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研究生:蔡佩君
研究生(外文):Pei Chun,Tsai
論文名稱:遊民健康保險醫療資源耗用分析-以高雄市某區域醫院為例
論文名稱(外文):An Analysis on the Health Care Insurance Resource Used by the Homeless--Examples from a Community Hospital in Kaohsiung City
指導教授:1.郭瑪琍亞助理2.胡木成
指導教授(外文):1.Dr.Maria Kuo2.Dr.Mu-Chen Hu
學位類別:碩士
校院名稱:樹德科技大學
系所名稱:金融保險研究所
學門:商業及管理學門
學類:財務金融學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:83
中文關鍵詞:遊民全民健康保險高危險群醫療費用流動性併發症合併症
外文關鍵詞:homeless、national health insurancefuturetaiwanissue
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依據內政部處理統計遊民資料顯示,官方登記在案的遊民人數大都維持在三、四千人左右。對經濟發展快速、生活水準提升的台灣社會而言,遊民現象是非常令人不解且困惑的社會現象。流浪為生的遊民是極易受傷的,更是容易罹患疾病的高危險群,而遊民健康更是一個容易被忽視的社區衛生與安全問題。而目前遊民的健康問題並無專責機構負責建檔與管理,且遊民的流動性高更不易掌握其健康狀態,常造成醫療中斷或醫療資源的重複利用與浪費。而遊民醫療過程經濟問題是其主要的原因。多數遊民無穩定工作,無固定收入,因此遊民更易在罹患各式各樣疾病後,仍遊走於社會每個角落,成爲疾病的散播者之一。
本研究在探討遊民個人背景、生活習慣、就醫情形與門急診及住院醫療時健保申報醫療費用耗用之情形。研究結果發現,遊民普遍教育程度偏低,未婚居多,經濟來源以打零工為主,屬於長期或慢性遊民人口,相當高比例有菸酒上癮習慣,無每日盥洗者居多,這與顯現在外骯髒、惡臭相符,經常處於挨餓狀態,勢必減弱規律工作時所需的體力及精神,大多獨來獨往無與他人往來。以第六類人口加入全民健康保險,但多無力負擔健保費及就醫之醫療費用,大多於離院後無門診追蹤。門急診就醫及住院治療次數範圍很廣,就醫主診斷以損傷及中毒為最多,顯示流浪在外的生活較易遭受意外傷害或因悲觀情緒而產生自我傷害。就醫診斷個數以2個為最多,顯示遊民就醫時通常非單一診斷,因此治療次數及天數常因疾病所伴隨之合併症或併發症而有所不同。遊民的親人網絡絕大部分因故無伸出援手或無法提供協助,以致在事故發生時無所依靠。
無醫療後續追蹤與不安定的生活型態,更加速遊民身體的衰弱。沒有錢買藥、看病是遊民最大的困難。而遊民的醫療問題並非是單一機構就可以解決的,它需要多面向的合作與支援才有可能成功。本研究期能提供政府部門對未來遊民醫療問題能發展有效之因應對策。
According to the statistics on the homeless people compiled by the Welfare Department of the Internal Affairs Ministry, the number of homeless people who have registered with that agency is around 3-4 thousand. Homeless is a perplexing social phenomenon for Taiwan, whose economy develops and living standard is raised. Homeless people get injured easily due to their unsteady, wandering lives. Moreover, they are in for the prey of diseases. Their health issue is easily neglected and has been a problem with the general community health and safety. Currently, no governmental agency has been held responsible for the health issue with the homeless; the homeless people’s health issue is neither on file nor under management. The issue is exacerbated by their high mobility. The discontinuation of health care or redundancy / waste of health care resources thus has often occurred. Above all, economic condition is the main reason behind the lack of or inappropriate health care for the homeless. Most homeless people have no steady job nor steady income. Therefore, despite the fact that they may have contracted a variety of diseases, they continue living here and there in the society, and become a media for certain contagious diseases.

