Out-of-county Medical Utilization and Its Related Factors among Residents in Nantou County

• Main Authors: TSENG, HUI-MIN, 曾惠敏
• Other Authors: LEE, MEI-WEN
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/86557z

碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 107 === Purpose：Insufficient local medical resources or the pursuit of better medical resources will lead to out-of-area medical utilization. Compared with other counties and cities, there is relatively scarce medical resources in Nantou County. The aim of this study was to investigate the situation of out-of-county medical utilization by the residents, patient flow, and its influencing factors in Nantou County.Methods：Data were obtained from the Longitudinal Health Insurance Database 2010 (LHID 2010), one of the subsets of the National Health Insurance Research Database (NHIRD). This study was a cross-sectional study. Residents who have been diagnosed as upper respiratory tract infection in their ambulatory medical records in 2011 are enrolled. The logistic regression was used to examine the odds ratios (ORs) for out-of-county medical utilization of physician visits and hospital admissions by the residents in Nantou County. Results: Physician visits and hospital admissions during 2011 for 13,219 residents in Nantou County were studies. There were 287,188 visits for physician visits, and 2,038 visits for hospital admissions; the percentage of out-of-county medical utilization for hospital admissions was higher than that for physician visits (43.2% v.s. 17.6%, respectively). The top three diseases in the out-of-county medical utilization for physician visits were neoplasms (59.7%), congenital anomalies (58.1%) and diseases of the blood and blood-forming organs (35.2%), whereas the top three diseases for out-of-county hospital admission were diseases of the blood and blood-forming organs (88.9%), neoplasms (81.3%) and congenital anomalies (66,7%). The three highest-ranked townships of out-of-county physician visits were Jhushan (21.9%), Lugu (19.8%) and Caotun Townships (19.7%), and the three leading townships of out-of-county hospital admission were Lugu (64.1%), Guoshing (63.2%) and Caotun (54.0%) Townships; overall, Taichung City and Changhua County was the first and second choice for out-of-county medical utilization. Logistic regression analysis of the influencing factors for out-of-county medical utilization revealed that in the physician visits, residents at the age of 15-44 years old were more prone to out-of-county physician visits for those more than 65 years old (OR=1.432, 95% CI=1.313~1.536); compared to residents with insurance amount of more than TWD 28,064, those who have insurance amount between TWD 1-28064 had less frequent out-of-county physician visits (OR=0.871, 95% CI=0.792~0.958), conversely, the dependents (TWD 0) were found more frequently to out-of-county physician visits (OR=1.248, 95% CI=1.119~1.390); compared with residents of Nantou City, those of Puli, Jhongliao, and Renai Townships were less likely to out-of-county medical utilization for physician visits (OR=0.777, 95% CI=0.691~0.875; OR=0.648, 95%CI=0.493~0.852; OR=0.512, 95%CI=0.386~0.678), whereas residents of Jhushan, Jiji, Mingjian, Lugu, Guoshing and Shueili Townships were more prone to out-of-county medical utilization for physician visits (OR=1.695, 95% CI=1.471~1.953; OR=3.163, 95% CI = 2.686 ~ 3.725; OR=1.662, 95% CI=1.245~2.219; OR=1.779, 95% CI = 1.539~2.057); compared to residents diagnosed with diseases of the respiratory system, the use of out-of-county medical resources appeared more prevalent in patients with diseases other than certain conditions originating in the perinatal period; the higher the number of physicians per 10,000 population in the county where the medical facilities were located, the more prevalent the out-of-county medical utilization (OR=15.216, 95% CI = 14.729~15.720). For hospital admission, the higher the number of acute beds per 10,000 population in the county where the medical facilities were located, the more apparent the utilization of out-of-county medical resources (OR=25.072, 95% CI = 13.943~45.082).Conclusions：Here we show that there were more hospital admissions than physical visits in the ratio of out-of-county medical utilization by residents in Nantou County. The ratio of out-of-county medical utilization was higher in residents suffering from neoplasms, diseases of the blood and blood-forming organs and congenital anomalies than those with other diseases, and neighboring counties and cities were the most frequent locations for out-of-county medical utilization. Based on the results of this research, we provide the departments concerned the references for planning and allocation of medical specialty and resources.