矯正機構收容人在加入全民健康保險前後求醫行為的改變

Changes in Prisoners' Medical Seeking Behaviors before and after Enrollment in National Health Insurance

10.3966/168232812016122604001

陳勃仲(Po-Chung Chen)；楊銘欽(Ming-Chin Yang)

收容人 ； 求醫行為 ； 醫療滿意度 ； 全民健康保險 ； help-seeking behavior ； National Health Insurance ； patient satisfaction ； prisoner

台灣家庭醫學雜誌

26卷4期（2016 / 12 / 01）

187 - 198

繁體中文

背景與目的：2011年全民健康保險修正後，矯正機關收容人被納為第四類被保險人，本研究目的在瞭解收容人之求醫行為、醫療滿意度與自評身體健康程度，在加入全民健保前後的改變。方法：以北部地區某兩所監獄收容人中，在服刑期間經歷過全民健保將收容人納保前、後時期者為研究對象，採用研究者自擬結構式、自填式問卷進行抽樣調查。抽樣方式依收容人編號採系統抽樣，輔以定額抽樣法。資料經蒐集、譯碼及登錄建檔後，以SPSS 20.0軟體進行統計分析。結果：自2014年4月至11月調查共回收有效問卷1,178份，收容人在納入健保後，就醫變得較頻繁，無任何就醫顧慮的比例增加，顧慮費用太高與醫療品質不佳的比例降低，不能及時得到適切醫療的比例減少，因醫療專業不足而無法得到適切醫療的比例減少，平均醫療服務滿意度增加，自評身體健康程度為健康或非常健康的比例上升。結論：整體而言，收容人納入健保後，監所內的醫療品質有所提升，收容人較能得到適切的治療，且滿意度及健康皆有所改善，就醫變得較頻繁，可見收容人納入健保，不僅保障其醫療人權，與國際潮流相符，且收容人之健康也獲得改善，此結果可做為相關單位於政策修訂及宣導時參考。

Background and purpose: With the amendment of National Health Insurance (NHI) Act in 2011, prisoners are eligible for NHI coverage as Type D insurants. The study aimed at assessing the changes in prisoners' medical seeking behaviors, satisfaction with medical care, and self-perceived health status before and after their enrollment in NHI. Methods: The study adopted a self-administered structured questionnaire to survey prisoners who had medical experiences both before and after enrollment in NHI in two prisons in northern Taiwan. Systematic sampling with quota sampling were applied, and SPSS statistic software were used for data analysis. Results: A total of 1178 valid questionnaires were collected from April to November, 2014. Major results revealed an increase after NHI enrollment, in the frequency of seeking medical help, in the number of prisoners free from any worry, in the degree of overall satisfaction with the provided medical service, and in the number of prisoners rating ＂good＂ and ＂very good＂ in terms of self-perceived health status. The number of prisoners worrying about medical expense and medical quality, as well as that of prisoners in fear of failing to receive proper medical care due to the lack of needed medical specialists, appeared to decline. Conclusion: The quality of medical care in prisons undergoes improvement after the coverage of prisoners in NHI. Prisoners now enjoy easier access to more adequate treatment. In addition, a rise has been observed in the degree of patient satisfaction, their self-perceived health status and the frequency of seeking medical help. It is therefore obvious that rendering prisoners eligible for NHI coverage not only ensures their rights to medical care but also improve their health in general. The study results can be expected to serve as reference for related policyadjustment and advocacy.

