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    Title: 由全民健保資料庫探討就醫習性與人口移動的關聯
    Using National Health Insurance Database to Explore the Relationship between Medical Usage and Domestic Migration
    Authors: 林佩柔
    Lin, Pei-Rou
    Contributors: 余清祥
    鄭宗記
    林佩柔
    Lin, Pei-Rou
    Keywords: 人口遷移
    全民健康保險資料庫
    空間分析
    醫療利用
    死亡率
    Migration
    National Health Insurance
    Spatial Statistics
    Medical Accessibility
    Health
    Date: 2019
    Issue Date: 2019-08-07 16:01:00 (UTC+8)
    Abstract: 人們會因為資源需求、氣候變遷等因素而改變居住地區，大規模人口移動往往反映重大環境變化，人類歷史裡不乏這些紀錄，中國五胡亂華、近年中東難民都是其中範例。然而人口遷移不易追蹤及確認，我國戶口普查雖然紀錄常住人口，但十年一次的頻率經常無法符合實際需求；內政部戶籍登記的遷徙資料較為即時，但戶籍紀錄中的搬遷未必與真實人口移動一致。我國全民健康保險（簡稱健保）的納保率高達九成九，全國各鄉鎮市區均有特約醫療院所，健保已是國民日常生活的一部份，遇到小病痛大多選擇經常活動地附近就醫，因此經常就醫地的變化可用於描述人口移動。有鑑於此，本文以健保資料庫的就醫紀錄探討國人國內移動，同時評估移動與醫療利用、死亡率的關聯，希冀研究結果可做為國人遷移的參考，彌補戶口普查、戶籍紀錄的不足。
    本文根據健保資料庫的2005年百萬人抽樣檔，透過門診處方及治療明細檔等紀錄，將合計點數小於555點的就醫地視為常住地，用以評估人口移動。研究結果發現：健保遷移遠較戶籍遷移頻繁，青壯年的移動比例較高，移動的方向以六都和鄰近的縣市為主，移動與醫療利用、死亡率有關，移動者的死亡率較不移動者高，但門診次數卻以不移動者較多。其中，縣市間的移動者就醫次數最為頻繁，但就醫的疾病較為嚴重，代表縣市間移動者可能較不健康或是移動與醫療需求有關；死亡率以男性縣市間的移動者較高，不同類型的女性移動者死亡率差異較小。
    People migrate because of resource needs, climate change and other factors. Large-scale population movements often reflect major environmental changes, such as Wuhu Chaos in China and the Middle East refugees in recent years. However, human migration is not easy to track and the official statistics from household registration cannot reveal the actual movements. The population census collect the records of permanent resident population but the frequency of every ten-year cannot provide up-to-date information. On the other hand, Taiwan implemented the National Health Insurance (NHI) in 1995 and more than 99% of Taiwan’s residents participate in this program. The NHI becomes a part of our daily life and every township has at least one hospital or clinic. According to past studies, people tend to have outpatient visits in their living areas for minor illnesses, and thus we can use these medical records to study Taiwan’s domestic migration.
    In the study, we explore the relationship between medical usage and domestic migration from the NHI Research Database. We found that the migration rates from the NHI are higher than those from household registration. The young adults move more frequently than other groups, and most migrants move to nearby municipality and cities. The mortality rates of migrants are higher than those of non-migrants. Those who migrate to cities have less medical utilization but their medical costs are higher (i.e., more serious conditions), indicating that the migrants are less healthy.
