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研究生:陳怡婷
研究生(外文):Yi-TingChen
論文名稱:三歲以下兒童醫療補助計畫對兒童健康不平等的影響
論文名稱(外文):The impact of health inequalities by the medical service subsidy plan for children below three years old
指導教授:王亮懿
指導教授(外文):Liang-Yi Wang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:101
中文關鍵詞:兒童健康不平等醫療利用氣喘醫療補助計畫
外文關鍵詞:child health inequalitieshealth care utilizationasthmamedical service subsidy plan
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研究目的:
本研究欲探討「全國三歲以下兒童醫療補助計畫」的實施是否讓不同都市化程度與不同社經地位的兒童其醫療利用趨於平等,將分析各年度兒童的全病因與氣喘就醫情形。
研究方法:
本研究資料來源為全民健保資料庫,選取出生日期介於1994年1月1日至2007年12月31日的兒童樣本,串聯兒童三歲以下的醫療使用紀錄。進一步將兒童分成五組社經地位,分別是高所得組、中所得、低所得組與地區人口組和低收入戶組,在控制年齡、性別、投保地區後,利用ANOVA、負二項迴歸、卡方檢定等統計方法檢定五組社經地位的醫療利用與健康的差異。
結果:
在兒童的全醫療利用上,在不同都市化程度中可以發現在2002年3月1日計畫實施之後,拉近了偏鄉老農市鎮與其他三個都市化地區的門診就醫次數,但在住院次數無明顯改變;而在不同社經地位中的門診醫療利用可以發現,三組所得組的門診次數無差異,但低收入戶與地區人口組卻顯示較低的門診次數,且計畫實施後也未有明顯的改變;在住院方面則顯示低收入戶的使用明顯高於其他四組的趨勢。而氣喘盛行率由出生年1996年的1.96%上升至2004年的5.43%,而高所得組的氣喘盛行率最高。在不同社經地位的氣喘兒童因氣喘至門診就醫無差異,但低收入戶組因氣喘住院明顯高於其他組,計畫實施對住院使用無明顯影響。在健兒門診使用可發現低收入組的健兒門診使用次數最少,而地區人口的非健兒門診使用是最少次。
結論:
「全國三歲以下兒童醫療補助計畫」對於不同社經地位的兒童其門診和住院沒有明顯縮小其差距。本研究發現地區人口無論是在全病因門診或是因氣喘至門診就醫,都明顯低於其他社經地位。地區人口可能也屬於經濟弱勢,但其醫療利用卻沒有受到計畫影響而有明顯提升。相對的低收入戶在全病因住院和因氣喘住院的情形仍是普遍較高,可能原因推測低收入戶可能有較嚴重的健康問題需要住院或有過度使用住院資源的情形。
Objectives:
This study mainly focused on the implementation of “the medical service subsidy plan for children below three years old”. We analyzed the medical utilization pattern of all-cause disease and asthma for children who were under the different urbanization and at different socio-economic status to investigate the tendency of the subsidy programs to equality.
Methods:
Data source form the National Health Insurance from National Health Research Institute. We observe the children cohort who were born on 1994 Jun 1st - 2007 Dec 31, and linked their medical record before the age of three. Furthermore, children are divided into five socioeconomic status groups (high, middle, low-income group, local population group and law defined the low-income household group). After controlled by age, gender, and insurance area, ANOVA, negative binomial regression and chi-square test were applied to examine whether there were discrepancies in the health care utilization and health status for the children from different socioeconomic status groups.
Results:
On the all-cause medical use of children in the different urbanization, we found that the outpatient visits in urban areas came closer to the other urbanized areas after the implementation of the plan on March 1, 2002. However, the number of hospitalizations difference between those two areas was not significantly changed. Stratified by socio-economic status, there was no difference between the three income groups in outpatient visits while law defined low-income households and local population groups showed that the low outpatient visits with no significantly changed even after the introduction of the plan. The hospitalization of low-income households group in law showed a trend which was higher than of the other four groups significantly. The asthma prevalence increased from 1.96% (birth in 1996) to 5.43% (birth in 2004), while the high-income group obtained the highest asthma prevalence. There was no statistic significant between different socio-economic statuses in asthma outpatient counts for children who had asthma; however, the asthma caused hospitalization of low-income group was significantly higher than other groups, and even after the plan implementation. In addition, the use of well-baby clinic revealed the lowest resource usage in the law defined low-income group whereas non-well-baby clinic usage showed the lowest counts in the local population group.