1. 蔡文正、龔佩珍、廖家慧(2008)。監所收容人納入全民健康保險可行性之探討。台灣衛誌，27，198-213。
   連結：
2. 中央健康保險署：103年衛生福利部新聞1月新聞。台北：衛生福利部，2014。
3. 法務部：監所舍房空間、監所人力、收容人費用與健康保險及看守所改制為監獄等問題檢討。台北：立法院第6屆第1會期司法委員會第20次全體委員會議，2005。
4. 張伍隆：法務部中區醫療專區設置計畫，法務部專題報告。台北：法務部，2003。
5. Andersen, RM(1995).Revisiting the behavioral model and access to medical care: does it matter?.J Health Social Behav,36,1-10.
6. Binswanger, IA,Krueger, PM,Steiner, JF(2009).Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population.J Epidemiol Community Health,63,912-9.
7. Bjørngaard, JH,Rustad, AB,Kjelsberg, E(2009).The prisoner as patient - a health services satisfaction survey.BMC Health Serv Res,9,176.
8. Feron, JM,Paulus, D,Tonglet, R,Lorant, V,Pestiaux, D(2005).Substantial use of primary health care by prisoners: epidemiological description and possible explanations.J Epidemiol Community Health,59,651-5.
9. Gatherer, A,Moller, L,Hayton, P(2005).The World Health Organization European Health in Prisons Project after 10 years: persistent barriers and achievements.Am J Public Health,95,1696-700.
10. Gilles, M,Swingler E,Craven, C,Larson, A(2008).Prison health and public health responses at a regional prison in Western Australia.Aust NZ J Public Health,32,549-53.
11. Ginn, S(2013).Promoting health in prison.BMJ,346,f2216.
12. Harzke, AJ,Baillargeon, JG,Pruitt, SL,Pulvino, JS,Paar, DP,Kelley, MF(2010).Prevalence of chronic medical conditions among inmates in the Texas prison system.J Urban Health,87,486-503.
13. Marshall, T,Simpson, S,Stevens, A(2001).Use of health services by prison inmates: comparisons with the community.J Epidemiol Community Health,55,364-5.
14. Nobile, CGA,Flotta, D,Nicotera, G,Pileggi, C,Angelillo, IF(2011).Self-reported health status and access to health services in a sample of prisoners in Italy.BMC Public Health,11,529.
15. Sheps, SB,Schechter, MT,Prefontaine, RG(1987).Prison health services: a utilization study.J Community Health,12,4-22.
16. Tanguay, S,Trestman, R,Weiskopf, C(2014).Patient health satisfaction survey in connecticut correctional facilities.J Correct Health Care,20,127-34.
17. Way, BB,Sawyer, DA,Kahkejian, D,Moffitt, C,Lilly, SN(2007).State prison mental heath services recipients perception of care survey.Psychiatr Q,78,269-77.
18. Williams, BA,Stern, MF,Mellow, J,Safer, M,Greifinger, RB(2012).Aging in correctional custody: setting a policy agenda for older prisoner health care.Am J Public Health,102,1475-81.
19. Wilper, AP,Woolhandler, S,Boyd, JW(2009).The health and health care of US prisoners: results of a nationwide survey.Am J Public Health,99,666-72.
20. Yu, SSV,Sung, HE,Mellow, J,Koenigsmann, CJ(2015).Self-perceived health improvements among prison inmates.J Correct Health Care,21,59-69.
21. 史麗珠、彭佩宜、高鳳聲、蘇靖鈞、鄭蔥君、李幸禧(2000)。北部某大學學生的求醫行為：中西醫之選擇。秀傳醫學雜誌，2，151-9。
22. 吳正博(2006)。碩士論文(碩士論文)。嘉義，中正大學犯罪防治研究所。
23. 吳就君(1981)。台灣地區居民社會醫療行為研究。公共衛生，8，25-49。
24. 邱聖豪、陳星助、林欣榮(2003)。以門診顧客滿意度調查結果探討門診顧客的需求。志為護理─慈濟護理雜誌，2，49-58。
25. 洪士軒(2013)。碩士論文(碩士論文)。台北，臺灣大學科際整合法律研究所。
26. 高汶珊(2005)。碩士論文(碩士論文)。台北，臺北醫學大學醫務管理學系。
27. 高美英、呂碧鴻(2000)。慢性病患者對醫療院所之滿意度評量。臺灣家醫誌，10，212-25。
28. 張育誠(2008)。碩士論文(碩士論文)。雲林，雲林科技大學科技法律研究所。
29. 張苙雲(1998)。「逛醫師」的邏輯：求醫歷程的分析。臺灣社會學刊，21，59-87。
30. 黃國晉、梁繼權、李龍騰、陳慶餘(1995)。某山地鄉民眾中西醫醫療使用及對其評價。中華家醫誌，5，64-73。
31. 蔡文正(2005)。,台北:行政院衛生署。
32. 盧映潔(2013)。德國老年受刑人在監相關問題之探討。中正大學法學集刊，38，1-46。
33. 蕭聖霖(2014)。碩士論文(碩士論文)。台北，臺灣大學法律學研究所。

1. 謝至鎠、黃亮凱、陳志強、邱雲柯(2018)。矯正機關收容人納入二代健保前後之門診使用狀況分析─以花蓮監獄為例。臺灣家庭醫學雜誌，28(1)，9-17。