[[alternative]]The Comparison and Analysis of Medical Resources Utilization between Veterans without Employment and the General Public

[[abstract]]背 景：無職榮民享有全民健康保險保費及醫療費用之全額補助，加上高齡化的人口學特質，其在門診、急診及住院方面的利用卻未有完整的探討，本研究擬針對此特定對象之醫療利用狀況與一般民眾的利用進行比較分析。目 的：探討無職榮民與一般民眾在門診、急診利用次數及醫療費用、住院高科技檢查項目利用次數及精神科門診、精神科住院之利用上是否具統計上顯著差異。材 料：2003年國家衛生研究院「全民健康保險學術研究資料庫」之「醫事機構基本資料檔」、「重大傷病證明明細檔」、「門診處方及治療明細檔」、「住院醫療費用清單明細檔」、「住院醫療費用醫令清單明細檔」及「承保資料檔」。方 法：採匹配研究對照設計的概念，針對無職榮民(研究組)的性別與年齡，匹配條件相符的一般民眾為對照組。採用複迴歸分析檢定研究對象在門、急診醫療費用上的差異；用對數線性複迴歸檢定研究對象在門、急診利用次數及住院高科技檢查項目利用次數上的差異；用邏輯斯迴歸分析研究對象在精神科門診及精神科住院利用上之差異。結 果：無職榮民在門診利用次數、急診利用次數、每次急診醫療費用、精神科門診利用率及精神科住院利用率均顯著高於一般民眾。結 論：除了達統計上顯著差異的項目外，在門診醫療費用未達統計上顯著差異的原因，可能是以每次費用為分析基礎所致，在住院高科技檢查項目利用的部份，可能因研究對象疾病診斷影響研究的結果。限 制：受限於次級資料的使用，本研究儘可能針對資料庫中所能取得會影響醫療利用的變項進行控制，並以合併症指標對資料庫中無法確實呈現的疾病嚴重度，進行最佳的估計。關 鍵 字：榮民、醫療利用、健保資料庫[[abstract]]Background: Veterans without employment enjoyed full subsidiary on National Health Insurance premiums and medical expenditure. They were also distinguishable for their demographic characteristics of aging. However, their use of outpatient, emergency and inpatient resources had not been comprehensively researched. This study sought to conduct a comparative analysis on the medical resources utilization between this particular group and the general public.Object: To verify if the following facts between veterans without employment and the general public had any statistically significant difference: the number of visit and medical expenditure for outpatient and emergency services, the number of high-tech examination at inpatient, and the utilization of Psychiatry, both outpatient and inpatient.Data source: The data were drawn from National Health Insurance Research Database(NHIRD) for 2003. Method: A study-control design was employed, matching the age and gender of both subjects. Applied multiple-regression-analysis on the difference of medical expenditure for outpatient and emergency services; Used multiple linear regression analysis on the difference of visits to outpatient and emergency services, and number of high-tech examination at inpatient. Applied logistic regression on the difference of utilization of Psychiatry, both outpatient and inpatient.Result: Veterans without employment had significantly more visits to outpatient and emergency, higher medical expenditure per emergency visit and higher utilization on outpatient and inpatient Psychiatry.Conclusion: Beside those with statistically significant difference, the medical expenditure for outpatient services was not statistically significant, probably because the comparison was based on the expenditure of each visit. As to the number of high-tech examination at inpatient, the different diagnosis from both subjects would lead to different examinations, which made the comparison unpractical.Limitation: Owing to the use of secondary data, the study strived to regulate all the variables available, which could influence the utilization of medical resources. If the severity of diseases of any sample could not be identified, comorbidity index was used as the best estimate for it.Key words: veterans, medical resources utilization, National Health Insurance Research Database(NHIRD