    Reference: 一、中文部分
    1.余清祥、簡于閔、梁穎誼（2019），「健保資料與抽樣調查」，to appear in《調查研究─方法與應用》。
    2.吳依凡（2004），「醫療資源可近性對個人醫療利用的影響－台灣地區的實證研究」，國立中央大學產業經濟研究所碩士論文。
    3.林民浩、楊安琪、溫在弘（2011），「利用地區差異與人口學特徵評估全民健保資料庫人口居住地變項之推估原則」，《台灣衛誌》，Vol. 30：347-361。
    4.林敬昇（2016），「以全民健保資料庫探討臺灣人口特性與變遷」，國立政治大學商學院統計學系碩士論文。
    5.許筱翎（2017），「以全民健保資料庫探討高齡人口的醫療需求」，國立政治大學商學院統計學系碩士論文。
    6.陳寬政、廖正宏（1984），「人口遷移與就業」，《人口學刊》，Vol. 7：107-126。
    7.陳肇男、劉克智（2002），「台灣2000年戶口普查結果的評價：常住人口與戶籍登記人口的比較分析」，《人口學刊》，Vol. 25：1-56。
    8.彭建文、吳文傑、龔書玉（2009），「縣市內部人口遷徙影響因素分析」，《人口學刊》，Vol. 39：85-118。
    9.蔡文正、龔佩珍（2003），「民眾對基層診所評價與就醫選擇影響因素」，《臺灣衛誌》，Vol. 22（3）：181-193。
    10.薛立敏、曾喜鵬、謝鈺偉（2007），「台灣地區近年來遷移行為變化之影響因素分析─家戶遷移決策與遷移地點選擇之聯合估計」，《人口學刊》，Vol. 34：69-107。
    11.謝淑惠（2016），「以地址最末兩碼調整之戶中選樣表」，《調查研究‒方法與應用》，Vol. 41：119-147。
    12.簡于閔（2017），「以全民健保資料庫探討國人就醫習性」，國立政治大學商學院統計學系碩士論文。
    13.顏貝珊、余清祥（2010），「2010年各國人口普查制度之研究」，《人口學刊》，Vol. 40：203-229。

    二、英文部分
    1.Brown, R.L. (1997), “Introduction to the Mathematics of Demography”, Society of Actuaries.
    2.Chang, C., Yue, C.J., and Chen, Y. (2018), “Does Migration Result in Mortality Improvement: A Case Study in Taiwan”, to appear in North American Actuarial Journal.
    3.Kibele, E., Scholz, R., and Shkolnikov, V. (2008). “Low Migrant Mortality in Germany for Men aged 65 and older: Fact or Artifact?”, European Journal of Epidemiology, 23: 389-393.
    4.Lee, E.S. (1966), “A Theory of Migration”, Demography, 3: 47-57.
    5.Ng, E. (2011). “The Healthy Immigrant Effect and Mortality Rates”, Health Reports, 22: 25-29.
    6.Palloni, A. and Arias E. (2004). “Paradox Lost: Explaining the Hispanic Adult Mortality Advantage”, Demography. 41: 385-415.
    7.Penchansky, R. and Thomas, J.W. (1981) “The Concept of Access: Definition and Relationships to Consumer Satisfaction. ” Medical Care, 19: 127-140.
    8.Rogers, A. (1988), “Age Patterns of Elderly Migration: An International Comparison”, Demography, 25(3): 355-370.
    9.Singh, G.K. and Miller, B. A. (2004). “Health, Life Expectancy, and Mortality Patterns among Immigrant Populations in the United States”, Canadian Journal of Public Health, 95(3): 114–21.
    10.Thomson, E.F., Nuru-Jeter, A., Richardson, D., Raza, F., and Minkler, M. (2013). “The Hispanic Paradox and Older Adults’ Disabilities: Is there a Healthy Migrant Effect?”, International Journal of Environmental Research and Public Health, 10(5): 1786-814.
    11.Wallace, M. and Kulu, H. (2014). “Low Immigrant Mortality in England and Wales: A Data Artefact?”, Social Science and Medicine, 120: 100-109.
    12.Wang, H., Yue, C.J., and Wang, T. (2018), “Do Domestic Immigrants Live Longer? An Approach for Estimating Life Expectancy of Small Populations”, to appear in Migration Letters.
    Description: 碩士
    國立政治大學
    統計學系
    106354004
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0106354004
    Data Type: thesis
    DOI: 10.6814/NCCU201900516
    Appears in Collections:[Department of Statistics] Theses

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