身心障礙兒童之健康不均：以醫療福利資源利用面向探討

Health Inequality in Children with Disabilities: Medical and Social Welfare Utilization Perspective

嚴嘉楓(Chia-Feng Yen)；林祥偉(Shyang-Woei Lin)

身心障礙 ； 身心障礙兒童 ； 健康不均 ； 發展遲緩 ； 衛生福利 ； Anthropogenic delayed ； children with disabilities ； disability ； health inequalities ； health welfare

身心障礙研究季刊

12卷4期（2014 / 12 / 01）

191 - 206

繁體中文

從許多身心障礙兒童的健康相關研究發現，他們的確有較差的健康情形及較高的醫療利用，本研究即以「健康不均（Health Inequality）」的觀點檢視身心障礙兒童在醫療及福利服務使用與一般群體的差異，藉由整理身心障礙兒童在醫療及福利服務使用相關文獻，深入了解身心障礙兒童接受療育服務的相關因素。研究方法以PubMed資料庫檢索，主要關鍵字包括身心障礙、身心障礙兒童、健康不均、發展遲緩等。「健康不均」隱含對健康不公的關懷與道德評價，所以本研究期待先藉由文獻回顧瞭解影響身心障礙兒童在醫療、福利資源的使用或其健康情形，以及探討可能受到那些結構性因素影響造成其健康不均，更期待在目前以國際健康功能身心障礙分類系統（International Classification of Functioning, Disability and Health, ICF）為鑑定及需求評估基礎的衛生福利政策上提供未來身心障礙兒童福利配置的參考依據。

Children with disabilities have higher health needs than the general population, and their health needs are different and require more specialized services. There are evidence reported poorer health outcomes and less effective health interventions encounter by children with disabilities in Taiwan, and other countries as well. Closing the gaps of health inequalities between children with disabilities and general children is a vital priority in health service policy. The aim of this study is to describe the health care and social welfare service profile and to investigate the associated factors in these services for children with disabilities and their family based on current reference reviews. We searched references in PubMed as the following key words: anthropogenic delayed, children with disabilities, disability, and health inequalities. Results reveal that the occurrence of health inequalities of child with disability is affected by many social factors such as poor economic, poor living conditions, families with unemployed and discrimination than their body impairments solely. The future health welfare policy should consider the new disability identification system-International Classification of Functioning, Disability and Health (ICF) to initiate appropriate health and welfare services for this population.

