全民健康保險精神疾病病患牙醫門診醫療利用分析

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Title:	全民健康保險精神疾病病患牙醫門診醫療利用分析 Exploring the Dental Care Utilization of Psychiatric Patients in Taiwan
Authors:	吳淑雯
Contributors:	醫務管理系(所) 翁瑞宏
Keywords:	醫療利用精神疾病牙醫門診全民健保 National Health Insurance outpatient services dentist psychiatric disease medical utilization
Date:	2012
Issue Date:	2013-04-22 14:58:56 (UTC+8)
Abstract:	動機與目的：精神疾病患者受到精神疾病影響日常行為能力，口腔健康狀況普遍不佳，牙醫門診醫療利用困難度比一般人高。本研究旨在探討精神疾病患者牙醫門診醫療利用情形，並以Aday & Anderson發展的醫療服務行為模式來分析其影響因素。研究方法：採用全民健保學術研究資料庫所提供的「2002-2007年精神疾病住院病患歸人檔」作為資料來源，有效樣本為95,435人，並使用描述性分析、Student t-test、單因子變異數分析，探討精神疾病患者牙醫門診醫療利用情形與相關影響因子。結果與結論：全體研究對象之利用牙醫門診醫療比率為34.01％，每年平均牙醫門診醫療利用次數為1.24次，年平均牙醫門診醫療利用總費用為1420.58元。在影響因素方面，女性之利用次數及費用皆較高；年齡層以20歲以下利用次數與費用皆為較高；投保身分以其他身分者其利用次數與醫療費用皆較高；投保金額以40001元以上平均利用次數與費用皆為較高；投保地區連江縣平均每人每年利用次數與費用為較高；每萬人口牙醫師數6名以上平均利用次數與費用為較高；是否為低收入戶利用次數與費用皆無顯著差異；免部分負擔者之醫療次數高於需部分負擔者，費用上無顯著差異；重大傷病者之利用次數與費用高於非重大傷病者。建議：（1）加強精神病患自我及其照顧者口腔衛教資訊之宣導；（2）針對青少年與兒童族群規劃完善之口腔健康管理；（3）重視偏鄉地區口腔衛生宣導與照護品質：（4）修訂全民健康保險牙醫門診總額特殊醫療服務於精神病患之給付；（5）建立身心障礙牙醫專業人才培育制度；（6）針對牙醫師人數進行合理控管與分配。 Background and Objectives: The daily behavior of psychiatric patients is affected by the mental illness. Generally the oral health of psychiatric patients is not good and the utilization of dental health care of them is more difficult than the other people. This study aims to examine the utilization of dental outpatient care in psychiatric patients, and to adopt Aday and Andersen’s health behavior model to analyze its associated influence factors. Research Method: The 95,435 valid samples were selected from Psychiatric Inpatient Medical claim dataset (PIMC) from 2002 to 2007. We used descriptive analysis, Student t-test, One-Way ANOVA to explore the utilization of dental outpatient care in psychiatric patients and associated factors which would affect the utilization of dental outpatient care. Results and Conclusion: 34.01% of all samples have utilized dental outpatient care. An average frequency of dental outpatient care is 1.24 times, the mean of the total cost of dental outpatient care is $ 1420.58. In terms of the associated factors, females have more dental outpatient care visits and expenditures than males. People aged below 20 utilize more dental outpatient care visits and expenditures than the people in other ages. Persons insured other identity, with insured amount above $40,001 have more dental outpatient care visits and expenditures. The average visits and expenditures of dental outpatient cares per person per year in Lianjiang county is the highest. In regions with more than 6 teeth physician per 10,000 population, the mean of the total cost of dental outpatient care visits and expenditures are higher than the persons in the other region. The effect of low-income households on the utilization of dental outpatient cares is not significant. Persons with catastrophic illnese have more of dental outpatient cares visits and expenditures than the others. Recommendations: (1) To enhance the awareness information of oral health education for psychiatric patients and their care givers; (2) To plan the perfect oral health management for the young people and the child; (3) To attach importance to oral health promotion and care quality in remote districts; (4) To modify the rules about the payment of dental outpatient cares of psychiatric patients in National Health Insurance; (5) To establish the program training the medical professionals to take care of the disabled; (6)To control and distribute the teeth physician number reasonably.
Relation:	校內外均一年後公開，學年度：100，109頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

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