持續門診高醫療利用保險對象之人口特徵及就醫背景因素探討; Characteristics of insured population with continuing high utilization of outpatient clinics and investigation of their background and the related factors

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Title:	持續門診高醫療利用保險對象之人口特徵及就醫背景因素探討;Characteristics of insured population with continuing high utilization of outpatient clinics and investigation of their background and the related factors
Authors:	喻崇文;Tsung-Wen Yu
Contributors:	醫務管理學研究所碩士班
Keywords:	持續高醫療利用;疾病診斷;高用藥;就醫次數;continuing high utilization of outpatient clinics;diagnoses of diseases;more days of outpatient clinic medication;frequency of outpatient clinic visits
Date:	2009-07-13
Issue Date:	2009-08-12 16:22:39 (UTC+8)
Abstract:	背景與目的：國人年平均門診就醫次數由健保開辦之12.53次，至今已達15次，健保局亦實施門診高醫療利用輔導計畫。本研究希望瞭解持續高醫療利用之影響因素，以作為日後擬定對策之參考。　　方法：以2005、2006、2007等3年門診就醫次數超過200次者計515人次為研究對象，藉由健保醫療及承保資料檔，取得人口特徵及就醫背景資料。進行描述性統計分析、雙變量分析、羅吉斯迴歸分析及複迴歸分析。　　結果：本研究由羅吉斯迴歸分析得知，低收入者較有一定雇主者、疾病診斷多者較疾病診斷少者、門診用藥日數多者較門診用藥日數少者，有較高之機率成為持續門診高醫療利用保險對象；而就醫跨層級多者較就醫固定層級者，有較低之機率成為持續門診高醫療利用保險對象。又經複迴歸分析顯示，低收入者較有一定雇主者之隔年改善就醫次數百分比低；而就醫跨層級數、門診就醫次數，與隔年改善就醫次數百分比呈現正相關；另門診用藥日數與隔年改善就醫次數百分比呈現負相關。結論：低收入者、疾病診斷數、就醫跨層級數及用藥日數，均影響成為持續高醫療利用之因素。另低收入者、就醫跨層級數、就醫次數及用藥日數，均是影響其輔導後隔年改善就醫次數百分比之因素。　　本研究結果可作為健保局未來對持續門診高醫療利用者研擬更有效措施來改善醫療資源使用。 Background and objective The average outpatient clinic visits increased from 12.53 times per year in the beginning of National Health Insurance that at present up to 15 times per year; the bureau of National Health Insurance also implemented the assistant plan to manage frequent outpatient clinic use. The purpose of this study is to understand the factors influencing continuing high utilization of outpatient clinics to be the reference of future strategies. Methodologies Patients visiting outpatient clinics for more than 200 times in year of 2005, 2006, and 2007, total 515 subjects were selected in the study. Their information of characteristics and backgrounds collected from the medical and insurance coverage database of National Health Insurance was analyzed by descriptive, binomial, logistic regression, and multiple variable regression analyses. Findings According to the logistic regression analysis of this study, insured population with low-income, more diagnoses of diseases, and more days of outpatient clinic medication had higher probabilities of using outpatient clinics than those with regular employers, fewer diagnoses of diseases, and fewer days of outpatient clinic medication, respectively. Patients visiting various hierarchies of hospitals used more medical resources of outpatient clinics than those in regular hospitals. The multiple variable regression analyses revealed that the percentage of improving outpatient clinic visits in the next year was lower in low-income patients than in patients with regular employers. However, visiting various hierarchies of hospitals and frequency of outpatient clinic visits were positively related to the percentage of improving hospital visits in the next year. Furthermore, days of outpatient clinic medication was negatively related to the percentage of improving hospital visits in the next year. Conclusion Low-income people, the number of disease diagnosis, the number of visiting various hierarchies of hospitals, and the number of days of outpatient clinic medication are affected as a continuing high utilization of outpatient clinics factors. Another low-income people, the number of visiting various hierarchies of hospitals, frequency of outpatient clinic visits and the number of days of outpatient clinic medication are affecting the percentage of improving outpatient clinic visits in the next year. The results of this study may be served as a reference for the bureau of National Health Insurance to develop strategies to improve consumption of medical resources in insured population with continuing high utilization of outpatient clinics.
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