Factors Associated with Access to Healthcare for Infertility Problems under Taiwan’s National Health Insurance Program

Factors Associated with Access to Healthcare

for Infertility Problems under Taiwan’s National

Health Insurance Program

Likwang Chen

*

_{Shu-Fang Shih}

**

_{Chen-Li Lin}

***

_{Wei-Chih Yang}

****

Ken-Nan Kuo

*****

Abstract

In Taiwan, there is little study on how many women seek consultation or treatment from the National Health Insurance system and the characteristics

健康促進與衛生教育學報

第 43 期，頁 59-76，2015 年 6 月

Journal of Health Promotion and Health Education No. 43, pp. 59-76, June 2015

* Associate Principal Investigator, Institute of Population Health, National Health Research Institutes, Miaoli Country, Taiwan

** Assistant Professor, Department of Health Promotion and Health Education, School of Education, National Taiwan Normal University, Taipei City, (Corresponding author), E-mail: annsshih@ ntnu.edu.tw

Corresponding address: No. 162, Sec. 1, Heping E. Rd., Da-An Dist., Taipei City 106, Taiwan

*** Deputy Superintendent, and Department Director Department of Obstetrics and Gynecology, Taipei City Hospital, Taipei City, Taiwan

**** Research Assistant, Institute of Population Health, National Health Research Institutes, Miaoli Country, Taiwan

***** Director, Center for Evidence-based Medicine, Taipei Medical University, Taipei City, Taiwan

Manuscript received: May 19, 2015; Revised: June 9, 2015; Accepted: June 30, 2015 DOI: 10.3966/207010632015060043003

60

健康促進

與

衛生教育

學報　第 43 期

of these women so far. Our study aims to estimate the number of women who seek consultation or treatment for infertility, analyzed their comorbidities and investigated the factors that are associated with infertility care seeking in Taiwan. We used the 2005 Longitudinal Health Insurance Database. Those women who aged between 20 to 49 years old on January 1, 2015 were included in our analysis and the total sample size was 191,917. We identified the infertility cases using the ICD9-CM 628 diagnosed by OB/GYN physicians from outpatient care (CD) and inpatient (DD) claims data. We estimated the number of women who have sought for help due to infertility problems, analyzed their related comorbidities, and used the logistic regression model to investigate the factors associated with the access to healthcare for infertility problems.

The results showed that more than 133,000 Taiwanese women sought consultation and/or treatment for infertility from 2005 to 2009. The top three diseases associated with infertility included disorders of menstruation and other abnormal bleeding from the female genital tract, ovarian dysfunction, and the inflammatory disease of cervix, vagina and vulva. Those who had a higher socioeconomic status were more likely to seek consultation and/or treatments for infertility. There is a pressing need from women who desire to have children in Taiwan in spite of the decreasing fertility rate. Health promotion programs or patient education for women should focus more on reproductive health and prevention of diseases related to infertility or emphasize the importance of healthy behaviours for reproductive health. More research on investigating whether infertile couples have childbirth is suggested.

Key words: access to health care, infertility, National Health Insurance Program, women

　Factors Associated with Access to Healthcare for Infertility

　Problems under Taiwan’s National Health Insurance Program

₇₃

Likwang Chen, Shu-Fang Shih, Chen-Li Lin,

Wei-Chih Yang, Ken-Nan Kuo

References

Chachamovich, J. R., Chachamovich, E., Ezer, H., Fleck, M. P., Knauth, D., & Passos, E. P. (2010). Investigating quality of life and health-related quality of life in infertility: A systematic review. Journal of Psychosomatic Obstetrics and

Gynecology, 31(2), 101-110.

Dill, S. (2002). Consumer perspectives. In E. Vayena, P. J. Rowe, & P. D. Griffin (Eds.),

Current practices and controversies in assisted reproduction: Report of a meeting on “medical, ethical and social aspects of assisted reproduction” (pp. 255-271).

Geneva, Switzerland: World Health Organization.

Domar, A. D., Zuttermeister, P. C., & Friedman, R. (1993). The psychological impact of infertility: A comparison with patients with other medical conditions. Journal of

Psychosomatic Obstetrics and Gynaecology, 14 Suppl, 45-52.

Downey, J., Yingling, S., McKinney, M., Husami, N., Jewelewicz, R., & Maidman, J. (1989). Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation. Fertility and Sterility, 52(3), 425-432.

Fathalla, M. F. (2002). Current challenges in assisted reproduction. In E. Vayena, P. J. Rowe, & P. D. Griffin (Eds.), Current practices and controversies in assisted

reproduction: Report of a meeting on “medical, ethical and social aspects of assisted reproduction” (pp. 3-12). Geneva, Switzerland: World Health

Organization.

