全民健保對健康差距之影響－以平均餘命為測量

Changes in Health Disparity after Introduction of National Health Insurance: Measurement on Life Expectancy

10.6288/TJPH2007-26-03-04

吳宛蕙(Wan-Hui Wu)；楊長興(Chiang-Hsing Yang)

全民健保 ； 平均餘命 ； 健康差距 ； 都市化 ； 時間數列 ； National Health Insurance ； life expectancy ； health disparity ； urbanization ； Box and Tiao's event intervention analysis

台灣公共衛生雜誌

26卷3期（2007 / 06 / 01）

196 - 207

繁體中文

目標：探討全民健保是否有助於改善男性、女性最高與最低都市化，以及最高與中等都市化程度民眾平均餘命之差距。方法：以1987至2003年為研究期間，使用內政部之人口資料檔及衛生署之死因資料檔，計算出各都市化程度民眾的平均餘命後，採用Box及Tiao的時間數列介入分析，比較全民健保介入民眾平均餘命差距之影響評估。結果：全民健保實施後，並沒有顯著降低最高、最低都市化位階民眾平均餘命的差距，但是男性最高、中等都市化位階65歲平均餘命差距，以及女性最高、中等都市化位階0歲、5歲、65歲平均餘命差距皆有顯著性的縮小。結論：全民健保的實施對於民眾的健康有正向的改善，城鄉間女性健康差距較男性小，同時對於最高、中等都市化位階平均餘命差距改善程度優於最高、最低都市化位階平均餘命差距，特別是老年人的部份，但是最高、最低都市化位階民眾平均餘命的差距並沒有顯著性的縮小，因此未來應持續推動最低都市化位階地區民眾婦女保健、產前照護、環境改善及教育提升，使偏遠地區民眾得以獲得適當照顧，進而提升偏遠地區民眾平均餘命，以縮短城鄉間平均餘命的差距。

Objectives: To examine whether National Health Insurance has narrowed the gap of life expectancy between levels of urbanization. Methods: For the period from 1987 to 2003, population data were was obtained from the Taiwan-Fuchien Demographic Fact Book, and cause of death information was obtained from the Department of Health. Life expectancy for residents was transformed to mortality series, and the event intervention analysis by Box and Tiao was employed to compare the disparities in life expectancy among the resident groups. Results: After the implementation of national health insurance in Taiwan, the gap in life expectancy between residents living in areas of the highest and those living in the lowest levels of urbanization was not statistically significantly reduced. For men at age 65, between areas of the highest and the middle levels of urbanization, the lifespan gap was significantly reduced. For females at birth, age 5, and 65, the gap between areas of the highest and middle levels of urbanization was also significantly reduced. Conclusions: Implementation of national health insurance was associated with reduction of health disparities for both genders, although seeming to be more apparent for females than males. The improvement of the gap in life expectancy between residents living in the areas of the highest and middle levels of urbanization was larger than that between the areas of the highest and lowest levels of urbanization, especially for senior citizens. In order to ensure health equity for all citizens, more resources need to be allocated for women's health care, prenatal care, and environmental protection and education in remote areas.

1. 溫啟邦、蔡善璞、鍾文慎(2005)。高雄市和台北市居民平均餘命差距之分析。台灣衛誌，24，125-134。
   連結：
2. Balabanova D,Mckee M,Akingbade KP.(2004).Urbanrural disparities in health and living conditions in the Former Soviet Union: towards a comprehensive regional analysis.Eur J Public Health,14,62-63.
3. Box GEP,Jenkins GM,Reinsel GC.(1994).Time Series Analysis-Forecasting and Control.Englewood Cliffs, NJ:Prentice-Hall.
4. Box GEP,Tiao, GC.(1975).Intervention analysis with applications to economic and environmental problems.J Am Stat Assoc,70,70-79.
5. Burstrom K,Johannesson M,Diderichsen F.(2005).Increasing socio-economic inequalities in life expectancy and QALYs Sweden 1980-1997.Health Econ,14,831-850.
6. Deaton A.(2003).Health, inequality, and economic development.J Econ Lit,41,113-158.
7. Dickute J,Padaiga Z,Gragauskas V,Nadisauskiene RJ,Basys V,Gaizauskiene A.(2004).Maternal socioeconomic factors and the risk of low birth weight in Lithuania.Medicina,40,475-482.
8. Dow WH,Schmeer KK.(2003).Health insurance and child mortality in Costa Rica.Soc Sci Med,57,975-986.
9. Fleming NS,Becker ER..The impact of Texas 1989 motorcycle helmet law on total and head-related fatalities, severe injuries, and overall injuries.Med Care,30,832-845.
10. Girard DZ.(2000).Intervention times series analysis of pertussis vaccination in England and Wales.Health Policy,54,13-25.
11. Ho PS,Wang TN,Hsieh TK,Ko YC.(2000).Differences in physician utilization between aboriginal and non-aboriginal children.Fam Pract,17,414-421.
12. Kalediene R,Petrauskiene J.(2000).Inequalities in life expectancy in Lithuania by level of education.Scand J Public Health,28,4-9.
13. World population data sheet
14. Shmueli A.(2004).Population health and income inequality: new evidence from Israeli time-series analysis.Int J Epidemiol,33,311-317.
15. Shryock HS,Siegel JS.(1976).The Methods and Materials of Demography.NY:Academic Press.
16. Starkuviene S,Petranskiene J,Kalediene R.(2004).Inequalities in mortality of Lithuanian urban and rural populations: the effect of educational level.Eur J Public Health,14,113.
17. Vorster HH,Wissing MP,Venter CS(2000).The impact of urbanization on physical, physiological and mental health of Africans in the northwest province of South Africa: the THUSA study.S Afr J Sci,96,505-514.
18. Wen CP,Tsai SP,Shih YT,Chung WS.(2004).Bridging the gap in life expectancy of the aborigines in Taiwan.Int J Epidemiol,33,320-327.
19. Whitehead M,Scott-Samuel A,Dahlgren G.(1998).Setting targets to address inequalities in health.Lancet,351,1279-1282.
20. Health for all in the 21th century
21. Zimmer Z,Martin L,Lin HS.(2005).Determinants of old-age mortality in Taiwan.Soc Sci Med,60,457-470.
22. 健保局簡介
23. 內政部統計處(2004)。中華民國九十一年台閩地區簡易生命表。台北:內政部。
24. 行政院主計處(2003)。中華民國台灣地區九十一年家庭收支調查報告。台北:行政院主計處。
25. 行政院衛生署(2004)。中華民國92年衛生統計(一)－公務統計。台北:行政院衛生署。
26. 曾國雄、吳水源(1986)。台灣地區市鎮鄉都市化位階特性之研究。師大地理研究報告，12，287-323。
27. 楊長興、蔡尚學、楊俊毓(2000)。就醫可近性對於國民健康之影響－「可避免死亡率」之趨勢分析。台北:王金茂醫管論文獎。
28. 謝啟瑞(1996)。健康經濟學。台北:五南書局。
29. 羅紀琼(1995)。所得重分配量能來付費－全民健康保險之保費規劃。會計研究月刊，117，42-47。

1. 陳冠伯(Guan-Bo Chen);蘇弘慈(Hung-Tzu Su);李建輝(Chien-Hui Li);李永恆(Yung-Heng Lee);陳峰毅(Fung-Yi Chen);林鴻(Hong Lin);段生輝(Sheng-Hui Tuan)(2021)。偏鄉地區衛生所復健醫療服務量與品質之研究。台灣復健醫學雜誌。49(2)。159-172。