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題名：兒童固定就醫場所與醫療利用
書刊名：臺灣公共衛生雜誌
作者：黎伊帆／江東亮
作者(外文)：Li, Yi-fan／Chiang, Tung-liang
出版日期：2018
卷期：37:3
頁次：頁244-253
主題關鍵詞：兒童；固定就醫場所；門診；急診；住院；Children；Regular sources of care；Ambulatory care；Emergency services；Hospitalization
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:1
  • 共同引用共同引用:64
  • 點閱點閱:11
目標：探討兒童的固定就醫場所對門診、急診，以及住院利用的影響。方法：資料來自台灣出生世代調查研究，共有18,845名兒童同時完成6個月至66個月共4次調查，完訪率為88.7%。自變項為兒童在6個月至36個月時分別以診所、醫院為固定就醫場所，以及沒有固定就醫場所3組，依變項為兒童66個月時的醫療利用。結果：63.5%的兒童有固定就醫場所，其中44.7%為診所、18.8%為醫院。父母親教育程度較低、母親為非本國籍、家庭月收入多在3萬元以下的兒童，其沒有固定就醫場所的百分比較高。控制社會人口學特性及健康狀況，以診所為固定就醫場所者門診利用較高，然而，以醫院為固定就醫場所（急診OR=1.6；住院OR=1.8）與沒有固定就醫場所（急診OR=1.2；住院OR=1.4）其急診及住院情形顯著高於以診所為固定就醫場所者。結論：以診所為固定就醫場所的兒童，其急診、住院利用率顯著低於以醫院為固定就醫場所、或是沒有固定就醫場所的兒童，建議政府宜推出鼓勵相關財務誘因與診所品質資訊透明化的政策，以鼓勵家長選擇診所為固定就醫場所。
Objectives: The aim of this study was to determine the relationship between children's regular sources of care (RSOC) and health care utilization including ambulatory care (AC), emergency services (ES), and hospitalization (HOSP) care in Taiwan. Methods: Data came from the Taiwan Birth Cohort Study. A total of 18,845 children were included. Their parents completed four waves of interview surveys between 6 and 66 months of age, with a response rate of 88.7%. The independent variable was children's RSOC including RSOC in clinics, RSOC in hospitals, and no RSC when the children were 6 to 36-months old, and the dependent variable was medical utilization when the children were 66-months old. Results: A total of 63.5% of the children had a RSOC including 44.7% in clinics and 18.8% in hospitals. Children were less likely to have a RSOC with parents' of lower education, foreign-born mothers, and a household monthly income less than 30,000 NTD dollars. After controlling for children's gender, maternal nationality, socioeconomic characteristics, and health status, children with RSOC in hospital was significantly associated with higher likelihood of ES and HOSP (ES, OR=1.6; HOSP, OR=1.8) as were those who did not have a RSC (ES, OR=1.2; HOSP, OR=1.4), compared with those who did not have a RSOC. Conclusions: Children with RSOC in clinics was significantly associated with lower likelihood of ES and HOSP. This suggests that the government implemented financial incentive and transparency of quality in clinics policies for encouraging parents to use clinics as the RSOC.
期刊論文
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6.許績天、韓幸紋、連賢明、羅光達(20110800)。部分負擔調整對醫療利用的衝擊：以2005年政策調整為例。臺灣公共衛生雜誌，30(4)，326-336。new window  延伸查詢new window
7.江東亮、楊志良、張秀蓉(20160400)。陳拱北與全民健保。臺灣公共衛生雜誌，35(2)，107-112。new window  延伸查詢new window
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13.DeVoe, J. E.、Tillotson, C. J.、Wallace, L. S.、Lesko, S. E.、Pandhi, N.(2012)。Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling。Matern Child Health J，16，306-315。  new window
14.Andersen, R. M.、Yu, H.、Wyn, R.、Davidson, P. L.、Brown, E. R.、Teleki, S.(2002)。Access to medical care for lowincome persons: how do communities make a difference?。Med Care Res Rev，59，384-411。  new window
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16.Jones, D. S.、McNagny, S. E.、Williams, M. V.、Parker, R. M.、Sawyer, M. F.、Rask, K. J.(1999)。Lack of a regular source of care among children using a public hospital emergency department。Pediatr Emerg Care，15，13-16。  new window
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21.Mafi, J. N.、Wee, C. C.、Davis, R. B.、Landon, B. E.(2017)。Association of primary care practice location and ownership with the provision of low-value care in the United States。Jama Internal Medicine，177(6)，838-845。  new window
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24.蔡文正、龔佩珍(20030600)。民眾對基層診所評價與就醫選擇影響因素。臺灣公共衛生雜誌，22(3)，181-193。new window  延伸查詢new window
25.Andersen, Ronald M.(1995)。Revisiting the behavioral model and access to medical care: Does it matter?。Journal of Health and Social Behavior，36(1)，1-10。  new window
研究報告
1.衛生福利部。85年全民健康保險統計--特約醫事服務機構門住院費用申報狀況--按層級別分。  延伸查詢new window
2.衛生福利部中央健康保險署。104年全民健康保險統計--門住院醫療費用申報狀況--按特約類別分。  延伸查詢new window
圖書
1.行政院經濟建設委員會全民健康保險研究計畫專案小組(1990)。全民健康保險制度規劃報告。臺北：行政院經濟建設委員會。  延伸查詢new window
2.衛生福利部(1978)。加強農村醫療保健計畫。臺北：衛生福利部。  延伸查詢new window
3.Donabedian, Avedis(1980)。Explorations in Quality Assessment and Monitoring, Volume I: The Definition of Quality and Approaches to its Assessment。Ann Arbor, Mich：Health Administration Press。  new window
其他
1.衛生福利部中央健康保險署(2013)。部分負擔及免部分負擔說明，http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18&menu_id=683&webdata_id=384&WD_ID=759， 。  延伸查詢new window
 
 
 
 
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