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研究生(外文):Pei Chun,Tsai
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(外文):1.Dr.Maria Kuo2.Dr.Mu-Chen Hu
外文關鍵詞:homeless、national health insurancefuturetaiwanissue
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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.

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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