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| Title: | 身體質量指數對台灣健保支出的影響 |
| Authors: | 許秀李 |
| Contributors: | 黃智聰
許秀李 |
| Keywords: | 身體質量指數
健保支出
醫療資源利用 |
| Date: | 2006 |
| Issue Date: | 2009-09-14 12:34:47 (UTC+8) |
| Abstract: | 台灣地區由於社會經濟蓬勃發展，國民平均所得逐年增加，生活、飲食習慣有所改變，高熱量、高脂肪及低纖維食品成為國人食物主要來源之ㄧ，進而導致熱量和脂肪的過度攝取，及營養供給的不均衡。台灣1998年公告的第三次全國營養調查結果顯示，國人身體質量指數有上升趨勢。
身體質量指數偏低或過高都有較高的死亡率。很多的研究顯示，許多慢性疾病的罹患率和死亡率會隨者身體質量指數的上昇而增加，故肥胖本身是一個獨立的危險因素。根據衛生署最新的資料統計顯示，2005年台灣地區主要死亡原因腦血管疾病、心臟疾病、糖尿病、高血壓分別為十大死因的第二、三、四及十位。肥胖與醫療資源利用及醫療費用亦逐年上升。
本研究欲以身體質量指數為衡量指標，進行體重過重、肥胖者與台灣健保醫療資源利用是否相關性之實證研究探討，並了解其對健保財務負擔影響程度，是否值得重視。研究資料取自國民健康局於2001年執行之「國民健康訪問調查」抽樣樣本，連結健保利用資料，並採最小平方法（ordinary least squares，OLS）為實證分析之方法。本研究以全樣本及男性樣本之模型實證結果發現，身體質量指數過低或過高，都會增加健保門診費用效果；個人的身體質量指數對門診健保費用的影響，並非線性，而是呈現U型的曲線。值得注意的是，以女性樣本之模型，身體質量指數並未顯著地影響健保門診就醫情形，這可能是台灣女性平時較注重健康，會留意體重的變化，以防止體重體重過輕或過重而引起病痛。
關鍵詞：身體質量指數、健保支出、醫療資源利用
The Body Mass Index (BMI) Impact to the Expenditure of National Health Insurance on Taiwan
Abstract
Due to economic grows vigorously on Taiwan, the average income per person increase extremely year by year. Consequently, the living style and eating habit have significantly changes in searching major foods always with high colorific, full fat and low fiber. Therefore, it causes the body absorbing excessively of the colorific and fat as well as in unbalance supply of nutrition. The result of the third Nutrition and Health Survey in Taiwan (NAHSIT) announced in Year 1998, the Taiwanese’ Body Mass Index was toward to rise.
Either lower or higher of Body Mass Index is always subjected higher death rate. Many researches show, there are high correlation coefficient between high percentage of chronic morbidity and death and up trends of Body Mass Index. Therefore, the obesity itself will be an independent dangerous factor. According to newest statistics of National Health Administration, Year 2005 in Taiwan, the main death reason from brain blood vessel disease, heart disease, diabetes, high blood pressure are ranking at the second, third, fourth and tenth of top ten cause of death respectively. Also the obesity is significantly associated with excess medical care cost and resources of hospitalization rising up year by year.
This Research tends to apply Body Mass Index to be an indication of health measuring. Study and discuss the high correlation coefficient between overweighed and obesity and consuming resources of hospitalization of Taiwan. Meanwhile, it deserves paying more attention for understanding the influence level of financial to health insurance. The present data were derived from Bureau of Health Promotion which committee was implemented the National Health Interview Survey at Year 2001 and directly link to expenditure of National Health Insurance. The study method is adopting ordinary least squares (OLS) for real case analysis. This research discovered with the result of study model using completed samples and male samples, either lower or higher of the Body Mass Index will increase outpatient medical care cost. And there was a U-shaped association between Body Mass Index and outpatient medical care cost but liner-shaped.
It deserves paying attention to the model of the samples of female, the Body Mass Index do not obviously encouraging them to see a doctor. Because of Taiwanese women relatively focus on the health regular, will look out for the change of the weight, in order to prevent the weight from being underweight or overweight and causing the illness.