1. 李志偉、嚴嘉楓、羅慶徽、李宗楠、林金定(2005)。台灣地區智能障礙者的醫療利用特性與影響因素：以2001 年門診利用分析。身心障礙研究，3，5-17。
   連結：
2. 張剛準、江博煌、徐尚為(2010)。台灣地區學齡前智能障礙者門診利用情形初探。身心障礙研究，8，214-26。
   連結：
3. 嚴嘉楓、林金定(2009)。智能障礙青少年健康情形與醫療利用及其相關因素之研究。身心障礙研究，7，94-120。
   連結：
4. 衛生福利部統計處（2010）。身心障礙者人數，http://www.mohw.gov.tw/CHT/CommonPages/TornadoRedirect.aspx?pk=17132（2014/10/18）
5. 衛生福利部統計處（2010）。發展遲緩兒童早期療育服務個案通報概況，http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4179（2014/10/20）
6. 國家衛生研究院（2011）。全民健康保險資料庫，http://w3.nhri.org.tw/nhird/faq_e.htm（2011/02/19）。http://w3.nhri.org.tw/nhird/faq_e.htm
7. Andersen, R. M.(1995).Revisiting the behavior model and access to medical care: Does it matter?.Journal of Health and Social Behavior,36,1-10.
8. Barr, O.,Gilgunn. J.,Kane, T.,Moore, G.(1999).Health screening for people with learning disabilities by a community learning disability service in Northern Ireland.Journal of Advanced Nursing,29,1482-1491.
9. Beresford, B.,Rhodes, D.(2008).Housing and Disabled Children.York:Joseph Rowntree Foundation.
10. Brookes, M. E.,Alberman, E.(1996).Early mortality and morbidity in children with Down's syndrome diagnosed in two regional health authorities in 1988.Journal of Medical Screening,3,7-11.
11. Carvill, S.(2001).Review: Sensory impairments, intellectual disability and psychiatry.Journal of Intellectual Disability Research,45,467-483.
12. Center, J.,Beange, H.,McElduff, A.(1998).People with mental retardation have an increased prevalence of osteoporosis: A population study.American Journal on Mental Retardation,103,19-28.
13. Chaplin, R. H.,Thorp, C.,Ismail, I. A.,Collacott, R. A.,Bhaumik, S.(1996).Psychiatric disorder in Asian adults with learning disabilities: patterns of service use.Journal of Intellectual Disability Research,40,298-304.
14. Cooke, L. B.(1997).Cancer and learning disability.Journal of Intellectual Disability Research,41,312-316.
15. Doody, G. A.,Johnstone, E. C.,Sanderson, T. L.,Cunningham-Owens, D. G.,Muir, W. J.(1998).'Pfropfschizophrenie' revisited: Schizophrenia in people with mild learning disability.Journal of Psychiatry,173,145-153.
16. Duff, M.,Hoghton, M.,Scheepers, M.,Cooper, M.,Baddeley, P.(2001).Helicobacter pylori: Has the killer escaped from the institution? A possible cause of increased stomach cancer in a population with intellectual disability.Journal of Intellectual Disability Research,45,219-225.
17. Emerson, E.(2003).Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability.Journal of Intellectual Disability Research,47,51-58.
18. Emerson, E.,Einfeld, S.(2010).Emotional and behavioural difficulties in young children with and without developmental delay: A bi-national perspective.Journal of Child Psychology and Psychiatry,55,583-593.
19. Emerson, E.,Einfeld, S.,Stancliffe R.(2010).The mental health of young Australian children with intellectual disabilities or borderline intellectual functioning.Social Psychiatry and Psychiatric Epidemiology,45,579-587.
20. Emerson, E.,Hatton, C.(2007).The contribution of socio-economic position to the health inequalities faced by children and adolescents with intellectual disabilities in Britain.American Journal on Mental Retardation,112,140-150.
21. Emerson, E.,Hatton, C.(2007).The mental health of children and adolescents with intellectual disabilities in Britain.British Journal of Psychiatry,191,493-499.
22. Emerson, E.,Hatton, C.(2007).Poverty, socio-economic position, social capital and the health of children and adolescents with intellectual disabilities in Britain: A replication.Journal of Intellectual Disability Research,51,866-874.
23. Emerson, E.,Madden, R.,Robertson, J.,Graham, H.,Hatton, C.,Llewellyn, G.(2009).,Lancaster:Centre for Disability Research, Lancaster University.
24. Emerson, E.,Malam, S.,Davies, I.,Spencer, K.(2005).Adults with Learning Difficulties in England 2003/4.Leeds:Health & Social Care Information Centre.
25. Evenhuis, H. M.(2001).Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability.Journal of Intellectual Disability Research,45,457-464.
26. Glidden, LM(ed.),Seltzer, MM(ed.)(2010).On Families: International Review of Research on Mental Retardation.New York:Academic Press.
27. Grant, H. J.,Pickett, W.,Lam, M.,O'Connor, M.,Ouellette-Kuntz, H.(2001).Falls among persons who have developmental disabilities in institutional and group home settings.Journal on Developmental Disabilities,8,57-73.
28. Hasle, H.,Clemmensen, I. H.,Mikkelsen, M.(2000).Risks of leukaemia and solid tumours in individuals with Down's syndrome.Lancet,355,165-169.
29. Hermon, C.,Alberman, E.,Beral, V.,Swerdlow, A. J.(2001).Mortality and cancer incidence in persons with Down's syndrome their parents and siblings.Annals of Human Genetics,65,167-176.
