民眾就醫層級與醫療利用分析：SARS疫情前後的觀察

The Analysis of Level of Outpatient Visits and Healthcare Utilization: A before and after Observation of the SARS Outbreak

10.6288/TJPH2006-25-01-08

王冠懿(Kwan-I Wang)；鄭守夏(Shou-Hsia Cheng)

SARS ； 醫療利用 ； 就醫層級 ； SARS ； healthcare utilization ； level of outpatient visit

台灣公共衛生雜誌

25卷1期（2006 / 02 / 01）

75 - 82

繁體中文

目標：台灣民眾就醫次數偏高以及越級就醫情形普遍，一直受到衛生單位關切，本研究利用大樣本的健保資料，描述民眾就醫層級的分佈，並利用2003年SARS疫情造成之就醫恐慌，來檢視民眾醫療利用的改變情形。方法：本研究資料來源為健保局台北分局民眾承保檔及醫療院所點數清單檔，自承保人口抽樣10萬人，依據專業醫師的共識，將門診疾病依特性分為預防保健、慢性病、常見輕病、常見疾病等，並觀察SARS疫情發生期間，樣本人口各疾病類別之西醫門診就醫層級與次數與去年同期之差異。結果：本研究發現各疾病類別在各層級院所間分佈明顯不同，醫學中心看診多為慢性疾病(61%)，基層則以常見疾病為主（約80%）。SARS疫情期間之門診量與去年同期相較，整體約減少23%，醫院層級越高者於SARS期間門診量下降幅度越大（醫學中心降幅達46%，基層院所為12%），在疾病類別方面也有明顯差異，常見輕病在大型醫院之降幅超過六成，在基層下降不到一成五，而慢性疾病在大醫院減少超過三成，在基層則只下降不到5%。結論：民眾選擇到不同層級醫院診所看診，其疾病類別分佈明顯不同，顯示民眾有一定程度的就醫素養。SARS疫情對民眾在不同層級與各種類型疾病的門診有不同影響，本研究也對輕病越級就醫的問題提出討論。

Objectives: For a long time, people's healthcare utilization, including high frequency of physician visits and upgrades in seeking outpatient service, are of great concern in Taiwan. This study employed the National Health Insurance (NHI) claim data to examine the distribution of disease categories among various hospital/clinic levels and the changes of outpatient visits during SARS outbreak. Methods: Data sources for this study came from the claim files provided by the Taipei Branch of the Bureau of NHI. Disease categories such as preventive care, chronic disease, common minor illness and common illness etc. were established via the consensus of a panel of clinical experts. This study assessed the medical care utilization during the SARS outbreak compared with that in the previous year of a cohort of one hundred thousand residents in greater Taipei area. Results: The distribution of disease categories among various levels of hospitals and clinics varied significantly. Medical centers had the highest proportion of chronic diseases (61%), while the primary care facilities had the majority of common illnesses (around 80%). The SARS outbreak resulted in an overall 23% decrease in outpatient visits. Higher-level medical facilities suffer from a bigger magnitude of volume decrease (46% for medical centers and 12% for primary care facilities). The decrease of service volumes also differed among disease categories. The volume of common minor illnesses fell more than 60% in large-scaled hospitals, while it was less than 15% in primary care facilities. The volume of chronic diseases decreased over 30% in large-scaled hospitals, while it was less than 5% in primary care facilities. Conclusion: The distribution of disease categories varied among different levels of medical care facilities. People showed a certain level of knowledge in making a reasonable selection of medical care providers. Different SARS impacts were observed in the disease categories among the various levels of medical care facilities. The problems of upgrade or overuse of physician visits is discussed in the study.

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