臺灣博碩士論文加值系統

自民國84年3月開辦全民健康保險以來，由實務上顯示，一群健康保險高使用頻率者，其耗費較多的醫療資源，然此此群人到底是何種特質？如何利用醫療資源，少有調查研究探討。故本研究以健康保險開辦初期的高使用頻率者為研究對象，意指自民國84年3月至12月底使用13.8 ±3.8張健保卡的高屏分局的被保險人6,581人，進行檔案分析，結果發現其平均年齡為59.9 ±14.7歲，男性佔49.6%，女性佔50.4%，其保險身分以第三類農漁水利人員42.3%為最多。另外選取平均每次就醫間隔小於3.5天的相對高使用頻率者作為電話訪問的對象，扣除死亡、電話錯誤者，電話受訪率為72.7%可供分析的完訪問卷樣本共987人，其平均年齡為60.5±13.6歲，男性佔51.7%，女性為48.7%；教育程度不識字佔44%，國小程度為33%；已婚者佔76.5%，職業專業化程度大多為半技術員63.0%，有5.0領負有重大傷病卡。
完成樣本在健康方面：有43.7%自覺不健康，且平均每人有2.0 ±2.1種醫師確診疾病，其中最常見是高血壓、胃腸疾病、關節炎、白內障、心臟病等；有2.9 ±2.1種自覺症狀數，其中最常見為腰酸背痛、頭痛、疲勞、視力模糊及失眠等症狀；在就醫意向及習慣方面有93.2%，遇身體不舒服即去看醫師，且有81.4%人可自行前往就醫，有72.2%看病在同一地點，67.8%看病同一個醫師的習慣。在受訪樣本常用健保卡就醫的為感冒(32.5%)、胃腸疾病(16.5%)、高血壓(16.2%)、腰酸背痛(12.5%)、頭痛(11.9%)、心臟病(1.4%)、關節炎(10.6%)等。在西醫就診疾病分面亦以感冒為最多見，中醫則是腰酸背痛。就醫利用而言，二週內西醫門診利用比例為最多76.1%，就診2.94 ±3.08次；而中醫利用僅有11.4%，平均0.25±0.88次；一年內住院利用比例為43.9%，平均0.88 ±1.72次；急診利用比例為29.8%，平均為0.71 ±1.69次；有復健醫療服務利用比例為22.6%，其中有64.6%為健保後才有利用復健醫療服務。完成樣本對整體的實施健康保險現況的滿意度達62.8-68%，不滿意者4.5%-6.5%。
由上述可知高使用頻率者大多數為教育水準較低、專業化程度低的老年人居多，且平均約有5種疾病及症狀，利用健保卡就醫以感冒為最多，因此本研究建議對此群人多提供衛生保健常識，特別是健康的體能活動，以減少一些身體的小問題，維持良好的健康狀況。另外宜建立醫療院所檔案進行每家院所平均每人就診次數，以監督醫療院所是否有超常態的診療行為情形。

Following the implementation of National Health Insurance on March 1, 1995, we found a group of people with a high frequency of health insurance use, who utilized a large share of medical resources. But we do not know what the natures of those people are, and how much medical resources are they taking. Little research has focused on this subject. So our study is intended to explore high-frequency health insurance users. We collected data on 6581 high-frequency health insurance users from the Kao-Ping area, who had used an average 13.8 ±3.8 health insurance cards between March and December of 1995. We found that their average age was 59.9 ±14.4 years old; 49.8% were male and 50.2% female, and the most frequent insurance status was 3rd comprising 42.3% of the subjects.
We selected subjects with a relatively high frequency of health insurance use for phone interview, who sought medical services on average every 3.5 days. A total of 987 people were interviewed by phone with a response rate of 72.7%. This sample was 51.7% male with a mean ±SD age of 60.5 ±13.6 years old. Their rate was 44% illiteracy, 76.5% of them were married, 63% semitechnician. Five percent of the sample was issued a special National Health Insurance card for people with severed disease.
Of the 987 completed subjects, 43.3% poor health status, They had a mean ±SD 2.0 ±2.1 diagnosed chronic diseases per person. The most common diseases reported were hypertension, gastroenteric disease, arthritis, catartact, and heart disease, They also had an average mean ±SD of 2.9 ±2.1 self-assessed symptoms per person, including pains in the loins and back, and headache. The proportion that reported visiting a doctor when feeling unwell was 93.2%, 81.4% were able to visit the doctor by themselves, 72.2% usually visited the doctor at the same place and 67.8% regularly visited the same doctor.
The most common conditions for which the study subjects sought ambulatory care using their Health Insurance cards were: cold (32.5%), gastroenteric disease (16.5%), hypertension (16.2%), pains in the loins and back (12.5%), headache (11.9%), heart disease (11.4%), and arthritis (10.6%). The average subject had visited a physician 2.94 ±3.08 times in the past two weeks and proportion with at least one visit was 76.1%. The average number 0.25 ±0.88 times Chinese medicine physician visits in the past two weeks and the visit-rate was 11.4%. The average subject had 0.88 ±1.72 hospital admissions in the past year and the admission-rate was 29.8%. The subjects had a mean ±SD 0.71 ±1.69 emergency service visits in the past year and this rate was 76.1%. Rehabilitation services rate was 22.6%, and 64.6% of all began to use this service after universal health insurance. The proportion of subjects expressing satisfaction with the overall health insurance program was 62.8%∼68%, and the proportion expressing un-satisfaction was 4.5%∼6.5%.
So we can found this sample were low education and professional elderly and they had average five disease and symptoms. More than 50% of those sampled used medical care with their Health Insurance cards for common colds. So this investigation suggests that this population should be provided with more information about health care, especially the health benefits of exercise. Additionally, to establish the hospital file to supervise the normal treatment behaviors of hospital and clinic.