全民健保議題國小學生認知與行為現況分析

The analysis of elementary students’ National Health Insurance knowledge and behavior: Yunlin County as an example

自84年施行全民健保制度後，鑑於國人認知不足，濫用醫療資源導致務虧損，102學年度始將健保納入健康促進學校推動議題，並以珍惜健保概念作為推動主軸。本研究主要調查雲林縣國小六年級學生對全民健保認知與行現況，於104年4月期間透過全縣網路平台機制，針對縣內156所國小學生行問卷施測，共計發放6168份，回收有效問卷5159份，回收率為83.6％。結果顯示，學生認知層面正確率，以全民納保72％及健保資源有限6190得分最高。量能付費23%及自助互助34％得分最低；行為層面執行率以向親友說明全民健保優點72%頻率最高，避免重複就醫45.4％頻率最低，其中女性學生健保認知正確率顯著高於男性學生（p ＜ .001）；以內政部行政區域劃分城鄉地區進行認知與行為變項之單因子變異數分析及Post Hoc推論，認知分佈由高至低依序為鄉區＞鎮區＞市區（p＜ .001），行為層面則無顯著差異研究歸納雲林縣國小六年級學生在健保認知及珍惜行為均較不足，又以市區學校或男性學生更待加強。建議未來各校應確實推廣健保教育，並參照健康促進學校六大策略作整體規劃策略，使珍視健保概念確實自國民教育扎根，讓健保制度得以永續經營。

Taiwan government has implemented the National Health Insurance (NHI) since 1995. Owing to people's lack of health insurance knowledge and overuse of medical resources, the Ministry of Education added the issue ＂National Health Insurance＂ to the Health Promoting School in 2013, hoping students can cherish our medical recourses. This study aimed at investigating the six-grade students' knowledge and behaviors of cherish the NHI in elementary schools in Yunlin County. In April 2015, there were totally 156 elementary schools involved in, 6,168 questionnaires delivered, and 5,159 (83.6%) were valid of all. The results showed that 72% students had the knowledge of ＂all nations join the insurance＂ and 61% of ＂medical resources are limited＂, which were the highest in the knowledge dimension. 23% of ＂the ability of payment＂ and 34% of ＂mutual help＂ were the two lowest. In the behavior dimension, it was the highest that 72% students can explain the benefits of the NHI to the family. ＂Can avoid taking medical treatments repeatedly＂ was the lowest (45.5%). After using ANOVA and post Hoc comparison, we found that the knowledge score was rural＞ town＞ city (p＜.001); the behavior score didn't have a significant difference. According to t-test by the gender, the knowledge score of female students was significant higher than male's (p＜.001). To sum up, both respondents' knowledge and behaviors were deficient, especially in cities and male students. We suggest that schools should develop the comprehensive NHI education which connects to the six strategies of health promoting school program and community coalition activity.