臺灣博碩士論文加值系統

　本研究旨在探討不同生產方式婦女產後60天內的醫療利用及就醫風險。
本研究材料來自國家衛生研究院發行之1999-2002年全民健康保險承保抽樣歸人檔，以4995位產婦為研究對象，並採用二部模型(Two Part Model)對產後有就醫的產婦進行分析，比較不同生產方式婦女產後60天內的醫療利用及各類疾病的就醫風險。
本研究結果發現，剖腹產婦女產後60天內有就醫者的平均門診就醫次數、平均門診就醫費用均高於自然產婦女；剖腹產婦女產後60天內有就醫者的平均門診就醫間隔天數則比自然產婦女短：在門診就醫風險方面，相較於自然產，剖腹產會增加婦女產後60天內門診就醫的風險，若進一步分析各類疾病的門診就醫風險，剖腹產婦女在「妊娠、生產及產褥期之併發症」、「皮膚及皮下組織疾病」、「骨骼肌肉系統及結締組織之疾病」、「徵候、症狀及診斷欠明之各種病態」、「損傷及中毒」、「影響健康狀況因子及需要醫療服務之補充分類」及「產後感染」等診斷上的就醫風險明顯高於自然產婦女。
由研究結果可知，剖腹產會增加婦女產後60天內門診醫療利用及就醫風險，因此，建議產婦及婦產科醫師除非病情需要，否則儘量避免採行剖腹產手術，以降低婦女產後醫療利用及就醫風險。

　The purpose of this study is to explore the relationship between the delivery method and the risk of postpartum contact and the medical utilization within 60 days after discharge from the birth child hospitalization.
This study used the data of sampled registry of beneficiaries of National Health Insurance from 1999 to 2002, which included 4995 parturient women. And then used Two-Part Model to estimate the risk of postpartum contact and medical utilization associated with mode of delivery within 60 days after discharge.
Compared with spontaneous vaginal delivery, women with cesarean delivery has higher mean number and expenditure of postpartum outpatient contact, but lower mean number of days from delivery until outpatient contact. Cesarean delivery was significantly associated with an increased risk of postpartum outpatient contact, especially for complications of pregnancy, childbirth and the puerperium, diseases of the skin and subcutaneous tissue, diseases of the musculoskeletal system and connective tissue, symptoms, signs, and ill-defined conditions, injury and poisoning, other reasons for contact with health services, puerperal infection.
The most important finding is that women with cesarean delivery was at an increased medical utilization and the risk for postpartum outpatient contact. These results add a further dimension of information that should help obstetricians and women discussing the benefits and risks of cesarean delivery.

目錄

國立台北護理學院醫護管理研究所碩士論文摘要 I
目錄 III
表目錄 IV
圖目錄 V

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 3
第三節 研究目的 4
第二章 文獻探討 5
第一節 自然產與剖腹產的現況與趨勢 5
第二節 醫療服務利用行為模式 9
第三節 影響婦女產後醫療利用之因素 15
第四節 婦女產後醫療利用之相關實證研究 21
第三章 研究材料與方法 32
第一節 研究架構 32
第二節 研究假說 34
第三節 資料來源及研究對象 35
第四節 研究變項 41
第五節 資料處理及分析 47
第四章 研究結果 50
第一節 描述性統計分析 50
第二節 產後門診醫療利用分析 51
第三節 產後住院醫療利用分析 55
第四節 產後各類疾病就醫風險分析 57
第五章 討論及建議 87
第一節 重要結果討論 87
第二節 研究限制 93
第三節 研究建議 94
參考文獻 96
中文部分 96
英文部分 98

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