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  • 學位論文

經濟弱勢家庭兒童醫療資源利用之探討

Medical Care Utilization of Children in Low-income Families

指導教授 : 黃國哲

摘要


兒童期是成長發育的關鍵期,週遭生活環境是否能提供適當的支持和保護,對於他們的發展與適應情況有極大的影響。自從1995年全民健保開辦將兒童納入健保範圍,使兒童醫療照護更加提昇,但國內學多研究及資料分析顯示,無論在牙醫的利用、醫院服務量及急診使用率分布都有偏富的情形。本研究係以全民健康保險研究資料庫為資料來源,分析經濟弱勢家庭兒童與一般家庭兒童之門診、急診及住院醫療利用之關連性,並依研究目的將兒童的個人特質(如年齡、性別等)、健康狀況(是否有重大傷病、發展遲緩、腸胃炎、呼吸道感染及氣喘)、就醫醫院層級及投保地區都市化程度等因素列為控制變項,以進一步分析經濟弱勢家庭兒童與一般家庭兒童間醫療利用是否有顯著性的差異。 本研究使用2010年全民健康保險資料庫系統抽樣檔,選取5歲以下兒童為研究對象,在醫療費用部份使用複回歸分析,而住院天數採用負二項廻歸進行分析。整體而言,經濟弱勢家庭兒童的門診醫療利用較一般家庭兒童高(B=0.026, p=.019)。此外,個人特質、健康狀況、就醫醫院層級及投保地區都市化程度等特性等因素,對於兒童門診醫療利用有顯著性的影響力。而在住院醫療費用的部分經濟弱勢家庭兒童住院費用低於一般家庭兒童(B=-0.374, p<.001),而住院天數的部份以經濟弱勢兒童高於一般家庭兒童(B=0.180, p=.002),並且都達到統計上顯著差異,而各個變項在住院醫療也有達到顯著的差異,但投保地區都市化程度除了偏遠鄉鎮有統計上顯著差異外,其他鄉鎮市區在住院醫療部份則不顯著。 兒童是未來的主人翁,為了讓生長在不同家庭的兒童不會因家庭的經濟狀況不同而在醫療照顧上有所差異,因此政府不斷提供兒童在各種福利上的補助,尤其在醫療的照護上,希望藉由政府的資源來彌補家庭不足的部份,使兒童在生長的過程不因家庭因素而影響其成長,使經濟弱勢家庭兒童也享有一般家庭兒童應享有的健康照護。但城鄉差距對於醫療資源的分配卻會影響兒童醫療的利用,而這部份是政府需要積極正視的問題。

並列摘要


Childhood is the key point in children’s growth; the environment to provide appropriate support and protection, has a great impact on their development and adaptation. Since 1995, the National Health Insurance has included children with various health care ranges, making child care more enhanced. This is especially true in the area of domestic science research and data analysis which has shown that regardless of the use of dentists, hospital services and emergency usage, still has a biased rich situation. In this study, we use the National Health Insurance Research data to analyze the situation of children in low income and general-family conditions in their use of out-patient, emergency and inpatient medical utilization. Depending on the research purposes, factors, and control variables such as age, gender, health status, hospital level insured areas of urbanization and other aspects, further analysis of low income families children and general family child should be done. In this select study of children under age 5, we use multiple regression analysis and. negative binomial regression. Overall, children of low income families have a higher usage rate of outpatient medical utilization than children from general family situation (B = 0.026, p = .019). In addition, personal characteristics, health status, medical treatment hospital level and degree of urbanization of the insured area characteristics and other factors for children's use of ambulatory services have a significant influence. In the hospital medical expenses part of the low income families children below gemeral families children (B = -0.374, p <.001), while hospitalization of low income family childreni is high and significant (B = 0.180, p = .002). Children grow up in different families and economic conditions, but the government always seeks to fill in any gap in medical care for lower children from lower socio-economic backgrounds through a variety of children’s subsidies and benefits, especially in the medical care field. It is hoped that government resources continue to make up for the what poorer families lack for their children because their growth should not be limited by the economic limittions of their parent’s situation. Children from low income families should enjoy the same benefits of children of ordinary families, especially in health care. The current reality is that there is a gap between urban and rural areas in the allocation of medical resources; and, this disparity will affect children's health care utilization. It is this inequality that the government need to actively address.

參考文獻


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