| 摘要: | 目地：離島地區受地理環境影響較難吸引醫事人員前往執業，因此醫療資源嚴重不足，部分醫療需求（如急重症）無法適時獲得滿足。本研究目的為探討金門地區民眾轉診至台灣其疾病型態及醫療利用情形。
方法：資料來源為「全民健康保險學術研究資料庫」之1997~2010年3套100萬人承保抽樣歸人檔。本研究分析2000~2010年以投保地為金門之民眾為母群體，在金門就醫後7天內轉診至台灣就醫者為研究對象，排除於台灣中醫、牙醫及診所就醫之資料。以GEE模式分析影響是否住院及醫療費用之相關因素。
結果：2000~2010年金門地區民眾轉診至台灣醫院就醫年齡以45-54歲最多(16.39%)，女性多於男性，投保薪資以17880~22800元最多(38.78%)，轉診就醫層級以醫學中心為主(61.08%)，醫院權屬以私立(含法人)醫院最多(99.67%)。平均醫療總費用為10,039元。就醫門診科別前三名為婦科、骨科、腸胃內科；住院科別為骨科及一般外科、泌尿科及婦科、小兒科。轉診疾病類別前三名為惡性腫瘤、心血管疾病、代謝疾病；手術類別以鼻、口及咽手術、消化系統手術、骨骼肌肉系統手術。轉診當次因重大傷病就醫次者以癌症(77.17%)，第二為慢性精神病(7.09%)。GEE羅吉斯分析；女性比男性有較高的住院風險(OR=1.46)，轉診疾病類別為肺部疾病(OR=5.43)、惡性腫瘤疾病(OR=19.73)、良性腫瘤疾病(OR=10.44)、血液疾病(OR=3.94)、心血管疾病(OR=7.34)、腦血管疾病(OR=4553)、肝臟疾病(OR=8.59)、腎臟疾病(OR=7.16)、泌尿疾病(OR=13.76)、耳鼻喉疾病(OR=3.14)、外因傷害(OR=17.32) 、代謝疾病(OR=3.14)、自體免疫疾病(OR=4.28)、中樞神經病變疾病(OR=9.35)、骨骼疾病(OR=3.18)、男性生殖器官疾病(OR=2.38)、女性生殖器官疾病(OR=3.86)、眼睛相關疾病(OR=4.33)、消化道疾病(OR=2.51)、皮膚疾病(OR=5.08)、產科疾病(OR=6.17)有較高的住院風險，2006年之後有較高的住院風險。GEE之複迴歸分析，年齡?75歲醫療費用顯著高於?18歲。眼手術、男性及女性生殖器官手術、產科醫療顯著高於無手術。轉診疾病類別為惡性腫瘤、血液病、腎臟疾病醫療費用顯著高於非此疾病類別。共病程度CCI ?5分、醫學中心醫療費用較高。
結論：本研究呈現2000~2010年金門地區民眾轉診至台灣其疾病型態及醫療利用現況及影響因素，希望提供衛生政策決策者有效的資訊，以制訂用相關政策，俾利提升離島醫療品質。
Background: The Taiwan offshore islands are medically underserved regions because geographic restriction limits willingness of healthcare providers to work there. Therefore, patients with urgent or critic medical conditions cannot be promptly managed. The purpose of this study is to investigate distribution of the diseases that referral is required and usage of medical services in Kinmen, one of the Taiwan offshore islands.
Method: This retrospective cohort study designs was conducted by using the 「National Health Insurance Research Database」from 1997 to 2010, 3 sets of「Longitudinal Health Insurance Database」. The residents being insured in Kinmen from 2000 through 2010 were the target population. The patients being referred to the hospitals in Taiwan within 7 days of medical treatment in Kinmen were recognized as the study cohort. Information of Chinese medicine, dental procedure and outpatient clinics were excluded from analyses. The factors associated with hospitalization and medical costs were analyzed by using generalized estimating equation (GEE) model.
Results:Among the Kinmen residents who were referred to hospitals in Taiwan from 2000 through 2010, more patients were at 45-54 years of age (16.39%), female, and at income bases between $17,880 and $22,800 NTD (38.78%). Majority of the patients were transferred to medical centers (61.08%), and 99.67% of the health care institutes were private or corporation-owned. The average medical costs were $10,039 NTD. The top three out-patient referral services were in gynecological, orthopedics, and gastrointestinal departments. The in-patient referral services were mainly in orthopedics, general surgical, genitourinary, gynecological, and pediatric departments. The diseases associated with referral were malignant,cardiovascular, and skeletal diseases. The top surgical procedures were related to nose and oropharyngeal region, digestive system, and skeletomuscular system. The top catastrophic illnesses for referral were cancer (77.17%) and chronic psychiatric diseases (7.09%). GEE logistic regression showed the risk factors for hospitalization were women (OR=1.46), lung(OR=5.43),cancer(OR=19.73),benign neoplasm
(OR=10.44),hematologic(OR=3.94),cardiovascular(OR=7.34), cerebrovascular(OR=4553),liver(OR=8.59),renal(OR=7.16),urinary
(OR=13.76),ENT(OR=3.14),injury(OR=17.32), metabolic(OR=3.14), autoimmune(OR=4.28),central nervous system lesions(OR=9.35), skeletal(OR=3.18),male genital(OR=2.38),female genital(OR=3.86), eye-related(OR=4.33),gastrointestinal (OR=2.51),skin (OR=5.08),and obstetric disease (OR=6.17).Patients being referred after 2006 were hospitalized more. GEE multiple covariate regression analyses were conducted to explore the factors related to high medical costs, and the results were as follows. Patients older than or equal to 75 years old need significantly higher medical costs than those who were younger than or equal to 18 years old did. Healthcare for patients having ophthalmological, genital and obstetric surgeries cost significantly more comparing to that for those who did not accept surgeries. The patients with oncologic, hematologic, and renal diseases had significant higher medical costs. The patients with comorbidity (CCI?5) or treated in medical centers had higher medical costs.
Conclusions:This study disclosed distribution of diseases, medical utilization, and important factors that impact chances of hospitalization and medical costs for Kinmen residents being referred to Taiwan. The aim of this study is to provide information for healthcare officials to establish effective policies and to promote quality of healthcare in offshore islands. |