Conclusions:
The policy “the medical service subsidy plan for children below three years old” did not significantly shrink the discrepancies of the socio-economic status in outpatient and inpatient. This study found that all-cause outpatient or asthma outpatient in the local population group, are significantly lower than it is in other socio-economic status. The local population group’s children may also belong to the economically disadvantaged, so their medical usage doesn’t been impacted by the project. Relatively, the counts of hospitalization owing to asthma and owing to all cause are both generally high in low income group. The possible reasons accounts for this phenomenon are- the resources are over used for hospitalization , and more likely, they easily meet severe healthy problems therefore need to be hospitalized due to the inequality in health.
摘要 i
Abstract iii
致謝 v
目錄 vi
表目錄 viii
圖目錄 ix
第一章 前言 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究問題 3
第四節 研究假設 3
第二章 文獻探討 5
第一節 兒童健康不平等 5
第二節 兒童氣喘 12
第三節 我國兒童健康不平等相關研究 16
第四節 我國兒童健康福利政策及其對消弭兒童健康不平等的相關研究 17
第三章 研究方法與材料 21
第一節 資料來源 21
第二節 變項定義 22
第三節 研究問題與分析策略 25
第四節 統計軟體 29
第四章 結果 31
第五章 討論 54
第六章 結論與建議 63
第一節 結論 63
第二節 建議 63
參考文獻 65
附錄 72
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劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義(2006),台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究,健康管理學刊,第四期第一卷,頁1-22。
賴麗珍(2005),屏南地區低收入戶之學童健康檢查評估,東港安泰醫護雜誌, 第十一期第一卷,頁 35-41。
韓幸紋、連賢明(2008a),降低部分負擔對幼兒醫療利用的影響:以北市兒童補助計畫為例,經濟論文叢刊,第三十六卷第四期,頁589-623。
韓幸紋、連賢明(2008b),利用「分量迴歸」分析部分負擔對兒童醫療利用的影響,台灣社會福利學會。
戴志江(2008),兒童氣喘與醫療資源利用,國立中山大學醫務管理研究所碩士論文。
謝承霖(2007),兒童氣喘,取自http://peri001.pixnet.net/blog/post/25670737-%E5%85%92%E7%AB%A5%E6%B0%A3%E5%96%98-。
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1. 韓幸紋、連賢明(2008a),降低部分負擔對幼兒醫療利用的影響:以北市兒童補助計畫為例,經濟論文叢刊,第三十六卷第四期,頁589-623。
2. 劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義(2006),台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究,健康管理學刊,第四期第一卷,頁1-22。
3. 賴麗珍(2005),屏南地區低收入戶之學童健康檢查評估,東港安泰醫護雜誌, 第十一期第一卷,頁 35-41。
4. 陳麗光、盧鴻興、張華志(2004),1996-2001年之全民健康保險兒童預防保健服務利用率,臺灣公共衛生雜誌,第二十三卷第一期,頁37-44。
5. 陳欽賢、朱子斌、劉彩卿(2006),全民健康保險制度下兒童預防保健服務之利用,醫務管理期刊,第七卷第一期,頁107-122。
6. 徐世達(2012),認識嬰幼兒過敏氣喘病, 取自 http://members.tripod.com/~asthma_family/infantasthma.htm。
7. 許君強、林澤余、沈希哲、張嘉莉、湯澡薰(2006),醫療補貼政策對醫療利用之影響-以台北市兒童醫療補助計畫為例,北市醫學雜誌,第三卷第三期,頁268-287。
8. 張鴻仁、黃信忠、蔣翠蘋(2002),全民健保醫療利用集中狀況及高、低使用者特性之探討,臺灣公共衛生雜誌,第二十一卷第三期,頁 207-213。
9. 林虹良、王瑞霞(2006),台灣兒童氣喘的危險因子,高雄護理雜誌,第二十三卷第一期, 頁23-32。
10. 洪文綺、黃淑貞(2005),父母相關因素與國小學童安全生活之相關性研究,衛生教育學報,第二十四卷,頁163-185。