長期照護機構住民醫療利用分析－以中部四縣市為例

Medical Care Utilization in long-term-care Organizations in Central Taiwan

10.6288/TJPH2009-28-03-02

陳雪姝(Sheue-Shu Chen)；蔡淑鈴(Shu-Ling Tsai)；黃欽印(Chin-Yin Huang)

長期照護 ； 醫療利用 ； 固定影響 ； long-term care ； medical care utilization ； fixed effect

台灣公共衛生雜誌

28卷3期（2009 / 06 / 01）

175 - 183

繁體中文

目標：人口老化所衍生之老人醫療照護在台灣已是迫切之問題。本研究的目標在分析台灣長期照護機構與非機構（社區）內老人全民健保醫療利用之現況與差異。方法：本研究為實驗對照研究，以1:1隨機配對方式選取與實驗組相同控制變項（含基本特性、疾病種類與疾病嚴重度等）之老人為對照組。在扣除對照組之固定影響(fixed effect)，計算出兩組醫療利用之差異。結果：以每人年門住診平均醫療利用而言，機構組之全民健保醫療費用較非機構組高出18%，達統計上顯著性差異；又收容疾病嚴重度較高之護理之家組，較非機構組之全民健保醫療利用差距仍高，差距縮小至12%，但未達統計上顯著性差異。結論：長期照護機構老人住民醫療利用，在全民健保醫療給付之誘因下，確存在較高之利用率，其中可能隱含供給誘發需求。未來台灣人口將快速老化，相關機關應及早規劃長期照護保險之財務與給付制度，以使全民健保的醫療功能更臻完善。

Objectives: The purpose of this research was to investigate differences in medical care utilization between elderly residents of long-term-care organizations and community residents under the National Health Insurance (NHI) program in Taiwan. Methods: A case-control study design using the fixed-effects model was employed. The experimental group was made up of elderly residents of long-term-care organizations. In order to obtain a precise estimate and control for possible confounding variables, the individual random matching method was used to select the community residents who made up the control group on the controlling variables (i.e., age, sex, disease severity, specific diseases, etc.). Results: The average rate of medical care utilization of the experimental group was 18% higher than that of the control group; this difference was statistically significant. Surprisingly, the average rate of medical care utilization of nursing-home residents was only 12% higher than that of the community residents, with no statistically significant difference between the two test groups. Conclusions: Supply-induced demand may exist in the medical care utilization of long-term-care organizations under the NHI program. The study results are important for planning long-term-care insurance programs to meet the requirements of the aging population of Taiwan.

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