Characteristics Influencing Behaviors of Health Service Utilization of Extracorporeal Shock Wave Lithotripsy in Urinary Stone Patients

• Main Authors: Wei-Chuan Chen, 陳偉權
• Other Authors: Herng - Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/11851294550828230786

碩士 === 高雄醫學大學 === 公共衛生學研究所碩士在職專班 === 93 === Objectives: The aim of this study is to explore the characteristics of urinary stone patients affecting the decision making in health service utilization of Extracorporeal Shock Wave Lithotripsy(ESWL). Methods: The sampling design was conducted by face-to –face interview way obtaining patients’ characteristics including general data, collecting way of medical information, identification of treatment guideline and attitude of health services utilization. The Aday and Andersen model was modified to structure the research framework. The patients’ characteristics were classified as three components such as predisposing, enabling and need component, respectively. The patients were divided into 3 groups as consensus, poor compliance and excess of demand (moral hazard) group, respectively, based on both guidelines by physicians and self-decisions by patients. Statistical analyses were performed to find the correlation and significance between results of decision making and the patients’ characteristics. Results: We found the following statistically significant variables as follows: (1) in consensus group (N=538), it suggests that the patients in city area have more consensus with physician’s decision(P<0.1, OR=0.334, 95% CI : 0.099-1.177). (2) in poor compliance group(N=10), it suggests that the patients with older age are less cooperative with the physicians(P<0.1, OR=4.632, 95% CI : 0.837-25.621). And (3) in moral hazard group, they were the age (P<0.05, OR=0.931, 95% CI : 0.868-0.999), the income (P<0.05, OR=5.234, 95% CI : 1.054-25.993), religion (P<0.1, OR=17.592, 95% CI : 0.587-527.451), the resident area(P<0.1, OR=0.121, 95% CI : 0.010-1.486), the stone size(P<0.05, OR=1.560, 95% CI : 1.032-2.356) and the decision changed by realizing the insurance payment before treatment(P<0.05, OR=58.867, 95% CI : 2.269-1527.359), To sum up, it suggests that the patients with older age, higher income, without religion believing, living in city areas, higher stone size and those who will change decision after realizing the insurance payment before treatment are more prone to moral hazard. Conclusion: Our results tend to support our hypotheses that consensus problem arises in the model of decision making in medical service utilization between physician(supply) and patients(demand). The excess use of medical care services caused by several patient characteristics existed in this study, in addition to health insurance. In limited resources of this country with global budget payment system, limiting the availability of high payment treatment such as ESWL may result in declining the utilization of medical care services. Nevertheless, our study concerning the patient characteristics causing consensus problem of medical service utilization in ESWL, especially, excess of demand may provide useful information to reform a health care delivery system, such as increased premium according to increased income, increased copayment and propaganda of health education. Key wards: Urolithiasis, Extracorporeal Shock Wave Lithotripsy, Meidcal Service Utilization, Moral Hazard.