Loading...
|
Please use this identifier to cite or link to this item:
https://nccur.lib.nccu.edu.tw/handle/140.119/124955
|
| Title: | 適用長期照護政策之特定族群就醫門診的決定因素
The determinants of medical treatment for specific groups fitting the long-term care policy |
| Authors: | 黃詳祐
Huamg, Hsiang-Yu |
| Contributors: | 吳文傑
連賢明
Wu, Wen-Chieh
Lien, Hsien-Ming
黃詳祐
Huamg, Hsiang-Yu |
| Keywords: | 門診利用
適用長期照護之對象
Panel Regression
Outpatient useing
Panel Regression
Specific groups fitting long-term care |
| Date: | 2019 |
| Issue Date: | 2019-08-07 16:51:55 (UTC+8) |
| Abstract: | 由於人口老化平均年齡上升、家戶人數逐年下降，使得家庭對於照顧老年人口時的負擔越來越重，所需要的醫療照護人次也越來越多，而行政院在2007核定了「長期照護十年計畫」。
本文旨在探討自行政院實施長期照護計畫適用之特定族群的就診因素，高門診就醫者的特性，其性別、年齡、有無慢性病與居住地等因素是否都可能影響醫療資源之使用。
本研究利用健保資料庫2008年至2013年的資料作為研究分析，針對台灣地區的門診資料，從性別、年齡、有無慢性病、居住地、投保金額、投保類別和醫事機構類型以及醫事機構所在地等因素，應用Panel Regression、Probit model及分量迴歸進行資料剖析，觀察門診次數與個人特徵、醫事機構特徵的關聯性。
研究結果發現，性別、年齡、有無慢性病、投保金額、就醫類型、居住地、醫事機構位置和醫事機構類型等因素，是驅使就醫門診次數差異的原因，上述因素所造成之醫療資源使用的不同，在長期照護計畫實施後民眾看診次數有下降趨勢，未來政府在擬訂醫療政策、社會發展計畫，增進社會福利等，可以將這些特性因素納入參考。
Due to population ageing and the number of households declines year by year, Average age raising. The burden on families to care for the elderly is getting heavier, and the amount of nursing care required is increasing. The Executive Yuan approved the “Long-Term Care Decade Plan” in 2007.
The main purpose of this paper is to explore the characteristics of the specific groups fitting the long-term care plan in the Executive Yuan. The characteristics of the high outpatients, whether their gender, age, presence or absence of chronic diseases and located of residence may affect the use of medical resources.
This paper used data from the Health Care Database from 2008 to 2013 as a research analysis. The outpatient data in Taiwan were based on factors such as gender, age, presence or absence of chronic diseases, place of residence, amount of insurance, type of insurance and type of medical institution, and location of medical institution. Data analysis was performed using Panel Regression, Probit model and Component regression to observe the relationship between the number of outpatient visits and personal characteristics and medical institution characteristics.