Keyword: Body Mass Index, expenditure of health insurance, resources of hospitalization |
| Reference: | 一、中文部份
中央健康保險局（2006），《全民健康保險簡介》。台北：中央健康保險局。
丁志音、江東亮（1996），「以健康行為型態分類台灣地區之成年人口群聚分析之應用」，《中華衛誌》，15，頁175-187。
尤嫣嫣（1999），「肥胖問題的探討」，《學校衛生雜誌》，35，頁85-99。
林文元（2003），「肥胖的預防與治療」，《傳統醫學雜誌》，14，頁97-101。
洪麗珍、普天間弘（1995），「肥胖、中央肥胖與高血壓盛行率關係之探討—梧棲鎮社區性調查」，弘光醫專學報，26，頁33-48。
翁瑞宏、郝宏恕、黃金安、黃靖媛、羅萱（2004），「健保中醫門診醫療服務之市場區隔變數分析」，《醫務管理期刊》，5（2），頁171-186。
黃國晉、陳慶餘（2002），「肥胖與健康」，《台大校友雙月刊》，第24期。
劉家鴻、吳岱穎、郭冠良、陳建志、林光洋、黃惠娟（2005），「過重與肥胖」，《基礎醫學》，20（9），頁219-231。
劉彩卿、陳欽賢（2001），「研析在全民健保制度下影響台北都會區民眾就診之因素」，《經濟研究》，37（1），頁69-92。
二、英文部分
Belloc, N. B., L. Breslow, and J. R. Hochstim (1971), “Measurement of Physical Health in A General Population Survey,” American Journal Epidemiol, 93, 328-336.
Berki, S. E. and M. L. Ashcraft (1979), “On the Analysis of Ambulatory Utilization: An Investigation of the Roles of Need, Access and Price as Predictors of Illness and Preventive Visits,” Medical Association Journal, 17(12), 1163-1181.
Birmingham, C. L., J. L. Muller, A. Palepu, J. J. Spinelli, and A. H. Anis (1999), “The Cost of Obesity in Canada,” Canadian Medical Association Journal, 160(4), 483-488.
Bray, G. A (1992), “ Obesity Increase Risk for Diabetes,” International Journal of Obesity, 16(4), 13-17.
Coggon, D., I. Reading, P. Croft, M. McLaren, D. Barrett, and C. Cooper (2001), “Knee Osteoarthritis and Obesity,” International Journal Obesity Related Metabolic Disorders, 25, 622-627.
Dietz, H. (2003), “The Obesity Epidemic and CV Risk,” American Journal of Hypertension, 16(5), 265-266.
Egger, G. and B. Swinburn (1997), “An Ecological Approach to the Obesity Pandemic,” British Medical Journal, 315, 477-480.
Felson, D. T., M. C. Nevitt, W. Zhang, P. Aliabadi, B. Baumer, D. Gale, W. Li, and L. Xu (2002), “High Prevalence of Lateral Knee Osteoarthritis in Beijing Chinese Compared with Framingham Caucasian Subjects,” Journal of Arthritis Rheum, 46, 1217-1222.
Finkelstein, E. A., I. C. Fiebelkorn, and G. Wang (2003), “National Medical Spending Attributable to Overweight and Obesity: How Much, and Who’s Paying? ” Health Affairs, 3, 219-226.
Fontaine, K. R., D. T. Redden, C. Wang, A. D. Westfall, and D. B. Allison (2003), “Years of Life Lost Due to Obesity in the United States,” Journal of American Medical Association, 289, 187-193.
Hu, G., N. C. Barengo, J. Tuomilehto, T. A. Lakka, A. Nissinen, and P. Jousilahti (2004), “Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension：A Prospective Study in Finland,” Hypertension, 43, 25-30.
Garrison, R. J. and W. P. Castelli (1985), “Weight and Thirty-Year Mortality of Men in the Framingham Study,” Annals Internal Medicine, 103, 1006-1009.
Ge, L. (1997), “Body Mass Index in Young Chinese Adults.” Asia Pacific Journal Clinical Nutrition, 6, 175-179.
Grossman, Michael (1972), “On the Concept of Health Capital and the Demand for Health,” Journal of Political Economy, 80(2), 223-255.
Guo, S. S., W. Wu, W. C. Chumlea, and A. F. Roche (2002), “ Predicting Overweight and Obesity in Adulthood from Body Mass Index Values in Childhood and Adolescence,” American Journal of Clinical Nutrition, 76(3), 653-658.
Hakkinen, U. (1991), “ The Production of Health and the Demand for Health Care in Finland,” Social Science of Medicine , 33(3), 225-237.
Harris, D. M. and S. Guten (1980), “Health Protective Behavior: Examination of the Conception,” Nursing Outlook, 28, 104-108.
Hopper, K. D., J. R. Landis, J. W. Meilstrup, M. A. McCauslin, and A. G. Sechtin (1991), “The Prevalence of Asymptomatic Gallstones in the General Population,” Invest Radiol , 26, 939-945.
