總額資源缺乏地區民眾利用牙醫改善方案之研究
論 文 摘 要
論文名稱 : 總額資源缺乏地區民眾利用牙醫改善方案之研究 研究所名稱 : 臺北醫學大學醫務管理學研究所
研究生姓名 : 洪素修 指導教授 : 溫信財博士
中央健保局為了改善偏遠山地與離島醫療可近性，推行各項給付提昇及健康保險多元服務方案，在牙醫方面於 2002 年開始推行牙醫總額醫療缺乏地區改善方案，每月依無牙醫鄉分級設定，提供最低保障額度，希望吸引牙醫師至醫 療缺乏地區服務，以提供適當牙醫醫療資源，而本研究目的為比較此改善方案實施前後，牙醫健保門診利用之改變
，並探討影響牙醫健保門診利用的因素。
本研究利用國家衛生院健保資料庫，以參與改善方案一年及二年之山地與平地鄉，在方案實施前一年 (2001 年 10 月 至 2002 年 9 月 ) 及實施後第一年 (2002 年 10 月至 2003 年 9 月 ) 及第二年 (2003 年 10 月至 2004 年 9 月 ) 資料，由牙 醫健保門診利用人數、人次、費用和治療項目的改變，分別以描述性和推論性統計進行資料分析。
結果發現，實施改善方案後，鄉民利用率和每人每年平均利用次數增加，並減少鄉外就診。在鄉內、鄉外牙醫門診 利用人數、人次和費用上，山地及平地鄉之鄉內皆較實施前鄉外提高，唯民眾每人次平均費用比實施前減少。但實 施後第二年利用人數、人次及費用之成長率較第一年低。在治療項目的分析上，山地及平地鄉之鄉內其他治療百分 比偏高，根管治療則偏低，另山地鄉鄉內齲齒填補、口腔外科、牙周病治療及其他治療利用人次及費用，皆比實施 前鄉外顯著提高，唯根管治療無統計差異；而平地鄉鄉內牙周病治療及其他治療，利用人次、費用及每人次平均費 用，亦比實施前鄉外顯著增加。在人口變項的分析上，女性、年齡層 5 歲至 14 歲及 45 歲至 64 歲者有較高牙醫門診 利用。逐步迴歸分析顯示，女性及鄉外看診對利用次數有正向影響， 25 至 44 歲年齡層、有牙周病者、平地鄉鄉民 與方案實施後第二年，對利用次數呈負向影響；另外女性、 25 歲至 64 歲民眾及平地鄉民，每人次平均費用較高，
有牙周病者與方案實施後第二年，對每人次平均費用呈負影響。有趣的是參與方案之山地鄉，即使利用次數成長高 於對照鄉，其費用成長仍較對照鄉低，其中原因有待暸解。
整體來說，牙醫總額醫療缺乏地區改善方案之實施，雖促使牙醫師至偏遠地區執業，提高就醫可近性，但提供之服 務是否符合民眾需求及長期效果如何，值得後續研究深入探討。
The Effect of Taiwan Global Budget Dental Access Program in Dental The Effect of Taiwan Global Budget Dental Access Program in Dental Health
Professional Shortage Areas
Title of Thesis: The Effect of Taiwan Global Budget Dental Access Program in Dental Health Professional Shortage Areas Author: Su-Hsiu Hung
Thesis advised by:Hsyien-Chia Wen PH.D.
With the implementation of the National Health Insurance (NHI) in 1995, the majority of Taiwan people have not dental servi ce access problem, as NHI covered most of the dental service . However, in some rural areas, there are not adequate dental acc ess due to lack of dentist in the regions. To improve dental access of these rural and remote regions, Taiwan bureau of NHI ha s implemented a dental access program under the dental global budget in year 2002. The program has provided a base amount of reimbursement depending on the remoteness of the regions .
The purpose of this study is to evaluate the outcomes of the dental program with administrative changes that conducted in den tal professional deficiency areas’from October 2002 to Seprember 2004. We assessed the intensity and type of utilization of d ental service for one year before the program carried out, compared with one and two years after the launch of the program. T he study data were obtained from the claim data from the Bureau of National Health Insurance to determine service use.
The results revealed providing of the dentalcare had increased the number of persons use dental service , number of dental visi ts, reimbursement fee, but decreased in average per visit fee. The percentage of the population had dental visit and number of visit per person per year also increasd. There were more dental services used in the first year than the second year after the im plementation of the program. The mix in the types of dental services had changed significantly after the program implemented . There were highest percentages of other non-specific treatment, and lowest percentages of endodonntic treatmen t. Female, a ge five to fourteen and fourty five to sixty four residents had higher dental utilization. Female, rural villages(compared with ru ral mountain villages) and age twenty five to sixty four residents had higher per visit fee.
The dental access program has improved dental access and increased dental utilization in these dental professional deficiency areas, especially first year after the implementation of the program. Follow –up studies are needed to determine if the program meet the local residents’ need, and the long term effects of the program on dental access and oral health of the local residents.