The study found that gender, age, presence or absence of chronic diseases, the amount of insurance, the type of medical care, the place of residence, the location of the medical institution, and the type of medical institution are the reasons for the difference in the number of medical visits. The use of the medical resources caused by the above factors is different. After the implementation of the long-term care plan, there has been a downward trend in the number of visits by the public. These factors can be included in the future if the government is studying medical policies, social development plans, and promoting social welfare. |
| Reference: | 中文部分
王慧齡(2008)，「台灣地區民眾高門診就醫族群家庭特性的研究」，國立暨南國際大學資訊管理學研究所學位論文。
李丞華、周穎政、陳龍生、張鴻仁，「全民健保中醫門診利用率及其影響因素」，台灣衛誌，23(2)，100-107。
李妙純、沈茂庭(2008)，「長期照護機構住民醫療利用分析—以中部四縣市為例」，台灣衛誌，27(3)，223-231。
林四海、楊慧真、陳墩仁、邱惠慈(2000)，「中部地區醫療服務高低利用者之相關因素研究」，醫務管理期刊，1(1)，57-70。
洪錦墩、郭慈安、李卓倫、陳文意、 黃光華、施雅文(2010)，「老年人於全民健康保險中醫門診醫療服務之利用分析」，臺灣老人保健學刊，6(2)，136-157。
郎慧珠、賴美淑、陳昭姿(2004)，「健保門診高醫療利用疾病之費用與用藥之政策分析」，臺灣醫學會雜誌，103(4)，280-285。
許志成、季瑋珠(1996)，「門診高度使用者之特性：以大溪鎮群醫中心門診病人為例」，中華衛誌，15(1)，91-96。
許績天、韓幸紋、連賢明、羅光達(2011)，「部分負擔調整對醫療利用的衝擊：以2005年政策調整為例」，台灣衛誌，30(4)，326-336。
陳雪姝、蔡淑鈴、黃欽印(2009)，「長期照護機構住民醫療利用分析—以中部四縣市為例」，台灣衛誌，28(3)，175-183。
陳崇倫(2004)，「門診部分負擔提升對民眾就醫行為的影響」，長榮大學醫務管理學研究所學位論文。
陳文意、李卓倫、林玉惠(2012)，「西醫基層總額分科計畫，實施前後門診醫療利用差異之研究」，台灣衛誌，31(4)，347-360。
陳蓓綺(2005)，「門診高診次醫療利用之相關因素探討」，高雄醫學大學公共衛生學研究所學位論文。
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」，台灣衛誌，21(3)，207-213。
張梅瑛、張育嘉、徐尚為(2012)，「台灣地區老人身體健康狀況與醫療利用之研究」，臺灣老人保健學刊，8(2)，130-152。
張羢琦(2005) ，「健保制度下病患就診模式的建構及探討」，國立臺北科技大學 商業自動化與管理研究所碩士學位論文。
張瑩慧(2005)，「門診病患就醫行為相關因素之探討」，中台醫護技術學院管理研究所學位論文。
黃郁清、支伯生、鄭守夏(2010)，「照護連續性與醫療利用之相關性探討」，台灣衛誌，29(1)，46-53。
黃彥慈(2011)，「台灣成人肥胖對醫療使用及慢性病之影響」，國立台灣大學生物資源既農學院農業經濟學系學位論文。
喻崇文(2009)，「持續門診高醫療利用病患之人口特徵及就醫背景因素探討」，中國醫藥大學醫務管理學系碩士班學位論文。
蔡宜芳(2010)，「全民健保門診高診次民眾之特徵及其住院醫療利用行為分析」，中國醫藥大學醫務管理學系碩士班學位論文。
蔡英哲、田峻吉(2016)，「以健保門診醫療支出觀察 65 歲以上國人 對健康需求的行為」，風險管理學報，18(2)，105-126。
蔡佩渝、喻小珠、黃凱琳(2002) ，「醫學中心家庭醫學科門診病人特徵與門診處方的關係：彰化基督教醫院之經驗」，彰化醫學雜誌，7(2)，103-107。
英文部分
Aday,L.A., & Andersen, R. (1974). A Framework for study of Acess to Medical Care, Journal of Health Services Research, 9(3), 208-220.
Angela G.E.M, Wouter,W. ,Hanneke,C.J.M(1997), Predictors of health care utilization in the chronically ill: a review of the literature, Health Policy, 42(2), 101-115
Andersen, R.A. (1968). A Behavioral Model of Families` Use of Health Services. Research Series No.23, Center for health administration studies, Chicago：University of Chicago press.
Andersen, R , & J.F.newman.(1973). Societal and Individual Determinants of Medical Care Utilization in United States. Milbank Memorial Fund Q Health Soc , 51(1), 95-124.
Andersen, R.M. (1995), Revisiting the Behavioral Model and access to medical care：Does it matter ? , Journal of Health and Social Behavior , 36(1), 1-10.
