兒童固定就醫場所與醫療利用

Regular sources of care and children’s health care utilization

目標：探討兒童的固定就醫場所對門診、急診，以及住院利用的影響。方法：資料來自台灣出生世代調查研究，共有18,845名兒童同時完成6個月至66個月共4次調查，完訪率為88.7％。自變項為兒童在6個月至36個月時分別以診所、醫院為固定就醫場所，以及沒有固定就醫場所3組，依變項為兒童66個月時的醫療利用。結果：63.5％的兒童有固定就醫場所，其中44.7％為診所、18.8％為醫院。父母親教育程度較低、母親為非本國籍、家庭月收入多在3萬元以下的兒童，其沒有固定就醫場所的百分比較高。控制社會人口學特性及健康狀況，以診所為固定就醫場所者門診利用較高，然而，以醫院為固定就醫場所（急診OR＝1.6；住院OR＝1.8）與沒有固定就醫場所（急診OR＝1.2；住院OR＝1.4）其急診及住院情形顯著高於以診所為固定就醫場所者。結論：以診所為固定就醫場所的兒童，其急診、住院利用率顯著低於以醫院為固定就醫場所、或是沒有固定就醫場所的兒童，建議政府宜推出鼓勵相關財務誘因與診所品質資訊透明化的政策，以鼓勵家長選擇診所為固定就醫場所。 Objectives: The aim of this study was to determine the relationship between children's regular sources of care (RSOC) and health care utilization including ambulatory care (AC), emergency services (ES), and hospitalization (HOSP) care in Taiwan. Methods: Data came from the Taiwan Birth Cohort Study. A total of 18,845 children were included. Their parents completed four waves of interview surveys between 6 and 66 months of age, with a response rate of 88.7%. The independent variable was children's RSOC including RSOC in clinics, RSOC in hospitals, and no RSC when the children were 6 to 36-months old, and the dependent variable was medical utilization when the children were 66-months old. Results: A total of 63.5% of the children had a RSOC including 44.7% in clinics and 18.8% in hospitals. Children were less likely to have a RSOC with parents' of lower education, foreign-born mothers, and a household monthly income less than 30,000 NTD dollars. After controlling for children's gender, maternal nationality, socioeconomic characteristics, and health status, children with RSOC in hospital was significantly associated with higher likelihood of ES and HOSP (ES, OR=1.6; HOSP, OR=1.8) as were those who did not have a RSC (ES, OR=1.2; HOSP, OR=1.4), compared with those who did not have a RSOC. Conclusions: Children with RSOC in clinics was significantly associated with lower likelihood of ES and HOSP. This suggests that the government implemented financial incentive and transparency of quality in clinics policies for encouraging parents to use clinics as the RSOC.