全民健保滿意度之各階層民眾態度分析

Abstract

本研究主要是針對過去十年來衛生署或健保局委託各單位所進行的民意調查研究結果，進行有系統的整理、分析，以找出長期的歷史變化趨勢，以及民眾態度的階層間異，並觀察民眾對健保的態度是否受各種歷史改革措施施行的影響。此外，並將針對此一研究結果，舉辦專家學者座談，研討並提出未來健保改革或政策推行的策略性建議，以及未來健保相關研究或民意調查之研究建議。

This study is to systematically review and analyze the research findings of the public opinion survey on the National Health Insurance (NHI) conducted in the past ten years, in order to identify the historical trend and the differentiation among stratums of the public opinion on the NHI. It is hoped that through this research effort, we can propose strategies for future NHI reforms and suggestions for future researches

本研究主要是針對歷年來健保民意調查研究的結果進行有系統的整理分析，以找出民眾對健保態度的歷史趨勢變化，以及不同社經地位與人口特徵的民眾間的態度差異，並據此提出未來健保改革策略與健保民意調查研究之建議。藉著聚合分析，書面報告中的結果與原始資料的統計數字得以充份使用。研究結論摘要如下： 一、民眾滿意度的歷史趨勢與階層差異 民眾對「全民健保制度」以及「醫療院所的醫療服務」有相當正面的評價，且兩者有高度相關。只有直接影響民眾經濟負擔感受的保費和部分負擔等改革措施，會對民眾滿意度造成負面影響。但此一影響是短暫的，民眾適應政策後滿意度即再度回升。無論對健保制度或對健保特約醫療院所醫療服務的滿意度，歷年來的調查結果發現以20-30歲、專科以上、軍公教人員、個人或家庭收入較高者的滿意度較高；滿意度最低的，則以40-59歲、國初中以下、自營商、專業證照、職業工會會員為主。 二、對未來健保調查研究之建議 可考慮長期委託同一機構進行調查，邀請專家學者成立一個委員會設計題目，並且列出一套執行方法。問卷設計應有長遠的規劃，兼採短期性與長期性問題。為了避免短期事件干擾，民調盡量固定在某幾個時間點。開放調查的原始資料檔供所有的研究者申請使用，以增加這些研究資料的使用效益。 三、對未來健保改革推動的策略建議 建議採用質化研究方法理解不同類型民眾的需求，提出有效的解決方案。民眾對健保不滿意的最主要原因，都和經濟負擔相關的「保費」和「部分負擔」有關。因此政府有必要讓人民瞭解，和其他國家比較，我國民眾享有如此完整的醫療保障，目前的保費負擔仍屬較輕。歷屆調查對健保特約醫療院所醫療服務不滿意的主要原因，為「健保使用的藥品品質不佳」、「醫療品質下降／醫生看病草率（診療時間太短）」、「掛號費太貴」、「醫護人員服務態度不好」等原因。政府有必要針對上述問題進行改革。歷史的分析顯示若干健保的改革措施會使民眾滿意度短暫下降，但是下降的程度有限，且很快又會回升。或許可以鼓勵執政者勇於推動正確和必要的改革。This study is to compile the results of the surveys conducted in the past ten years in order to find out the historical trend and the stratification of the people’s attitude toward the national health insurance system. By doing meta analysis, we can take the advantage of the results in the field reports and statistics from original data. The following are the main findings. The system of national health insurance and medical care of hospitals or clinics are highly evaluated. People’s evaluations on health insurance and medical care are highly correlated. Only the measures that directly influence people’s pocketbooks, such increasing insurance fees or partial expense, would cause some negative evaluations. However, this will not last long; the level of satisfaction will rise after people get used to the new policy. Surveys in different years show that people who are 20 to 30 years old, college educated, government employees, and have higher income are more satisfied with health insurance and medical care. People who are 40 to 59 years old, junior-high-school educated, self-employees, license holders, union members are least satisfied with health insurance and medical care. We suggest that the survey should be administered by a single institution. Moreover, there should be a committee composed of experts and scholars to design the questionnaire and a procedure of survey. To avoid the impact of the short-term issues, surveys should be conducted on some fixed time points. It is necessary to open the access to the original data to all applicants for more researches. In the future, we should consider applying the qualitative method to find out the need of different types of people and possible solutions. The main reason of dissatisfaction is “insurance fee” and “partial expense” related to people’s pocketbooks. Government should let people know that people’s burden is lighter than in other countries considering the quality and scope of medical service. Surveys also show that dissatisfactions with hospitals and clinics are largely about “low quality of medicine paid by the National Health Insurance,” “lowering quality of medical service/doctor spends less time on patients,” “registration fee is too expensive,” and “nurses or staffs have bad manners.” Government should respond to those complaints. The historical trend analysis shows that revision of health insurance may cause temporary dissatisfaction, but it is still worth of initiating correct and necessary reform.