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    Title: 以全民健保資料庫探討不同醫療層級的服務差異
    Using National Health Insurance Database to Explore the Attributes of Different Levels of Medical Institutes
    Authors: 林芃彣
    Lin, Peng-Wen
    Contributors: 余清祥
    Yu, Ching-Syang
    林芃彣
    Lin, Peng-Wen
    Keywords: 全民健保
    醫療供給
    大數據
    不均度
    市場區隔
    National Health Insurance
    Medical service
    Big sata
    Medical inequality
    Market segmentation
    Date: 2018
    Issue Date: 2019-03-04 19:02:39 (UTC+8)
    Abstract: 我國實施全民健康保險制度（以下簡稱健保）已逾20年，民眾納保率超過99%，達到了健保第一階段目標醫療可近性，全國所有鄉鎮市區層級都有一家以上的健保特約醫療院所，而且國人對就診、取藥等相關規定非常熟悉，健保已成為日常生活的一部分。但健保近來也面臨不少挑戰，如醫護人員過勞、健保給付範圍縮減、城鄉醫療資源差距過大等隱憂，近年政府推出的二代健保即針對這些缺失提出修正。其中分級醫療是二代健保的主要特色之一，在善用醫療資源的前提下，藉由分工合作讓國人獲得完善的醫療照顧。本文也以評估分級醫療為目標，分析醫療供給面，透過個人就醫習性等紀錄推敲醫療機構之營運特色，檢視醫療供給的現況與趨勢，並且評估其中潛在的風險與挑戰。
    本研究將透過健保資料探討臺灣醫療院所的服務差異性，使用素材為2005年百萬人抽樣資料，包括就醫門診處方及治療明細檔（CD）及醫事機構資料檔（HOSB）。由於採用的是抽樣資料，我們將先檢查樣本代表性，確定資料庫的分析結果與官方（衛福部）資料一致，檢查項目包括就醫次數、就醫金額等。醫療院所的服務差異性主要在於比較四個層級的醫療院所，探討病患的人口特性、看診疾病等是否存在明顯不同，透過辛普森指標等不均度指標找出主要差異。分析發現：近年國人有傾向醫學中心及區域醫院就醫的趨勢，前三層級醫療院所的疾病不均度相似，很難區隔它們扮演的角色；而基層醫療院所的門診主要為呼吸系統疾病，且疾病不均度在都會地區的差異性最大，但近年不均度有下降的傾向。本文研究結果除了可用於評估各級醫療院所的經營績效，包括二代健保的分級醫療實施作法，也可檢視病患的就醫屬性或偏好，作為增設、調整臺灣醫療資源配置的參考。
    Taiwan’s National Health Insurance (NHI) was implemented in 1995 and now more than 99% Taiwan’s citizens participate in the NHI. Taiwan’s NHI is world-famous because of good health service, including medical accessibility, i.e., at least one medical institution for every township in Taiwan, and the NHI becomes part of everyone’s daily life. However, the NHI also faces many potential challenges, such as too much workload for medical staff, reduced NHI coverage, and large gap of medical resource between urban and rural areas. Thus, Taiwan government proposes a series of modifications to the NHI in order to let the people have better medical care. In this study, we also aim to explore the potential challenges of NHI by analyzing the services given by different levels of medical institutes, and provide policy suggestions to Taiwan government.
    In this study, we investigate the attributes of different levels of medical institutes in Taiwan by using the sample data from NHI Research Database. The sample consists of one millions of people randomly drawn in 2005 and their medical records such as the out-patient visits (CD) and medical institution data files (HOSB). We first check the sample representativeness of the random sample, making sure that they can represent Taiwan’s total population. The goal of our analysis is to compare the attributes of four different levels of medical institutes, including the patient`s demographic characteristics, medical usages, and medical inequality. We found that it is difficult to differentiate the services provided by the first three levels of medical institutes (i.e., medical centers, regional hospitals, and local hospitals), and more people chose to visit medical centers and regional hospitals. On the other hand, people would choose the primary medical institutes (i.e., the fourth level) for respiratory diseases. Also, it seems there is medical inequality in the metropolitan areas. The analysis results can serve as a reference for the policy planning and medical resources allocation.
