以全民健保資料庫探討經濟狀況與健康不平等的關聯

Abstract

全民健康保險（簡稱健保）實施至今20餘年，我國國民納保率高達99%，健保已成為國人生活的一部份，每年健保門診或住院的就醫率超過九成。健保降低了就醫門檻及醫療負擔，提昇國人的健康及壽命，成為我國聞名國際的特色，但健保仍有不少需要改進的地方，像是部分負擔及自費醫療等項目對經濟弱勢者是沈重負擔。本研究依據健保六大各投保類別，探討社經狀況與醫療利用的關係，分析經濟弱勢是否和醫療弱勢相關，研究結果可作為政府訂定健保相關政策的參考，並提供商業保險業者根據社會保險的不足，設計可結合健保與商業保險之服務及商品。\n本研究主要比較六大投保類別的醫療利用及行為，亦包括罹病類型、就醫機構的選擇（如：四個醫療院所層級）、死亡率等，探討是否存在健康不平等之問題。本研究使用資料庫為2005年百萬人抽樣資料，包括承保資料檔、就醫門診處方及治療明細檔以及住院醫療費用清單明細檔等。首先將健保抽樣資料中投保類別的人口結構與官方資料比對，確定健保資料庫有不錯的樣本代表性；接著分析不同投保類別之醫療利用，包括門診次數、就醫點數、住院天數等，也針對不同疾病別、地區別、死亡率分析健康不平等。研究結果顯示：第六投保類別的就醫率最低，第二投保類別的高齡人口死亡率略高於其他類別，而且各類別的常住地分佈也有明顯差異。另外，各投保類別的門診次數差異並不大，但在住院方面、醫療行為、疾病種類上有明顯不同，第三投保類別、第六投保類別的就醫習慣較為不同，例如：平均門診次數低但平均就醫點數與住院發生率較高等。

Taiwan’s National Health Insurance (NHI) was implemented in 1995. The NHI has become a part of our daily life and more than 99% Taiwan’s citizens participate in this social insurance program now. It is believed that the NHI has improved the health and life span of Taiwan citizens, and it is a world famous public health insurance program. Although the NHI has already achieved the goal of medical accessibility, the affordability of health care is still a big problem to the low-income families. We aim to study the relation between socioeconomic status and medical utilization, and in particular, explore if there exists health inequality with respect to people’s incomes.\nThe NHI’s insureds are separated into six categories and we investigate the medical utilizations and mortality rates of these categories. The study is based on the 2005 Taiwan Longitudinal Study (LHID2005), Taiwan’s National Health Insurance Database, which contains the Registry for beneficiaries (ID), outpatient visits (CD), inpatient admissions (DD), and medical institution data files (HOSB). We first checked the sample representativeness of the data set used, making sure that they can represent Taiwan’s total population. Then, we analyzed the medical utilization of different insured classifications. We found that the second category has the highest mortality rate and the sixth category has the lowest annual compliance rate. Also, there are significant differences with respect to the number of inpatient visits and disease type, especially for the third and the sixth categories.