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    政大機構典藏 > 商學院 > 統計學系 > 學位論文 >  Item 140.119/99757
    Please use this identifier to cite or link to this item: http://nccur.lib.nccu.edu.tw/handle/140.119/99757


    Title: 以全民健保資料庫探討臺灣人口特性與變遷
    Using National Health Insurance Database to explore the Township-level Population and its Migration
    Authors: 林敬昇
    Contributors: 余清祥
    余清祥

    林敬昇
    Keywords: 全民健康保險
    人口特性
    大數據
    常住人口
    就醫地
    National Health Insurance Research Databases
    Demographic Attributes
    Big Data
    de jure Population
    Outpatient Visits
    Date: 2016
    Issue Date: 2016-08-09 10:41:57 (UTC+8)
    Abstract: 戶籍登記制度是臺灣的特色之一,但戶籍人口與實際上的活動人口兩者未必一致,無法確定從中衍生的政策規劃是否妥適,這也是我國仍舊每十年進行一次戶口普查,以獲得常住人口資訊的原因之一。然而,十年一次普查的間隔過長,調查項目也較少,近年不少國家嘗試以公務統計、抽樣調查取得所需資訊,彌補、甚至取代普查,我國2010年普查也改成抽樣調查(約16%抽樣)。本文尋求替代普查的資料來源為目標,其中全民健保是我國聞名國際的重要社會保險制度,實施至今已逾20年,國人無論貧富、居住地區皆享有就醫權利,透過個人的就醫記錄可反映出類似常住人口的特性。
    因目前的健保資料庫並未紀錄投保人之居住地,本研究透過健保資料庫之上呼吸道感染就醫地記錄,作為判斷常住地的依據,輔以投保人口的相關資訊,未來或可發展為類似戶口普查的常住人口之參考。本文亦利用就醫常住地探討就醫人口之特性及其變遷,包括就醫習性、跨區就醫與醫療資源的關聯,並將此就醫需求特性之結果做為調整臺灣醫療資源的參考。再者,透過就醫常住地的方法推估人口遷移矩陣(Origin Destination Matrix),提供與戶籍遷移不同面向的資料參考來源,進一步探討因醫療資源分佈不均所造成的就醫行為之變遷,以及估算跨區就醫所衍生的成本。
    結論:於「醫療層級」角度,約九成的感冒病患會選擇至基層院所就診,於「地」角度,約88%的感冒病患僅會在單一個縣市就診,感冒就醫地除了可作為投保人口常住地估計參考依據之ㄧ,亦可運用至人口特性及遷移等主題作進一步研究。如:本文發現各縣市間的癌症就醫人口之跨區就醫旅行距離差異大,縣市之間的癌症跨區旅行距離相差將近十倍;人口的遷移以鄰近地區為主、15至34歲的遷移率高於平均值,且遷移距離較長,與過去人口遷移相關研究成果相似。
    限制:感冒就醫行為在各年齡層間有所差異,因此人口結構在年齡層上受到感冒就醫比例影響,如:十歲以前的人口,因上呼吸道器官尚未發育完全而容易感染,因此感冒就醫比例相當高,人口比例較高,此外,亦無法探討未就醫之人口。因樣本代表性上的限制,也難以探討鄉鎮市區層級(Town-ship Level)。
    Although the population registration system is one of the distinctive features of Taiwan’s official statistics, it does not necessarily reflect the demographic information regarding the usual residential (or de jure) population. This is one of the reasons why Taiwan government still conduct population census every 10 years in order to acquire appropriate information for policy planning. However, the interval of 10 years is too long for most countries and thus there are some attempts (from Nordic countries especially) to integrate the records from official statistics and survey to construct the information of de jure population. Taiwan also experimented a survey of 16% sample to replace the traditional census in 2010. In this study, we also propose an alternative approach of data source to achieve the information of de jure population.

    Our approach is based on the National Health Insurance Research Database (NHIRD). Taiwan has national health insurance for more than 20 years, and everyone is eligible to join the NHI, no matter rich or poor, and now more than 99% of Taiwan population are covered. In a sense, the NHIRD covers practically whole population in Taiwan. In addition, every township of Taiwan has at least one medical institution, more than 10,000 medical institutions in 371 townships. People tend to visit nearby medical institutions for minor sickness, such as upper respiratory tract infection (URTI) and skin diseases. Therefore, the records of UTRI are used to approximate the de jure population. These records can also be used to acquire the pattern how people migrate by the change of their usual place of outpatient visit. We applied the outpatient migration data to migration models to evaluate the behavior of outpatient visits can be described by these models.

