發展遲緩兒童早期療育醫療資源之利用及其影響因 素分析

發展遲緩兒童早期療育醫療資源之利用及其影響因 素分析

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，期能作為衛生、教育、及社政主管機關制定早期療育政策時參考。

本研究為橫斷性研究，以台灣利用早期療育醫療資源之發展遲緩兒童為研究對象，以 2002 年全民健保資料庫及自行 製作之問卷為研究工具。問卷內容設計以 Anderson 的 The Behavioral Model of Health Service Use 為理論基礎，問卷 共發出 2000 份，回收之有效問卷為 293 份，回收率為 14.65% 。

本研究之主要結果如下：

一、 以 91 年健保資料庫分析顯示，早期療育兒童之平均年齡為 4.44 歲，盛行率為 3.368% 。平均每人全年早期療 育之就醫次數為 4.16 次。男童有 32,963 人，女童有 23,438 人，男性在每筆案件金額上較高，但用藥金額、用藥日 數以女性較高；有重大傷病卡者為 3,388 人，沒有者為 53,013 人，有重大傷病卡者在每筆案件金額、用藥金額及用 藥日數上均較無者高。平均每筆申報案件合計金額為 1607.05 元，用藥日數為 3.3 日，用藥金額為 110.4 元，以層級 別來區分，申報案件數多集中在醫學中心及區域醫院，合計金額以區域醫院為最高，用藥金額及日數以醫學中心為 最高。以權屬別來區分，財團法人醫院之個案為最多，用藥金額及日數也最高。以地區別來區分，台灣北部的個案 最多，每筆申報案件合計金額及用藥金額以台灣中部最高，台灣北部與東部比較，東部地區每筆申報案件用藥金額 及日數低於北部，但每筆申報案件合計金額高於北部。

二、 問卷分析顯示：發展遲緩兒童平均鑑定月齡為 27.45 個月，診斷至開始早期療育之日數為 56.57 日，開始早期 療育之月齡平均為 30.39 個月，平均每周利用早期療育之時數 2.19 小時， 81% 同時接受二種以上之治療項目，以職 能治療最多，其次是語言治療， 60% 接受早期療育相關補助， 64.1% 領有發展遲緩手冊或證明， 29.5% 領有重大 傷病卡，其主要照顧者 84.5% 為母親，外籍母親佔 7.9% ，照顧之困擾因素為缺乏教養資訊較多，對醫院職能及物 理治療師滿意度高於鑑定及目前早療之醫師，對醫院就醫流程耗費時間不滿意者較多。

三、 早期療育之醫療資源利用影響因素：

1. 發展遲緩兒童之主要照顧者教育程度、年齡、國籍、婚姻狀態及家庭收入等，對兒童之鑑定月齡無明顯差異，兒 童具有身心障礙手冊或發展遲緩證明者、有重大傷病者、出生時有缺氧情況或其他缺陷者，在鑑定月齡上會較小。

2. 發展遲緩兒童之主要照顧者教育程度較高者、接受早期療育相關補助者、參加社會支持性團體者、做鑑定後曾收 到鑑定報告書者、除於醫院進行早療也選擇發展中心早期療育者，其兒童利用早期療育之醫療資源時數上較高。

根據研究結果，本研究提出下述建議：一、衛生主管機關修改全民健保之規定，長期就醫之發展遲緩兒童可比照慢 性病患者開立 3-6 個月早期療育慢性治療醫囑，減輕家庭負擔。另兒童預防保健改採固定時程之健康檢查，避免錯 過生長發展遲緩關鍵期。二、政府統整發展遲緩兒童之早期療育補助並加強醫療、社會、教育等機構管理及資源分 配公平。三、制定品質監測制度，定期評估早期療育情況並確保品質及充足之早期療育措施。

Analysis of the Utilization and Relative Factors of Early Intervention Medical Service for

Developmental Delay Children in Taiwan

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The purposes of this study are to understand the utilization of early intervention medical services among developmental delay children and what relativ e factors can influence the utilization for health care, education, and social welfare administration to reference when defining early intervention medica l policies.

This study is a cross-sectional research. The data resources are questionnaires and the year 2002 database of Nation Health Insurance. A total of 2000 s tructured questionnaires are issued to gather data from the main caregivers of developmental delay children. Total 293 copies of the effective question naires are collected. The response rate is 14.65%. The questionnaire is designed according to Anderson’s The Behavioral Model of Health Service Use . The major findings of this study are:

1. According to the year 2002 National Health Insurance Database, the mean age of the developmental delay children is 4.44 years old. The prevalence rate is 3.368%. There are 4.16 early interventions of medical service visits per person-year. There are 32,963 boys and 23,438 girls. The payment per c ase for boys is higher than for girls, but the average pharmaceutical days and expense are both lower for boys. The number of children with catastrophi c card is 3,388. The catastrophic children have utilized more medical services than without catastrophic card’s children. The average pharmaceutical e xpense per visit is NT$110.4. Most cases aggregate in medical centers and regional hospitals. The average expense per visit in regional hospitals is hig her than the case in medical centers and district hospitals. The average pharmaceutical days and expense in medical centers is the highest. Distinguishi ng by the ownership, most of cases aggregate in non-profit proprietary hospitals. Their average pharmaceutical days and expenses also are higher than public hospitals’ and private hospitals’. Distinguishing by locale, most of cases aggregate in hospitals of northern Taiwan. The average expense per vis it and pharmaceutical expense in the central area are higher than the others. The average pharmaceutical days and expense of eastern Taiwan compared with northern Taiwan are lower, but their average expenses are higher than northern Taiwan’s.

2. The questionnaires reveal the following findings. The mean age of developmental evaluation at the first time is 27.45 months. From confirming the diagnosis of developmental delay to early intervention medical service on average takes 56.57 days. The mean age of getting early intervention medica l service is 30.39 months. The children average use early intervention medical service 2.19 hours every week. 81% of them take two types of therapy a t the same period. Most of them receive occupational therapy then speech therapy. 60% of them receive early intervention subsidy. 64.1% of them app ly the developmental delay certification. 29.5% of them get a catastrophic card from National Health Insurance Bureau. 84.5% of the main caregivers are children’ mother. How to take care and educate children bother them the most .

3. The relative factors of early intervention:

There are no significant differences between evaluation age and main caregivers’ education level, age, ethnic group, marital status, or family income.

The children who have developmental delay certification, catastrophic card, cyanosis and defects at birth will utilize medical evaluation younger than others.

There are several factors that will increase the utilization hours of early intervention medical service, such as higher main caregivers’ education level, r eceiving early intervention subsidy, joining the support group, having received evaluation report, also if receiving early intervention from the social w elfare system.

Based on the findings, there are four suggestions: (1) The Department of Health should allow prescribing long term medical orders of early interventio

n to decrease the family burden (give orders for 3 or 6 months). (2) The government shall set up the subsidy rules and policies to distribute resources e

quitably. (3) The government should set up a quality monitoring system to ensure the sufficient supply of quantity and good quality of early interventi

on, and integrate the administration of early interventions among medical, social welfare, education institutions.