Ishikawa-Takata, K., T. Ohta, K. Moritaki, T. Gotou, and S. Inoue (2002), “Obesity, Weight Change and Risks for Hypertension, Diabetes and Hypercholesterolemia in Japanese Men,” European Journal of Clinical Nutrition, 56, 601-607.
James, P. (1996), “Obesity, A Preventable Disease Report from the International,” Obesity Task Force (IOTF), WHO.
Jung, R. T. (1997), “Obesity as a Disease,” British Medical Bulletin, 53(2), 307-321.
Kenchaiah, S. and V. S. Ramachandran (2003), “ Obesity and Risk of Heart Failure,” Biomed Pharmacother, 57-110.
Kou, M. D. (1998), “The National Survey of the Changes in Nutrition and Health Status from 1992 to 1997 in Taiwan: Anthropometric Index and Obesity Final Report of the Department of Health,” Journal Formos Medical Association, 98, 254-260.
Lavie, C. J. and R. V. Milani (2003), “ Obesity and Cardiovascular Disease: The Hippocrates Paradox?” Journal of American College Cardiology, 42(4), 677-679.
Lévy, E., P. Lévy, P. C. Le, and A. Basdevant (1995), “The Economic Cost of Obesity: The French Situation,” International Journal of Obesity, 19(11), 788-792.
Lew, E. A. and L. Garfinkel (1979), “Variations in Mortality by Weight Among 750000 Men and Women,” Journal Chronic of Disease, 32(8), 563-576.
Lissner, L. (1994), “Causes, Diagnosis and Risk of Obesity,” Obesity Pharmacoeconomics, 5(1), 8-17.
Manson, J. E., G. A. Colditz, M. J. Stampfer, W. C. Willett, B. Rosner, R. R. Monson, F. E. Speizer and C. H. Hennekens (1990), “A Prospective Study of Obesity and Risk of Coronary Heart Disease in Women,” New England Journal of Medicine, 322(13), 882-889.
Manson, J. E. , W. C. Willett, M. J. Stampfer, G. A. Colditz, D. J. Hunter, S. E. Hankinson, C. H. Hennekens, and F. E. Speizer (1995), “Body Weight and Mortality Among Women,” New England Journal of Medicine, 323(11), 677-685.
McKeigue, P. M., B. Shah, and M. G. Marmot (1991), “Relation of Central Obesity and Insulin Resistance with High Diabetes Prevalence and Cardiovascular Risk in South Asians,” Lancet, 337, 282-286.
Mokdad, A. H., B. A. Bowman, E. S. Ford, F. Vinicor, J. S. Marks, and J. P. Koplan (2001), “The Continuing Epidemics of Obesity and Dibetes in the United States,” Journal of the American Medical Association , 286(10), 1195-1200.
Munoz, E., J. Cohen, and J. Goldstein (1989), “Socioeconomic Concerns in Vascular Surgery：A Survey of the Role of Age, Resource Consumption, and Outcome in Treatment Cost,” Journal of vascular Surgery, 9(3), 479-486.
Offer, A. (1998), “Epidermics of Abundance: Overeating and Slimming in the USA and Britain Since the 1950`s,” University of Oxford Discuss Papers in Economic and social History.
Pi-Sunyer, F. X. (1991), “Health Implications of Obesity,” American Journal Clinical Nutrition, 53(6 l), 1595-1603.
Polder, J. J., L. Bonneux, W. J. Meerding, and P. J. Van Der Maas (2002), “Age-Specific Increases in Health Care Costs,” European Journal of Public Health, 12(1), 57-63.
Quesenberry Jr, C. P., B. Caan, and A. Jacobson (1998), “Obesity, Health Services Use, and Health Care Costs Among Members of a Health Maintenance Organization,” Archives of Internal Medicine, 158(5), 466-472.
Raebel, M. A., D. C. Malone, D. A. Conner, S. Xu, J. A. Porter, and F. A. Lanty (2004), “Health Services Use and Health Care Costs of Obese and Non-Obese Individuals,” Journal of the American Medical Association, 164(19), 2135-2140.
Reeder, B. A., A. Senthilselvan, and J. P. Despres (1997), “The Association of Cardiovascular Disease Risk Factors with Abdominal Obesity in Canadn,” Canada Medicine Association Journal, 157(1), 39-45.
Reidpath, D. D., D. Crawford, L. Tilgner, and C. Gibbons (2002), “Relationship Between Body Mass Index and the Use of Health Care Services in Australia,” Obesity Research, 10(6), 526-531.