    We found that about 70% of people from database of one million sample in 2005 (LHI2005) would go to medical institution at least once annually because of UTRI, and 88% of these outpatient visits are in one county. Also, about 90% of people from LHI2005 would go to the doctors at least once for 2005-2007 (3-year interval) because of UTRI. In order words, the records of UTRI, including the locations of medical institution, can be used to estimate the place-of-residence. But this information should be used with care since they are not identical to those from census or population registration.
    Reference: 1. 林維娟(2003)。跨區醫療利用及其影響因素分析,國立陽明大學,醫務管理研究所碩士論文。
    2. 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,臺灣衛誌,Vol. 30,347-361。
    3. 林民浩、郭年真、陳威全(2016)。剖析臺灣民眾的就醫流動:利用引力模式評估就醫距離與醫療資源分布的影響,臺灣衛誌,Vol. 35,136-151。
    4. 洪永泰(1995)。戶籍登記常住人口與非常住人口之差異研究,國科會專題研究報告。
    5. 陳珮青、楊銘欽、江東亮、鄭守夏(2003) 。病人跨區住院與醫療區資源分布之探討,臺灣衛誌,22(1):27-32。
    6. 陳肇男(民79)。臺灣地區各類型遷徙之選擇性與差異性,第十三卷,頁43-57。
    7. 章殷超、溫在弘、賴美淑(2009)。利用地理資訊系統探討肝癌病患就醫地理可近性與醫院選擇間之相關性,臺灣衛誌,28(6):517-529。
    8. 張新儀、林明珠、洪永泰、林淑慧(2003)。臺灣地區常住人口與移動人口的比較2001年國民健康訪問調查資料的實證分析,調查研究,14:5-29。
    9. 銀慶貞(2004)。臺灣本島人口遷移的選擇性,國立東華大學,國際經濟研究所碩士論文。
    10. 薛立敏(2007),臺灣地區近年來遷移行為變化之影響因素分析,Vol. 34,69-107。
    11. 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。
    12. 顧漢凌(2006)。全民健保體系下醫療資源分佈對個人醫療使用的影響,國立東華大學,國際經濟研究所碩士論文。

    1. Bouge, D.J. (1959), “Internal Migration.” in P. M. Hauser and O. D. Duncan (eds.), The Study of Population:An Inventory and Appraisal. Chicago:University of Chicago Press, 486-509.
    2. Davies, P. S., M. J. Greenwood, and H. Li (2001), “A Conditional Logit Approach to U.S. State-to-State Migration.” Journal of Regional Science, 41, No.2, pp.337-60
    3. Greenwood, M. J. (1985), “Human Migration: Theory, Models, and Empirical Studies.” Journal of Regional Science, 25, pp.521-44.
    4. Greenwood, M. J. (1997), “Internal Migration in Developed Countries.” Handbook of Population and Family Economics, pp.649-720
    5. LaVela SL, Smith B, Weaver FM, Miskevics SA. “Geographical proximity and health care utilization in veterans with SCI&D in the USA”. Soc Sci Med. 2004;59:2387–99.
    6. Lin, J. P., K. L. Liaw, and C. L. Tsay (1999), “Determinants of Fast Repeat Migrations of the Labour Force: Evidence from the Linked National Survey Data of Taiwan.” Environment and Planning A, 31, No.5, pp.925-45.
    7. Lin, J. P. and K. L. Liaw (2000), “Labor Migrations in Taiwan: Characterization and Interpretation Based on the Data of the 1990 Census.” , 32, No.9, pp.1689-1709.
    8. Ravenstein, E.G. (1889), “The Laws of Migration,” Journal of the Royal Statistical Society, 7, 241-301.
    9. Schwartz, A. (1973), “Interpreting the Effect of Distance on Migration.” Journal of Political Economy, 81, pp.1153-69.
    10. Schwartz, A. (1976), “Migration, Age and Education.” Journal of Political Economy, 84, pp.701-19. Sjaastad, L. A. (1962), “The Costs and Returns of Human Migration.” Journal of Political Economy,70, pp.80-93.
    Description: 碩士
    國立政治大學
    統計學系
    103354021
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0103354021
    Data Type: thesis
    Appears in Collections:[統計學系] 學位論文

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