全民健保下不同所得群體醫療利用不均因素分析

Decomposition of income-related Inequality in Health Care Utilization under National Health Insurance in Taiwan

10.6288/TJPH2008-27-03-04

李妙純(Miaw-Chwen Lee)；沈茂庭(Mao-Ting Sheen)

醫療服務利用 ； 集中係數 ； 水平不公平 ； 台灣全民健康保險 ； Health care utilization ； Concentration index CI ； Horizontal inequity HI ； National Health Insurance

台灣公共衛生雜誌

27卷3期（2008 / 06 / 01）

223 - 231

繁體中文

目標：台灣在1995年建立全民健康保險(NHI)將全體國民納入為保險對象，重要的政策意涵是希望不論經濟狀況、社會狀態或地理位置，有相同醫療需要的人皆能公平的就醫。本研究目的以集中係數(CI)測量台灣醫療利用在不同收入群體之分布，並分析影響不均的因素。方法：以2001年國民健康訪問調查(NHIS)為研究對象，並串連其2001年全民健康保險門診及住院之就診資料，得到受訪者之實際醫療服務利用資料。結果：西醫門診次數呈現有「扶貧(propoor)」的水平不公平，費用及住院使用呈現不同收入間的使用是能依照其不同的需要而分佈。需要及地區因素是使用次數不均的主要兩大貢獻因素，而需要及收入是費用不均的兩大主要貢獻因素，收入不均會促使醫療服務利用往富人集中。結論：與歐洲國家比較，台灣西醫門診次數處於中度「扶貧」的水平不公平，與實施全民健保制度及對弱勢群體或偏遠地區居民的醫療協助方案習習相關。結果有助於規劃醫療資源分布的政策、建置良好的健康照護體系的參考。

Objectives: Since the inauguration of National Health Insurance (NHI) in Taiwan in 1995, the government has attempted to provide health services equitably for all of the population according to their needs, regardless of their economic resources, social standing, or geographical location. The objective of this paper is to measure and to decompose income-related inequality and horizontal inequity (HI) in health care utilization using concentration indices (CI). Methods: Samples were taken from the 2001 National Health Interview Survey (NHIS) in Taiwan and from records kept by the National Health Insurance (NHI) for health care utilization. Results: Significant pro-poor horizontal inequities in the number of visits for Western medicine emerged, while insignificant horizontal inequity indices for the expenditure of outpatient Western medicine and inpatient admission utilization appeared, indicating an equal utilization according to empirical needs. The two largest contributions for the number of visits of outpatient Western medicine and inpatient admission came from the inequality of need and geographic factors, while need and income were the two most important contributors for the inequality of expenditure. This analysis showed that pro-rich income inequality leads to pro-rich income-related inequality in health care utilization. Conclusions: When compared to OECD countries, Taiwan experiences moderate propoor horizontal inequity in the category of Western medicine. This finding supports the necessity of universal coverage of NHI and integrated health care strategies for the disadvantaged, such as exemptions from co-payments and an integrated delivery service plan. The implications of the results are important for how policy makers allocate resources and will assist with devising an equitable and functional health care system.

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