Carol M. Ashton, M.D., M.P.H., Nancy J. Petersen, Ph.D., Julianne Souchek, Ph.D., Terri J. Menke, Ph.D., Hong-Jen Yu, M.S., Kenneth Pietz, Ph.D., Marsha L. Eigenbrodt, M.D., M.P.H., Galen Barbour, M.D., Kenneth W. Kizer, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H.(1999), Geographic Variations in Utilization Rates in Veterans Affairs Hospitals and Clinics, The New England Journal of Medcine, 340,32-39.
Carla,A.G. & Clyde, R.P.(1999), Gender, psychosocial factors and the use of medical services: a longitudinal analysis, Social Science & Medicine, 48(10), 1363-1372.
Freeborn, D. K., Pope, C. R., Mullooly, J. P., & McFarland, B. H. (1990), Consistently high users of medical care among the elderly. Medical Care, 28(6), 527-540.
Haug, M. R. (1981), Age and medical care utilization patterns. Journal of Gerontology, 33, 103-111.
Heywood,P.L. , Blackie,G.C. , Cameron,I.H , Dowell, A.C(1998), An assessment of the attributes of frequent attenders to general practice, Family Practice, 15(3), 198-204.
Jewett, J. J., Hibbard, J. H., & Weeks, E. C. (1992), Predictors of health care utilization for the young-old and the old-old: A structural modeling approach. Behavior, Health, and Aging, 2(1), 29-41.
Kart, C. S., & Engler, C. A. (1995), Self-health care among the elderly: A test of the Health-Behavior Model. Research on Aging, 17(4), 434-458.
Kim,J,. Ko,S, Yang,B.(2005), The effects of patient cost sharing on ambulatory utilization in South Korea, Health Policy, 72(3), 293-300
Kortranski, L., Bolick, J., & Halbert, J. (1987), Neighborhood variations in the use of city-supported primary health care services by an elderly population. ,Journal of Community Health, 12(4), 231-245.
Nagi, S. Z., & Marsh, J. (1980), Disability, health status, and utilization of health services. Journal of Health Services, 10(4), 657-676.
Nelson, M. A. (1993), Race, gender, and the effect of social supports on the use of health services by elderly individuals. International Journal of Aging and Human Development, 37(3), 227-246.
Rosner, T. T., Namazi, K. H., & Wykle, M. L. (1988), Physician use among the old-old: Factors affecting variability. Medical Care, 26(10), 982-991.
Tai,W.T.C. , Porell, F.W. , Adams, E. K(2004), Hospital Choice of Rural Medicare Beneficiaries: Patient, Hospital Attributes, and the Patient–Physician Relationship, Health Services Research, 39(6), 1903-1922
Thorson, J. A., & Powell, F. C. (1992), Rural and urban elderly construe health differently. The Journal of Psychology, 126(3), 251-260.
Wan, T. H. (1982), Use of health services by the elderly in low-income communities. Milbank Memorial Fund Quarterly/ Health and Society, 60(1), 82-107.
Wan, T. H., & Soifer, S. J. (1974), Determinants of physician utilization: A causal analysis. Journal of Health and Social Behavior, 15, 100-108.
Yu, E. S., Liu, H., & Kyrzeja, W. T. (1985), Physical and mental health status indicators for Asian-American communities. In DHHS: Black and minority health: Cross-cutting issues in minority health. Washington, DC: U.S. Department of Health and Human Services. |
| Description: | 碩士
國立政治大學
財政學系
106255020 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G1062550201 |
| Data Type: | thesis |
| DOI: | 10.6814/NCCU201900469 |
| Appears in Collections: | [財政學系] 學位論文
|
Files in This Item:
| File |
Size | Format | |
|---|
| 020101.pdf | 707Kb | Adobe PDF2 | 0 | View/Open |
|
All items in 政大典藏 are protected by copyright, with all rights reserved.
|