Sakurai, Y., S. Kono, K. Shinchi, S. Honjo, I. Todoroki, K. Wakabayashi, K. Imanishi, H. Nishikawa, S. Ogawa, and M. Katsurada (1995), “Relation of Waist-Hip Ratio to Glucose Tolerance, Blood Pressure, And Serum Lipids in Middle-Aged Japanese Males,” International Journal of Obesity, 19, 632-637.
Segal, L., R. Carter, and P. Zimmet (1994), “The Cost of Obesity: The Australian Perspective,” Pharmaco Economics, 5(1), 45-52.
Seidell, J. C. (1995), “The Impact of Obesity on Health Status: Some Implications for Health Care Costs.” International Journal of Obesity, 19(6), 13-16.
Stampfer, M. J., K. M. Maclure, G. A. Colditz, J. E. Manson, and W. C. Willett (1992), “Risk of Symptomatic Gallstones in Women with Severe Obesity,” American Journal of Clinical Nutrition, 55, 652-658.
Stevens, J. and K. P. Truesdale (2003), “Epidemiology and Consequences of Obesity,” Journal Gastrointest Surgical, 7, 432-442.
Sundquist, J. and S. E. Johansson (1998), “The Influence of Socioeconomic Status, Ethnicity and Lifestyle on Body Mass Index in a Longitudinal Study,” International Journal Epidemiol, 27, 57-63.
Swinburn, B., T. Ashton, J. Gillespine, B. Cox, A. Menon, and D. Simmons (1997), “Health Care Costs of Obesity in New Zealand,” International Journal of Obesity, 21(10), 891-896.
Thompson, D., J. B. Brown, G. A. Nichols, P. J. Elmer, and G. Oster (2001), “Body Mass Index and Future Health Care Costs: A Retrospective Cohort Study,” Obesity Research, 9(3), 210-218.
Tikly, M., A. Bellingan, D. Lincoln, and A. Russell (1998), “Risk Factors for Gout: A Hospital-Based Study in Urban Black South Africans,” Revue du Rhumatisme, 65, 225-231.
Torgerson, J.S., A. K. Lindroos, I. Naslund, and M. Peltonen (2003), “Gallstones, Gallbladder Disease, and Pancreatitis: Cross-Sectional and Two-Year Data from the Swedish Obese Subjects (SOS) and SOS Reference Studies,” American Journal of Gastroenterology, 98, 1032-1041.
Troiano, R. P. and K. M. Flegal (1998), “Overweight Children and Adolescents: Description, Epidemiology, and Demographics,” Pediatrics, 101(3), 497-504.
Van-Itallie, T. B. (1985), “Health Implications of Overweight and Obesity in the United States,” Annals of International Mesicine, 103, 983-988.
Wang, G., Z. J. Zheng, G. Heath, C. Macera, M. Pratt, and D. Buchner (2002), “Economic Burden of Cardiovascular Disease Associated with Excess Body Weight in U.S. Adults,” American Journal of Preventive Medicine, 23(1), 1-6.
Wisnivesky, J. P., H. Leventhal, and E. A. Halm (2005), “Predictors of Asthma Related Health Care Utilization and Quality of Life Among Inner-City Patients with Asthma,” Journal Allergy Clinical Immunol, 116(3), 636-642.
World Health Organization (2000), “The Asia-Pacific Perspective: Redefining Obesity and Its Treatment,” Geneval, WHO.
Yudkin, J. (1983), “Obesity: A Report of the Royal College of Physicians,” Journal Royal Society of Medicine, 17(1), 5-65.
三、參考網站
行政院衛生署（2002），「國人肥胖定義及處理原則出爐」，2006/8/3取自http://www.doh.gov.tw/cht/content.aspx?dept=R&class_no=25&now_fod_list_no=3942&array_fod_list_no=&level_no=2&doc_no=32&show=.
行政院衛生署（2006），「94年死因統計」，2006/12/10取自http://www.doh.gov.tw/statistic/data/衛生統計叢書2/94/上冊/上冊.pdf.
行政院衛生署國民健康局（2004），「國民健康訪問調查簡介」，2006/12/10取自http://rds.bhp.doh.gov.tw/fileviewer?id=1557.
黃國晉、潘文涵、李美璇、張永漢，「老年人過重與肥胖之盛行狀況」，2006/11/2取自http://www.doh.gov.tw/ufile/Doc/200411_老年人過重與肥胖之盛行狀況.pdf.
Framingham.com (2006), “Profile of the Framingham Heart Study,” Retrieved 2007/1/19 from http://www.framingham.com/heart/profile.htm. |
| Description: | 碩士
國立政治大學
行政管理碩士學程
94921010
95 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0094921010 |
| Data Type: | thesis |
| Appears in Collections: | [行政管理碩士學程(MEPA)] 學位論文
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