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題名：台灣中老年人自覺健康之研究
作者：何淑熙 引用關係
作者(外文)：Shu-Hsi Ho
校院名稱：逢甲大學
系所名稱：經濟學所
指導教授：利菊秀
學位類別：博士
出版日期：2008
主題關鍵詞：自評健康；健康轉變；死亡率的估計；追蹤資料；panel data；estimation of mortality rate；health transition；self-perceived health
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台灣人口老化的現象，使得探討影響老人健康和死亡的問題已成為一個重要的課題。本論文擬以1996、1999與2003年的三波追蹤資料，從社會人口因素、身心狀況、與生活型態等方面，檢視台灣地區五十歲以上的中老年人自評健康的決定因素、健康轉變之探討、與死亡率的估計等三個研究主題。
自評健康通常可分為很好、好、普通、不好、很不好等五個等級，故本論文以隨機效果序列機率模型（Random Effects Ordered Probit Model）分析影響中老年人自評健康的決定因素。研究結果發現：教育程度較高者、客家人、外省人、已婚者、有運動習慣、與買商業保險者等變項，都呈現顯著且較好的自評健康。相對的，年齡較長、居住在鄉村、慢性病患者、身體功能較弱、與有吃檳榔習慣者等變項，都反映出顯著與較差的自評健康。
本研究以多元名目羅吉斯迴歸模型（Multinomial Logit Model）檢驗1996到1999年與1999到2003年，不同性別者的健康轉變情形。主要研究發現：不論男性或女性，都呈現出教育程度較高與有配偶者，顯著的健康狀況變好；而慢性病與身體功能差者顯著的健康狀況變壞。不同的是商業保險這個變數，在1996到1999年間對男性沒有顯著的影響；但於1999到2003年間卻出現顯著性。這顯示出：男性到了晚年一樣會擔心，需要額外的商業保險來確保其晚年生涯的生活安定。同時本文亦發現：在1999到2003年間，外省女性健康狀況顯著變差，但是外省男性可能因為有榮民保險與退休金的保障，其自評健康狀況顯著的變好。
在死亡率的估計方面，本文發現在1996到1999年間：性別、年齡、居住在鄉村、婚姻狀態、身體功能與自評健康等變數，對死亡率都產生顯著的影響。然而，在1999到2003年期間：年齡和居住地這兩項變數卻喪失其顯著的影響力；而性別、婚姻狀態、身體功能、與自評健康等變數仍具有顯著影響。本文發現「自評健康」在這兩段期間對死亡的估計都有顯著的影響力。故自評健康應該有其可靠性，能夠適度的估計台灣中老年人的死亡率。
Taiwan is gradually becoming an ageing country. The population ageing phenomenon illustrates that the issues of elderly health and mortality will be important topics. This thesis uses longitudinal data to empirically examine socio-demographic factors, physical functional ability, and individual lifestyle as determinants of self-perceived health, health transition, and to estimate the mortality rate among the middle age and elderly in Taiwan. The data used is from the Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan, which interviewed people aged 50 and over in 1996, and re-interviewed them in 1999 and 2003.
Since the statuses of self-perceived health are excellent, good, average, no good and poor. They are neither continuous nor cardinal; this thesis uses the random effects ordered probit model to examine the determinants of self-perceived health. The main empirical results show that the elderly with better education, Hakka, Mainlander, married, people who exercise regularly, and those with commercial insurance had a significantly better level of self-perceived health. In contrast, the variables of ages, living in rural areas, ailment, activities of daily living (ADL), instrumental activities of daily living (IADL), and betel nut, all revealed a significant negative influence on estimated self-perceived health.
This thesis further uses multinomial logit model to analyze the health transition by gender during the periods of 1996 to 1999 and 1999 to 2003. Findings illustrate that the elderly with better education and married persons, showed statistically significant effects and better health transition. In contrast, ailment, and instrumental activities of daily living (IADL) variables presented opposite trends on estimated health transition for both men and women, with the exception of the commercial insurance variable. For men, the commercial insurance variables had insignificant effects between 1996 and 1999, but they had significance during the period of 1999 to 2003. This implied that men might need commercial insurance to provide more security for their later lives. In addition, the health status of female Mainlanders became significantly worse between 1999 and 2003, but male Mainlanders became significantly better during the same period, perhaps due to the special Veterans Insurance and government pension benefits.
In terms of estimation of the mortality rate, the results show that the variables of female, age, living in rural areas, married, and self-perceived health had a statistically significant influence on estimated mortality during the period of 1996 to 1999. However, the factors of age and living in rural areas were insignificant; the female, married, and self-perceived health variables still remained significant between 1999 and 2003. This thesis highlights that the self-perceived health variable had a significant effect on estimated mortality rates throughout the period of the study. Therefore, self-perceived health can reliably estimate mortality rates.
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