| Summary: | 碩士 === 國立陽明大學 === 公共衛生研究所 === 87 === The problem of the increasingly being overcrowded in the Emergency Room (ER) over the whole world is now being incessantly paid attention.. Many foreign researches about ER utilization have been presented; however, it is scarcely seen about the essays of the nationwide analysis of ER utilization in Taiwan. As a result, this essay focuses on the related issues of the ER utilization after the implementation of National Health Insurance (NHI), including both the utilization of the patients, and the performance of the provider.
The outpatient medical benefit claim data from January 1 to December 31 in 1997 was analyzed by SAS 6.12. The important findings of this research as following:
I. In respect of the ER utilization of the patients: (1) In 1997, the ER utilization rate as 18.03%, and ER revisit rate as 26.23%. (2) For all the ER rate and the ER revisit rate and overstay rate, male were higher than female. (3) For both the ER rate and the ER revisit rate, both those aged 0~4 and over 65 were higher than the others; however, people aged 45~65 had the highest ER revisit rate during 3 days. For the overstay rate, the older the patients were, and the higher the rate was, especially those aged over 65 being top. (4) For the beneficiary category, the ER revisit rate during 3 days, category 5 being top; however, for the overstay rate, category 6 being top. (5) Male, the older, and patients in the district hospital and in the district teaching hospital were risk factors accounting for the higher ER revisit rate. Male, the older, and patients in the public hospital and medical center etc. were risk factors accounting for the higher overstay (> 2 or 3 days) rate. (6) The most common ER diagnoses were diseases of the upper respiratory, diseases of other parts of the digestive system, and open wounds and injury to blood vessels, especially disease of the respiratory accounting for one fifth of ER patients and for half of those less than aged 14 .
II. In respect of ER in hospitals: (1) For both the ER revisit (< 3 days) rate and overstay rate, public hospital were higher than private hospital. (2) From the analysis of the influencing factors for the ER revisit rate and that in the same hospital and for the same diagnosis (>3 days), the statistics of district hospital showed significance as for the level of institution. For those above ER overstay rate(>2 days and 3 days), only the statistical results of the medical center displayed the significance in the level of institution.
This essay suggests intensifying the correct perception of seeing cures for the patients so as to decrease the utilization of ER and revisit; at the same time intensifying the assistance and guidance for those hospitals of higher ER revisit rate and overstay rate so as to give the better sreving of ER. By making use of the results of analyzing the Health Care Insurance data as the supervision of the revisit rate and overstay for nationwide hospitals that could be referenced as the making of health policy for the the administrators of the health authority ,and as the basis of the comparision of the ER utilization in Taiwan and all over the world.
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