實施總額支付制度對台灣中部地區預防保健服務利用情形之探討

藉由健康檢查的預防保健服務，從兒童預防保健、婦女預防保健、成人預防保健以及孕產婦預防保健的推行，來達到早期發現早期治療等目標是促進健康生活的根本之道。而民國九十年七月一日起西醫基層總額支付制度的實施，是否可能影響行之有年的成人預防保健以及婦女子宮頸抹片檢查等預防保健項目的可近性值得深切關注。本研究以中區醫師公會申報健保給付資料，應用醫療可近性模式探討西醫基層總額支付制度實施後，對於預防保健申報件數是否有差異。 研究結果顯示，申報月份對於制度實施後，其婦女保健(p<0.05)、成人保健(p<0.05)有顯著的差異。申報縣市對於制度實施後，其兒童保健(p<0.05)、婦女保健(p<0.05)、成人保健(p<0.05)、孕產婦保健(p<0.05)有顯著的差異。而申報科別對於制度實施後，其兒童保健(p<0.05)、婦女保健(p<0.05)、成人保健(p<0.05)、孕產婦保健(p<0.05)有顯著的差異。本研究結果，西醫基層總額支付制度對於孕產婦保健的影響欠佳，主要在於婦產科的健保申報採用論病例計酬制度。 預防保健服務對於促進國民健康具高度效率與效益，建議衛生主管機關訂定全國預防保健目標及縮短縣市醫療的可近性及相關錯失以導正國人預防保健觀念提升受檢率以達到提昇國人生活品質、節制醫療費用之目標。

Abstract The spirit of physical examination is “Prevention is better than cure”, and it would be carry out by prevention health care service, especially child prevention health care, woman prevention health care, adult prevention health care, and pregnant woman prevention health care. The Global Budget System was dispensed on July 1, 2001; it may have the effect on adult prevent health care and woman cervix wipe piece check. The accesses of those two examinations are worth paying more attention on it. This study which is based on the data of declaring items from National Health Insurance and applied the mode of access inquires into the difference of number of declaring items for health prevention care service. The result of this study shows that there is no difference with pregnant woman health care under Global Budget System, and the main reason is that the department of gynecology and obstetrics declared by case payment. As by declaring month, woman health prevention health care (p<0.05) and adult prevention health care (p<0.05) show the differences. By declaring county, child prevention health care (p<0.05), woman prevention health care (p<0.05), adult prevention health care (p<0.05), and pregnant woman prevention health care (p<0.05) show the differences. And by the declaring department, child prevention health care (p<0.05), woman prevention health care (p<0.05), adult prevention health care (p<0.05), and pregnant woman prevention health care (p<0.05) show the differences. Prevention health care service promotes citizen’s health effectively and beneficially. Therefore, we suggest the health official government to have goals of national prevention health care, to abridge the medical assess in each county and to constitute related preventions.