Link, P. W., & Darling, C. A. (1986). Couples undergoing treatment for infertility: Dimensions of life satisfaction. Journal of Sex and Marital Therapy, 12(1), 46-59. Mascarenhas, M. N., Flaxman, S. R., Boerma, T., Vanderpoel, S., & Stevens, G. A.

(2012). National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLoS Medicine, 9(12), e1001356. National Health Research Institutes. (2010). Report of findings from the 2005 Taiwan

74

健康促進

與

衛生教育

學報　第 43 期

national health interview survey, No. 1. Taipei, Taiwan: Author.

Schieve, L. A., Wilcox, L. S., Zeitz, J., Jeng, G., Hoffman, D., Brzyski, R., ... Younger, B. (2002). Assessment of outcomes for assisted reproductive technology: Overview of issues and the US experience in establishing a surveillance system. In E. Vayena, P. J. Rowe, & P. D. Griffin (Eds.), Current practices and controversies in

assisted reproduction: Report of a meeting on “medical, ethical and social aspects of assisted reproduction” (pp. 363-376). Geneva, Switzerland: World Health

Organization.

Vayena, E., Rowe, P. J., & Griffin, P. D. (2002). Current practices and controversies in

assisted reproduction: Report of a meeting on “medical, ethical and social aspects of assisted reproduction.” Geneva, Switzerland: World Health Organization.

Zegers-Hochschild, F., Adamson, G. D., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K., ...World Health Organization. (2009). International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertility and

Sterility, 92(5), 1520-1524.

Ziebe, S., & Devroey, P. (2008). Assisted reproductive technologies are an integrated part of national strategies addressing demographic and reproductive challenges.

Human Reproduction Update, 14(6), 583-592.

　Factors Associated with Access to Healthcare for Infertility

　Problems under Taiwan’s National Health Insurance Program

₇₅

Likwang Chen, Shu-Fang Shih, Chen-Li Lin,

Wei-Chih Yang, Ken-Nan Kuo

不 孕 症 婦 女 尋 求 全 民 健 保 醫 療 照 護 之

相 關 因 素 探 討

陳麗光

*

施淑芳

**

林陳立

***

楊惟智

****

郭耿南

*****

摘要

國內目前對於有多少婦女曾經因不孕症困擾而至全民健保體制內尋求諮 詢或治療，以及對於該族群之相關特性並不是非常了解，因此，本研究目標 為了解國內因不孕症困擾而求醫之婦女人數以及其社會人口學特性與相關疾 病。本研究運用2005年全民健保承保抽樣歸人檔進行分析，篩選2005年1月1 日年齡為20～49歲191,917位女性之資料，確認這些婦女是否在2005至2009年 間就醫科別為婦產科，且門診處方、治療明細檔及住院醫療費用清單明細檔 中其任一國際疾病分類號為628之就醫資料，再進行歸人分析。本研究估算曾 因不孕症困擾求醫之婦女人數，並運用羅吉斯迴歸分析法分析與婦女尋求不 孕症醫療之相關因素。 本研究結果顯示，臺灣從2005至2009年間，有133,000位婦女曾被下不孕 症之診斷。與婦女不孕症診斷相關的前三項就診次數最高的婦女疾病為月經 異常病患及其他生殖道之異常出血、卵巢功能障礙、子宮頸、陰道及女陰之 炎症。較高社經地位之婦女比低社經地位之婦女更可能尋求不孕症之治療。 * 國家衛生研究院群體健康科學研究所副研究員 ** 國立臺灣師範大學教育學院健康促進與衛生教育學系助理教授（通訊作 者），E-mail: annsshih@ntnu.edu.tw 通訊地址：臺北市大安區和平東路一段162號，聯絡電話：02-77341698 *** 臺北市立聯合醫院和平婦幼院區醫務長兼部主任 **** 國家衛生研究院群體健康科學研究所研究助理 ***** 臺北醫學大學實證醫學研究中心主任 04-3_施淑芳(英)_p059-076.indd 75 2015/9/9 下午 05:18:50

76

健康促進

與

衛生教育

學報　第 43 期 雖然臺灣生育率很低，但仍有許多婦女曾因不孕症之困擾尋求醫療協助。與 不孕症相關之疾病以月經、卵巢、子宮頸及陰道相關疾病居多，建議未來推 動病人衛生教育或健康促進計畫時，可強化婦女對於不孕症相關疾病之了 解，或強調健康行為影響生育健康之觀念。未來可更深入了解不孕症婦女後 續生育之狀況。 關鍵詞：求醫、不孕症、全民健保制度、婦女 04-3_施淑芳(英)_p059-076.indd 76 2015/9/9 下午 05:18:50