are combined with medical recourse data and householder register data, then are omitted new born baby, death in midyear, and people who cut off his insurance. Therefore, the sample size is 151,480 in total. This research observes the situation of medical use in 2000, and applies the definition of Doctor Shopping in database of Quebec of Canada. Within one year, the distribution of medical advices more than 95 percent, which seeking medical advice more than 20 doctors is defined as doctor shopping in Canada; however, in Taiwan, seeking medical advises more than 20 doctors is defined as doctor shopping. A contrast group, less than 11 doctors, is also investigated for comparative analysis. The analysis is involved (1) statement analysis; (2) Bivariate analysis, (3) Multiple variable analysis.
The focal findings of this research present as follow:
1. The ratios of Doctor Shopping of children and elders are higher.
2. The ratio of Doctor Shopping of veterans is higher.
3. The residences with worse heath have higher ratio of Doctor Shopping.
4. The residences live in where medical recourses are rich have higher
ratio of Doctor Shopping.
According to this research, most Doctor Shoppers are children, elders, veteran, and residences whose health is worse and who live in where the medical recourses are rich. It implies that Doctor Shopper from weaker groups. It is suggested to deeply explore the impacts of Doctor Shoppers and Non Doctor Shoppers on progress medical qualities.
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