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研究生:吳春樺
研究生(外文):Wu, Chunhua
論文名稱:延遲退休對醫療利用之影響
論文名稱(外文):The effect of late retirement on health services utilization.
指導教授:林文德林文德引用關係
指導教授(外文):Lin, Wender
口試委員:王劼楊長興
口試委員(外文):Wang, JyeYang, Chianghsing
口試日期:2011-07-04
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫務管理學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:73
中文關鍵詞:提早退休延遲退休醫療利用傾向分數法重複測量
外文關鍵詞:early retirementlate retirementhealth services utilizationpropensity scorerepeated measures
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目的:本研究旨在探討不同退休年齡族群之退休者與相同條件的未退休者醫療利用之差異,與提早退休與延遲退休者和未退休者的醫療利用差異間,是否有所不同以及醫療費用差異是否隨退休時間增加而有所不同。。
方法:採回溯性世代研究之設計,利用全民健康保險資料庫2005年版 100萬抽樣歸人檔(LHID2005)為研究資料。提早退休者以退休年齡介於50-59歲判定,反之在60歲以後退休者則視為延遲退休者。兩組樣本之建構主要先以羅吉斯建構退休預測模型,再由傾向分數配對法(PS, propensity score)進行配對,依照其性別、職業類別、投保單位區域、退休前投保薪資、年齡與退休前的健康狀況,進行一對一貪婪配對(Greedy Match)。醫療利用係指退休組與配對組退休前三年與後六年之西醫門診與住院醫療費用,本研究以配對T檢定及Wilcoxon符號序位檢定分析退休與未退休者醫療利用之差異,再考量性別、退休前職業類別、薪資與健康狀況,以混合模型(mixed model)分析每年醫療利用差異與退休前一年是否顯著不同。
結果:經配對後研究樣本共12,262人,其中50-59歲退休者有9,268人,60-69歲退休者有2,994人。女性、公保、一般鄉鎮、退休前投保薪資、健康狀況及退休前二年整體醫療費用高者其提早退休之機率顯著較高。50-59歲退休者在退休後六年內門診醫療利用顯著高於未退休者,60-69歲退休者之門診醫療利用雖在退休後五年內高於未退休者,惟差異不顯著。50-59歲退休者在退休後五年內整體醫療利用顯著高於未退休者,而60-69歲退休者之整體醫療利用在退休後第四年低於未退休者,惟差異並不顯著。經控制其他影響因素,提早退休者與未退休者之門診與整體醫療利用差異均隨退休時間增加而顯著增加;延遲退休者與未退休者之門診及整體醫療利用差異情形則不顯著。
結論:退休後,提早退休者之醫療利用較未退休者顯著增加,但延遲退休者之醫療利用與未退休者並沒有顯著不同。因此,提早退休對於全民健保財務可能造成負面的影響,反之,延遲退休則並無負面效應,值得納入退休政策之參考。
Objective: Taiwan’s average retirement age is around 54-56, far below the average of OECD countries. Controversy exits about the timing of retirement on health service utilization. This study aimed to compare the health service utilization between the retired of various retiring age and the workers with similar health status.
Methods: With a retrospective cohort study design, we used Taiwan’s Longitudinal Health Insurance Dataset in 2005 (LHID 2005) which consisted of 1 million of representative sample of National Health Insurance beneficiaries to identify people who retired between 1997 and 2004 and aged 50-69. People who retired at the age of 50-59 are classified into early retirement group, whereas people retired after age of 60 are classified into late retirement group. We then traced back 3 years before their retirement and followed up for 6 years after their retirement to measure their health service utilization. Their counterparts who are not retired but have similar health status are selected by a greedy matching algorithm based on propensity score. The significance of difference in health service utilization between the matched pair is test using paired t test or Wilcoxon’s signed rank test, as appropriate. In additions, a mixed model is applied to control covariates when comparing the difference of health service utilization before and after retirement between the pairs.
Results: After matching all the covariates which may associated with the utilization of health services, people in the early retirement group (N=4,636) significantly utilized more health services in 5 years after their retirement compared to their counterparts who are continuous workers, the difference range from 2,563 New Taiwan Dollars (NTD) in first year of retirement to 6,087 NTD. Nevertheless, people in late retirement group (N=1,497) have similar health utilization with their continuous worker counterparts.
Conclusion: Apart from financial burden to the pension system, early retirement may have negative financial impact on the health care system as well. Policy to encourage late retirement should be seriously considered to mitigate the consequence of accelerating aging society.
中文摘要 II
ABSTRACT III
第一章 緒論 1
第二章 文獻探討 3
第一節 我國退休制度與退休現況 3
第二節 退休與健康之相關研究 11
第三節 影響醫療利用之因素 19
第四節 退休與醫療利用之相關研究 21
第五節 傾向分數配對法 28
第六節 文獻總結 29
第三章 研究方法 30
第一節 研究設計與架構 30
第二節 研究材料 31
第三節 統計分析方法 41
第四章 研究結果 45
第一節 個人特性與健康狀況 45
第二節 影響退休之因素 47
第三節 配對後樣本特性與健康狀況 48
第四節 退休對醫療利用之影響 49
第五章 討論 59
第一節 研究對象 59
第二節 研究方法 60
第三節 研究結果 63
第六章 結論與建議 66
第一節 結論 66
參考文獻 70



表目錄
表2-1:公務人員退休相關規定 5
表2-2:學校教職員退休相關規定 6
表2-3:勞動基準法退休相關規定 9
表2-4:2001-2009年一般勞工退休比例 9
表2-5:OECD 國家與我國退休年齡彙整表(1999-2004年) 10
表2-6:退休與健康相關文獻彙整表 15
表2-7:影響醫療利用相關因素 20
表2-8:退休與醫療利用相關文獻彙整表 23
表2-9:退休與健康相關研究之健康狀況測量彙整表 26
表3-1:資料庫內容使用說明 33
表3-2:疾病分類碼一覽表 38
表3-3:操作型定義一覽表 39
表4-1:配對前個人特性與健康狀況 51
表4-2:影響退休因素之羅吉斯迴歸表-依退休年齡族群 52
表4-3:配對後個人特性與健康狀況 53
表4-4:退休與未退休者退休前後門診醫療利用情形-依退休年齡區分 54
表4-5:退休與未退休者退休前後整體醫療利用情形-依退休年齡區分 56
表4-6:退休時間對醫療費用差異之影響-依門診與整體醫療利用區分 58




圖目錄
圖2-1:2002-2010年公務人員退休人數分布圖 7
圖3-1:研究架構圖 30
圖3-2:研究時程圖 32
圖3-3:研究樣本處理流程圖 36
圖3-4:統計分析流程圖 44
圖4-1:退休與未退休者退休前後門診醫療利用趨勢圖-依退休年齡區分 55
圖4-2:退休與未退休者退休前後整體醫療利用趨勢圖-依退休年齡區分 57



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