    Reference: 一、 中文部分
    1. 何雍慶、吳文貴(2005)。民眾就醫選擇之研究-品牌轉換模型之應用。產業管理學報，vol.5(2)，431-445。
    2. 吳肖琪、朱慧凡、黃麟珠、雷秀麗(2003)。從國際比較探討台灣每千人口需要多少醫師？，台灣公共衛生雜誌，vol.22(4)，279-286。
    3. 李妙純、沈茂庭(2008)。全民健保下不同所得群體醫療利用不均因素分析，臺灣衛誌，vol.27(3)，223-231。
    4. 林民浩、楊安琪、溫在弘(2011)。利用地區差異與人口學特徵評估全民健保資料庫人口居住地變項之推估原則。台灣衛誌，vol.30，347-361。
    5. 林敬昇(2016)。以全民健保資料庫探討台灣人口特性與變遷，國立政治大學商學院統計學系碩士論文。
    6. 張苙雲、楊孟麗、趙景雲 (2011)就醫行為的潛在類型與健康測量：全民健保資料的應用：全民健康保險資料的應用。台灣社會學刊，vol.46，207-247。
    7. 張鴻仁、黃信忠、蔣翠蘋(2002)。全民健保醫療利用集中狀況及高、低使用者特性之探討。臺灣公共衛生雜誌，vol.21(3)，207-213。
    8. 許筱翎(2017)。以全民健保資料庫探討高齡人口的醫療需求，國立政治大學商學院統計學系碩士論文。
    9. 許績天、韓幸紋、連賢明、羅光達(2011)。部分負擔調整對醫療利用的衝擊：以2005年政策調整為例，台灣衛誌，vol.30，326-336。
    10. 連珮誼(2017)。以高齡健保資料庫分析高齡人口醫療之需求，國立政治大學商學院風險管理與保險學系碩士論文。
    11. 郭平欣、胡玉惠、余清祥、顧漢凌(2006)。全民健保體系下醫療資源分佈對個人醫療使用的影響，國立東華大學國際經濟研究所碩士論文。
    12. 郭信志、楊志良(1994)。勞保門診醫療費用支付制度對醫療供給者行為之影響，中華衛誌，vol.13，315-329。
    13. 陳弘根(2008)。以醫療層級檢視民眾所得相關之醫療照護使用公平性，長庚大學醫務管理研究所碩士論文。
    14. 黃昱瞳、楊長興、薛亞聖(2002)。全民健保實施牙醫總額預算制度對醫療資源分布的影響評估，台灣公共衛生雜誌，vol.21(6)，403-410。
    15. 簡于閔(2017)。以全民健保資料庫探討國人就醫習性，國立政治大學商學院統計學系碩士論文。
    16. 劉彩卿、吳佩璟(2001)。全民健保實施下影響門診病患選擇就醫層級之因素探討：以在北市小兒科就診的門診病患為例，醫務管理期刊，vol.2(2)，87-108。
    17. 蔡文正、龔佩珍、楊志良、李亞欣、林思甄(2006)。偏遠地區民眾就醫可近性及滿意度調查。台灣衛誌，vol.25，394-404。
    18. 魏慶國、吳欣宸、黃渝珊、王小玲、吳貞慧(2006)。醫院醫師轉診行為與轉診制度相關因素分析，亞東學報，vol.26，231-240。

    二、 英文部分
    1. Baker, T. D., Perlman, M.(1967). Health Manpower in a Developing Economy: Taiwan, A Case Study in Planning. Baltimore : The Johns Hopkins University Press.
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    3. Burnham, P. K., Overton, S. W.(1978). Estimation of the Size of a Closed Population when Capture Probabilities Vary among Animals, Biometrika, vol. 65, 625-633.
    4. Chang, H. J., Chou, Y. J.(2002). Amending health disparities in Taiwan"s indigenous population, Harv Health Policy Rev. 3, 40-46.
    5. Chen, L., Yip, W., Chang, M. C.(2007). The effects of Taiwan"s national health insurance on access and health status of the elderly. Health Econ, vol. 16, 223-242.
    6. Dexter, F., Yue, C. J., Dow, A.J.(2006), Predicting Anesthesia Times for Diagnostic and Interventional Radiological Procedures, Anesthesia & Analgesia, vol. 102, 1491-1500.
    7. Dexter, F., Wachtel, R. E., Yue, C. J.(2003), Use of Discharge Abstract Databases to Differentiate Among Pediatric Hospitals’ Operative Procedures: Surgery in Infants and Young Children in the State of Iowa, Anesthesiology, vol. 99(2), 480-487.
    8. Good, I. J.(1953). The Population Frequencies of Species and the Estimation of Population Parameters, Biometrika, vol. 40, 237-264.
    9. Wolinsky, F. D., Kutz, R. S.(1984), How the Public Choose and Views Hospital, Hospital and Health Service Administration, vol. 29, 58-67.
    10. Yue, C. J., Clayton, M. K.(2005). An Overlap Measure based on Species Proportions, Comm. Statist, Theory Methods, vol. 34, 2123-2131.
    Description: 碩士
    國立政治大學
    統計學系
    105354003
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0105354003
    Data Type: thesis
    DOI: 10.6814/THE.NCCU.STAT.002.2019.B03
    Appears in Collections:[Department of Statistics] Theses

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