當台灣漸趨向人口老年化時,中老年人在健康、心理或是居住地區等各層面 的議題都逐漸受到關注。由台灣的前十大死因中有六項為慢性病,以及衛生福利 部的調查結果顯示台灣約有七成以上的中老年人被診斷出至少罹患一種慢性疾 病得知,慢性病中老年人佔所有中老年人的比例相當高。當台灣中老年人口中,
罹患慢性疾病比例逐漸提高的情況下,其心理健康亦必須被重視和值得探討。
本研究採衛生福利部的「中老年身心社會生活狀況長期追蹤調查」1989 年 到 2003 年資料,並以 difference-in-differences 模型分析全民健康保險對慢性病中 老年人的快樂是否有顯著的影響。分析結果顯示全民健康保險實施後,慢性病中 老年人的快樂沒有顯著的受政策影響。其他會影響慢性病中老年人快樂的重要因 素有年齡、教育年數、年所得、飲酒、擁有資產和日常活動能力。
除了探討全民健康保險對快樂造成的影響,本文還有進行道德風險的分析。
實證結果顯示全民健康保險的實施,會降低慢性病中老年人,抽菸、飲酒和嚼食 檳榔的機率,但是全民健康保險對抽菸、飲酒和嚼食檳榔行為的係數並沒有統計 上的顯著。其他影響慢性病中老年人的不健康行為因素中,性別、居住地區和日 常活動能力對慢性病中老年人的抽菸、飲酒和嚼食檳榔有統計上的顯著。
本研究的分析結果顯示,全民健康保險對慢性病中老年人的快樂和道德風險 並沒有顯著影響,造成不顯著的原因包含樣本的人數過少外,以及在資料的處理 上僅能從每年的問卷問項中選取相同或相近的問題衡量慢性病中老年人的快樂 和生活滿意度,藉此解決每年問卷內容不一致的問題。例如,在五波 CES-D 憂 鬱量表中,1989 年有 17 題問項,1993 年有 11 題,1996 年、1999 年和 2003 年 各有 10 題,所以本研究在各年度取 10 題相同或相近的問項來分析慢性病中老年 人的快樂。此外,在五波生活滿意度量表中,1989 年有 10 題問項,1993 年有 4 題,1996 年有 10 題,1999 年有 12 題和 2003 年有 12 題,因此僅能在各年度取 4 題相同或相似的生活滿意度問項做衡量。這可能導致本研究僅能衡量到部分慢
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性病中老年人的快樂和生活滿意度的面向。最後,由於本研究所採用的樣本為已 罹患慢性病的中老年人,全民健康保險的實施對快樂的影響可能無法抵銷疾病對 中老年人快樂的負向影響,因此造成實證結果在統計上並不顯著。
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