| 摘要: | 背景與動機：目前我國與全球先進國家皆面臨少子化(The trend of fewer children)問題，低生育率將影響國家的經濟生產力，而不孕症是導致生育率降低的原因之ㄧ。不孕症的診斷和治療皆已納入健保給付，唯人工生殖技術除外。本研究使用健保資料庫探討不孕症醫療利用相關因素，以作為不孕症醫療資源重新分配之參考。
目的：以健保資料庫分析台灣地區2002-2007年不孕症盛行率趨勢、醫療費用與醫療服務使用情形，以及探討影響醫療利用之相關因素。
方法：資料來源為全民健保2005年之承保抽樣歸人檔資料庫，本研究申購2002-2007年共100萬人進行分析。研究對象為主診斷前三碼為606(男性不孕症)及628(女性不孕症)以及就醫科別為婦產科、泌尿科之患者。本研究樣本六年共10,230人，其中不孕症男性患者為1,612人，女性為8,618人；住院共237人，其中男性為11人，女性為226人。以t-test、ANOVA及複迴歸進行雙變項與多變項分析。
結果：不孕症就醫盛行率以2002年(0.49%)最高，女性盛行率各年度皆比男性為高；門診就醫次數以2004年最高，自2005年開始逐年下降；門診醫療費用2005年為最低，但是整體趨勢顯示醫療費用近年來有攀升情形。性別、年齡、投保類別、慢性病、投保金額、低收入、就醫層級別及就醫權屬別在門診醫療費用上皆達統計上顯著差異。複迴歸分析顯示，影響不孕症醫療費用之相關因素為性別、年齡、投保分局別與健康照護體系資源以及就醫層級別。
結論：不孕症醫療資源之利用受到性別、年齡、投保類別、投保分局別、健康照護體系資源及就醫層級別之影響，且2002至2007年不孕症醫療費用有逐年上升的趨勢，而低收入患者在不孕症醫療利用上呈現偏低之情形。建議相關衛生單位能更加重視不孕症醫療使用在提昇生育率上之重要性，改善低收入患者之就醫障礙，提昇不孕症醫療資源之合理分配與適當使用。
Background: Nowadays Taiwan and developed countries are all facing the problem of the trend towards fewer children. Low fertility rate greatly impacts on nationwide economic productivity, and, notably, infertility is one of the causes of reduced fertility. Infertility diagnoses and treatments had been reimbursed by the National Health Insurance (NHI), except for artificial reproductive technology. Utilizing the NHI database, the present study sought to investigate the factors assocated with the health services utilization of infertility in order to provide a policy basis for medical resource reallocation.
Objectives: The NHI database 2002 - 2007 were used to analyze the trends in the prevalence, medical expenditure, and medical care utilization of infertility in Taiwan, with an emphasis on the examination of the related factors of health services utilization among infertility patients.
Methods: Data were drawn from the NHI Beneficiaries Claims 2005, a nationally representative database of health services utilization from the panel claims of one million patients from 2002 to 2007. Subjects were limited to obstetrics, gynecology, and urology patients with the ICD-9-CM principal diagnosis code 606 (male infertility) or 628 (female infertility). From the six years span of the 2005 beneficiaries, the present study obtained total 10,230 outpatients, of which 1,612 were males, 8,618 were females, and 237 used inpatient services. Among the inpatients, 11 were males and 227 were females. T-test, ANOVA, and multiple regression were used for the bivariate and multivariate analyses.
Results: The highest prevalence of infertility occured in 2002 (0.49%). Female showed higher infertility prevalence in each year of the period. Infertility outpatient visits in 2004 ranked highest during the six-year peiord, and the visits descended from 2005. In regard to medical expenditures of infertility outpatient care, 2005 was the lowest in the period, and, however, the overall infertility outpatient expenditure was increasing. According to the bivaraite analyses, gender, age, insurance category, chronic disease, insured amount, low-income, level of medical institution, and ownership of medical institution showed statistically significant differences in the infertility outpatient medical expenditure. Multiple regression analysis showed that the related factors of infertility outpatient medical expenditure were gender, age, insurance branch, medical resource, and level of medical institution.
Conclusion: The related factors of health services utilization among infertility patients were gender, age, insurance type, insurance branch, medical resoursce, and level of medical institutions. Overall, the medical expenditures of infertility during 2002-2007 were increasing. The low-income infertile patients revealed lower utilization. The present study recommended that the health authorities should value the critical role of infertility health care utilization in enhancing fertility rates and reduce the barriers of seeking medical care for low-income infertile patients, to advance the appropriate reallocation and utilization of infertility medical resources. |