This thesis focuses on studying the personal background of the homeless, their living habits, their mode of having health care, and the health care expenditure application with respect to regular and emergency intake and hospitalization. This study finds that the homeless generally are with little education, their marital status is single mostly, and their income comes from odd-job mostly. A high percentage of the long-term or chronical homeless people are addicted with alcohol or tobaccos. Most of them do not clean themselves regularly, which corresponds with their dirty appearance, and the accompanying smells. Their regular state of hunger helps weaken their physical stamina and metal strength required for a steady job. The homeless people are used to act alone, without interaction with others. They join Taiwan’s nationwide health care program in the sixth category. However, the homeless cannot afford their health care insurance premiums and co-payments. They also lack follow-up health care most of the time. The homeless tend to use a wide range of hospitals and they repeatedly see the doctor. Their main diagnoses are injuries and being poisoned, reflecting the fact that they are prone to get hurt by accident due to their wandering living style and self-injury due to depression. They are diagnosed with two different injuries / diseases mostly, showing that they probably have other complications which cause a variety of health care processes and days of health care. Further, a majority of the homeless do not have relatives who provide help financially or support them mentally; thus, the homeless usually are rendered helpless when an accident happens or a disease strikes.

No follow-up health care and unsteady living style contribute to the physical weakness of the homeless. As afore-mentioned, lack of money to buy the medicine and to see the doctor is the main difficulty for the homeless. This homeless people health care issue is not resolvable by s single agency; this issue needs cooperation and support from many resources in the society. I hope this study will provide the governmental departments with a clue for their strategy toward resolving this issue in the future.
目錄

中文摘要 ------------------------------------------------------------------------------ Ⅰ
英文摘要 ------------------------------------------------------------------------------ Ⅱ
謝辭 ------------------------------------------------------------------------------ Ⅳ
目錄 ------------------------------------------------------------------------------ Ⅴ
表目錄 ------------------------------------------------------------------------------ Ⅶ圖目錄 ------------------------------------------------------------------------------ Ⅷ
一、緒論 ------------------------------------------------------------------------------ 1
1.1 研究背景 ----------------------------------------------------------------- 1
1.2 研究動機 ----------------------------------------------------------------- 2
1.3 研究目的 ----------------------------------------------------------------- 3
1.4 研究範圍與限制 -------------------------------------------------------- 4
二、文獻探討 ------------------------------------------------------------------------ 5
2.1 遊民定義 ----------------------------------------------------------------- 5
2.2 遊民形成理論與因素 -------------------------------------------------- 10
2.3 遊民結構性分析 -------------------------------------------------------- 11
2.4 遊民身分及人數推估 -------------------------------------------------- 14
2.4.1 遊民身分 --------------------------------------------------------- 14
2.4.2 遊民人數推估 ----------------------------------------------------- 15
2.4.3 遊民令人懼怕的原因 -------------------------------------------- 16
2.5 英美台灣遊民問題與對策 ---------------------------------------------- 17
2.6 社會保險之功能 ---------------------------------------------------------- 20
2.6.1 現行社會保險問題 ----------------------------------------------- 21
2.6.2 我國社會保險問題分析 ----------------------------------------- 22
2.7 全民健康保險起源 ------------------------------------------------------- 25
2.7.1 全民健保組織架構與制度設計 -------------------------------- 26
2.7.2 全民健保實施成果 ----------------------------------------------- 26
2.7.3 實施全民健保後所產生之問題 -------------------------------- 27
2.8 全民健保支付制度 ------------------------------------------------------- 29
2.8.1 總額預算支付制度及優點 -------------------------------------- 30
2.8.2 全民健保制度相關之研究 -------------------------------------- 32
2.9 社經狀況與死亡率之相關研究 ---------------------------------------- 33
2.9.1 可避免死亡疾病的相關研究 --------------------------------- 33
三、研究方法 ----------------------------------------------------------------------- 35
3.1 研究流程 ------------------------------------------------------------------- 35
3.2 研究設計 ------------------------------------------------------------------- 36
3.2.1 研究實施程序----------------------------------------------------- 36
3.2.2 研究歷程 -------------------------------------------------------- 37
3.3 研究方法選擇 ---------------------------------------------------------- 37
3.4 研究樣本設計 ---------------------------------------------------------- 37
四、研究結果與討論----------------------------------------------------------------- 39
五、結論與建議----------------------------------------------------------------------- 74
5.1 研究結論 ------------------------------------------------------------------ 74
5.2 研究建議 ----------------------------------------------------------------- 76
參考文獻 ------------------------------------------------------------------------------- 79
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