30. Hollins, S.,Attard, M.,van Fraunhofer, N.,McGuigan, S. M.,Sedgwick, P.(1998).Mortality in people with learning disability: Risks causes, and death certification findings in London.Developmental Medicine and Child Neurology,40,50-56.
31. Hsieh, K.,Heller, T.,Miller, A. B.(2001).Risk factors for injuries and falls among adults with developmental disabilities.Journal of Intellectual Disability Research,45,76-82.
32. Jaffe, J. S.,Timell, A. M.,Gulanski, B. I.(2001).Prevalence of low bone density in women with developmental disabilities.Journal of Clinical Densitometry,4,25-29.
33. Jancar, J.(1990).Cancer and mental handicap: A further study.British Journal of Psychiatry,156,531-33.
34. Janicki, M. P.,Davidson, P. W.,Henderson, C. M.,McCallion, P.,Taets, J. D.,Force, L. T.(2002).Health characteristics and health services utilization in older adults with intellectual disability living in community residences.Journal of Intellectual Disability Research,46,287-298.
35. Kerr, A. M.,McCulloch, D.,Oliver, K.(2003).Medical needs of people with intellectual disability require regular reassessment, and the provision of client- and carer-held reports.Journal of Intellectual Disability Research,47,134-145.
36. Kerr, M.,Bowley, C.(2001).Multidisciplinary and multiagency contributions to care for those with learning disability who have epilepsy.Epilepsia,42,S55-56.
37. Kerr, M.,Bowley, C.(2001).Evidence-based prescribing in adults with learning disability and epilepsy.Epilepsia,42,S44-45.
38. Kwok, H.,Cheung, P. W. H.(2007).Co-morbidity of psychiatric disorder and medical illness in people with intellectual disabilities.Current Opinion in Psychiatry,20,443-49.
39. Lin, J.D.,Yen, C.F.,Li, C.W.,Wu, J.L.(2005).Health, healthcare utilization and psychiatric disorder in people with intellectual disability in Taiwan.Journal of Intellectual Disability Research,49,86-94.
40. Mantry, D.,Cooper, S-A.,Smiley, E.,Morrison, J.,Allan, L.,Williamson, A.(2008).The prevalence and incidence of mental ill-health in adults with Down syndrome.Journal of Intellectual Disability Research,52,141-155.
41. Matthews, T.,Weston, N.,Baxter, H.,Felce, D.,Kerr, M.(2008).A general practice-based prevalence study of epilepsy among adults with intellectual disabilities and of its association with psychiatric disorder, behaviour disturbance and carer stress.Journal of Intellectual Disability Research,52,163-173.
42. McGrother, C. W.,Hauck, A.,Bhaumik, S.,Thorp, C.,Taub, N.(1996).Community care for adults with learning disability and their carers: Needs and outcomes from the Leicestershire register.Journal of Intellectual Disability Research,40,183-190.
43. NHS Health Scotland(2004).People with Learning Disabilities in Scotland: Health Needs Assessment Report.Glasgow:NHS Health Scotland.
44. Puri, B. K.,Lekh, S. K.,Langa, A.,Zaman, R.,Singh, I.(1995).Mortality in a hospitalized mentally handicapped population: a 10-year survey.Journal of Intellectual Disability Research,39,442-446.
45. Robertson, J.,Roberts, H.,Emerson, E.(2010).,Durham:Improving Health & Lives: Learning Disability Observatory.
46. Ryan, R.,Sunada, K.(1997).Medical evaluation of persons with mental retardation referred for psychiatric assessment.General Hospital Psychiatry,19,274-280.
47. Sherrard, J.,Tonge, B. J.,Ozanne-Smith, J.(2002).Injury risk in young people with intellectual disability.Journal of Intellectual Disability Research,46,6-16.
48. Straetmans, JM.,van. Schrojenstein, JAA,Lantman-de Valk, HMJ.,Schellevis, FG.,Dinant, G-J.(2007).Health problems of people with intellectual disabilities: The impact for general practice.British Journal of General Practice,57,64-66.
49. Tyler, C. V. J.,Snyder, C. W.,Zyzanski, S.(2000).Screening for osteoporosis in community-dwelling adults with mental retardation.Mental Retardation,38,316-321.
50. Wagemans, A.,Cluitmans, J.(2006).Falls and fractures: A major health risk for adults with intellectual disabilities in residential settings.Journal of Policy and Practice in Intellectual Disabilities,3,136-138.
51. Warburg, M.(2001).Visual impairment in adult people with intellectual disability: Literature review.Journal of Intellectual Disability Research,45,424-438.
52. Wilson, D.,Haire, A.(1990).Health care screening for people with mental handicap living in the community.British Medical Journal,301,1379-1381.
53. 呂宗學(2010)。消弭健康不平等的相關政策─歐洲國家經。醫療品質雜誌，4，20-23。
54. 宋芊晴(2005)。台中市，靜宜大學青少年兒童福利學系。
55. 林雅雯(2003)。台北市，國防醫學院公共衛生研究所。
56. 張淑慧(2006)。台北市，國立臺北教育大學特殊教育學系碩士班。
57. 傅秀媚、林巾凱、張秀玉(2007)。內政部兒童局委託研究內政部兒童局委託研究,台中:內政部兒童局。
58. 黃英琪(2004)。台中，東海大學社會工作學系。
59. 葉淑文(1999)。台中市，靜宜大學青少年兒童福利研究所。
60. 儲鳳英(2005)。台北市，台北醫學大學醫務管理學系。

1. 闕帝宜,謝明娟,湯淑貞,陳楚杰,張一萍,林欣誼,李文傑(2023)。身心障礙老人的健康狀況及醫療利用。醫務管理期刊，24(3)，249-269。