我國每十年進行一次人口普查，以取得國人經常活動地區的資訊，作為中央及地方政府政策規劃的參考。然而，十年一次的人口普查無法即時反映各地區人口特質及其活動，隨著普查完訪率逐年下降、個人資料保護法意識抬頭等趨勢，普查的涵蓋率及其資料品質愈加受到質疑，近年各國思考以其他資料蒐集方式取代傳統普查。我國實施全民健康保險制度已逾20年，民眾納保率超過99%，因此本文以全民健保資料庫為研究素材，透過個人就醫行為探討國人經常活動地區，透過剖析各種疾病的就醫行為，可作為政府評估醫療資源規劃的參考。
本文以全民健保資料庫為依據，探討我國國民選擇醫療地點的特性，作為經常活動地區（或是常住地）的輔助參考。過去研究大多利用上呼吸道感染（俗稱感冒）作為估計常住地的依據，但每年平均只有接近70%國人會因感冒而就醫，其中青壯年、老年人因感冒而就醫的比例明顯較低，以此作為常住地的估計基礎恐有涵蓋率不足之虞。本文依據健保資料庫中的2005年百萬人抽樣檔，包括就醫門診處方及治療明細檔(CD)、承保資料檔(ID)等資料，比較數種常住地判斷的參考準則（包括感冒就醫），分析各方法所觀察到資料的特性及限制，評估以這些準則作為判斷常住地的可行性。
結論：本文提出除了感冒就醫之外的三種常住地推估準則，分別為：因為感冒或是消化就醫、單次健保補助金額較低、基層院所就醫。以樣本涵蓋率量而言，三種準則都能改善感冒就醫涵蓋率的不足，其中以單次金額與基層院所就醫的樣本數增加最多。另外，如果與所有門診資料、普查資料的人口資料比較，發現單次金額與基層院所就醫推估的人口年齡結構最為接近，但單次金額的縣市（地區）結構與普查資料的差異較大。
限制：受限於青壯年人口就醫率較低，本文提出的幾種常住地判斷準則在20歲至44歲的涵蓋率仍然偏低，建議未來研究可經由權數調整修正樣本的年齡等人口結構及比例，或是仰賴就醫以外的紀錄推估，但須考量資料串連及品質等問題。 / Many countries conduct population census every 10 years to acquire the information of population structure and its trend, but the information is not likely to updated since the 10-years period is usually too long. Moreover, the low response rate of questionnaire and the enforcement of Personal Information Protection Act further jeopardize the population census and many question its data quality. Thus, quite a lot of countries are seeking alternatives for collecting the information of de jure population, replacing the regular population census.
In this study, we explore the possibility of using the data from National Health Insurance (NHI) Research Database for acquiring the information of de jure population in Taiwan. Taiwan started the NHI in 1995 and more than 99% of Taiwan population are covered. Since the medical accessibility created by the NHI, Taiwan’s people tend to visit medical institutions near to where they live, when they have minor diseases. Past studies showed that the upper respiratory tract infection (or cold) is a popular choice of minor diseases. We will evaluate if the cold is a good candidate and propose alternative criteria for the definition of minor diseases.
We found that the proportion of populations with upper respiratory tract infection is about 70% and it is age dependent, with the elderly the lowest. On contrary, the records of smaller amounts and the records of physician clinics (or general practice clinics) can cover more than 90% population, much better than the records of upper respiratory tract infection. The records of digestive system diseases and upper respiratory tract infection can also increase the coverage of elderly population. We recommend using the medical records of smaller amounts to acquire the de jure population.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0104354019 |
| Creators | 簡于閔, Chien, Yu-Min |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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