摘要
背景：許多研究顯示，呼吸道疾病的健康照護支出對國家經濟有很大的影響，且呈現高漲的趨勢。根據中央健康保險局(簡稱健保局)統計資料顯示，西醫門診醫療費用最高，呼吸系統疾病的西醫門診醫療費用僅次於泌尿生殖系統疾病，被保險人平均就醫次數約14至15次，呼吸道疾病之門診平均就醫次數占整體被保險人的1/3。因此，呼吸道疾病的醫療利用分析與就醫趨勢分析是重要的議題。
目的：本研究首先探討2000至2004年皆有投保者，其2000至2004年的西醫呼吸道疾病門診就醫機率及因上、下呼吸道疾病就醫之趨勢分析，其次，探討2004年有利用西醫呼吸道疾病門診者的醫療利用情形及其影響因素。
方法：本研究利用國家衛生研究院「全民健保學術研究資料庫」進行分析。選取2000至2004年五年皆有投保者41,364人為研究對象。本研究利用「二部模型」(Two Part Model)進行資料分析，首先以羅吉斯迴歸(Logistic regression)探討影響2004年有無就醫的相關影響因素，再從中挑出有就醫者做複迴歸析，分析自變項對醫療次數與醫療費用的影響。而在上、下呼吸道疾病的趨勢分析部分則利用Ordered Binomials: Cochran- Armitage Trend Test做檢測。
結果：2000至2004年研究對象有利用西醫呼吸道疾病門診的就醫機率約70%。雖然上、下呼吸道疾病時間趨勢(T)經研究生用描述性分析後並未呈現趨勢效應，但卻因樣本數大而達統計上顯著水準(P<0.0001)。2004年有利用西醫呼吸道疾病門診者，其平均就醫次數5.63次，平均就醫費用2,158.65元。影響有無就醫西醫呼吸道疾病門診的因素中，性別、年齡、投保類別、是否免部份負擔與是否有慢性病皆達到統計上的顯著水準。影響有就醫西醫呼吸道疾病門診醫療次數的因素中，性別、年齡、投保類別、是否免部份負擔與是否有慢性病皆達到統計上的顯著水準。影響有就醫西醫呼吸道疾病門診醫療費用的因素中，性別、年齡、投保類別、是否免部份負擔與是否有慢性病皆達到統計上的顯著水準。

Abstract

Background: According to statistical data of statistics from the National Health Insurance Bureau of the Republic of China, Taiwan, average annual hospital visits for Taiwanese total 15, with respiratory diseases accounting for approximately one third of these visits. Therefore, the medical utilization and trend analysis of respiratory diseases is an important issue. Purposes: This study, first, describes enrollees between 2000 and 2004, the probability of seeing a western medical doctor for outpatients and trend analysis for upper and lower respiratory diseases. Second, describes medical utilization condition and related factors for western medicine in 2004. Methods: This study uses data from the data of national health insurance research database issued by national health research institutes (NHRI), which included 41,364 enrollees between 2000 and 2004. Next, the Two-Part Model is applied to analyze the data, including logistic regression and multiple regression, with the former describing related influential factors with visit or not in 2004, while the latter selects people with visit, and analyzes the independent variables affecting the number and expenditure of outpatient contacts. Trend analysis in upper and lower respiratory diseases uses Ordered Binomials: Cochran- Armitage Trend Test is used to test the results. Results: The probability that the sample uses western medical respiratory disease is 70%. Though time trends analysis of upper and lower respiratory disease are not statistically significant (P<0.0001), the descriptive data do not display increasing or decreasing trends. Because the test involved a large sample. For outpatients seeing western medical treatment for respiratory diseases of in 2004, the average number of visits was 5.636 times, while the average medical expense was NT $2,158.65. Factors influencing outpatients with respiratory diseases seeking western medicine treatment, significant influences on the number of visit and medical expense include gender, age, type of insurance, whether having copayment, whether having chronic disease are significant variables.