The research of cross-region health care utilization and it’s influencing factors– Case of primary physician clinics in Yunlin country

• Main Authors: Chi-Yeh Li, 李奇燁
• Other Authors: 王精文
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/qqu4t4

碩士 === 國立中興大學 === 高階經理人碩士在職專班 === 99 === The purpose of this research is to study the influence factors and trend changes of primary out-patients of cross-region doctoring taken by people of Yunlin County. Use 2005 National Health Insurance database "Underwriting sample classified file (LHID 2005)" as the research master file, and connect "Medical institutions basic data file (HOSB)", "Main file of the application list of total out-patient costs (CT)", "File of outpatient prescription and detailed treatment (CD)", and "Underwriting data file (ID)" as the study samples. The first step is to analyze the influence factors of people’s cross-region doctoring in 2008; the second step is to analyze the trend changes of people’s cross-township doctoring in 2004 & 2008 and also the trend changes of people’s cross-townships, cross-medical district, cross-sub medical district doctoring in Yunlin County in 2008. The results of the research are summarized as follows: 1.Influence factors of cross-region doctoring: (1) Population characteristics: "gender", "age", "insured salary", " insurance township " have significant impacts to cross-region doctoring. (2) Medical Department: “Internal Medicine”, “Surgery”, “Obstetrics and Gynecology”, Pediatrics”, and Ophthalmology” have significant differences for cross-region doctoring individually in which “Obstetrics and Gynecology” and “Pediatrics” have higher proportion of cross-region doctoring. (3) Medical Expenses: The medical expense of each item in this study has significant impact to cross-region doctoring. After controlling the medical expense of each item, it indicates: a.Expense of general case of western medicine: For those factors such as: “age above 65”, “cost more than NT$45,000”, all “medical departments”, and insurance townships other than “Chitong Township”, “Tongshih Township”, it’s easier to use cross-region doctoring in general western medicine. b.Prevention & Care Expenses: For those factors such as: “age above 65”, “Internal Medicine/Surgery/Obstetrics and Gynecology/Pediatrics, and insurance townships locate at “Huwei Town”, “Tuku Town”, “Peikang Township”, “Yuanchang Township”, and “Kohu Township”, it’s easier for people there to conduct cross-region doctoring while taking prevention & care treatment. c.Chronic Medical Expenses: For those factors such as: “female”,“age above 65”,“Ophthalmology”,and insurance townships other than “Tuku Town”,“Dabi Township”,“Erlun Township”,“Taishi Township”,“Four-lake Township”, it’s easier for people to use cross-region doctoring while having chronic medical treatments. 2.Flow and Trends of Cross-region Doctoring: (1)Trend changes of cross-region doctoring in 2004 & 2008: The most decreasing proportion of cross-region doctoring in years of 2004 & 2008 is “Mailiao Township” and “Four-lake Township”; “Baochung Township” and “Shiluo Town” are the locations which increase cross-region doctoring most. The average rate of cross-region doctoring in these 2 years is close to 40%, and the trend changes within these 2 years do not have remarkable difference. (2)Trend changes of cross-townships, cross-medical district, cross-sub medical district doctoring in 2008. a.“Cross-townships” and “Cross-sub medical district”: “Linnei Township” has a highest rate of decreasing and “Lunbei Township” & “Mailiao Township” have lowest rates of decreasing. b.“Cross-townships” and “Cross- medical district”: “Daoliu City” has a highest rate of decreasing and the location with lowest rate of decreasing is “Linnei Township”. The results of this study indicate that Yunlin County has widespread cross-region doctoring problem. It’s mainly because of the uneven resources distribution. We expect that local hygiene/health authorities may integrate the resources within the county, balance and allocate the resources properly also to well control the establishment of clinics in the county. Encourage doctors to those locations where are lack of physicians and to cope with the policy for opening clinics there in order to promote the accessibility of medical resources within Yunlin County.