智能障礙者全民健康保險中醫門診利用情形

The Utilization of Chinese Medicine Outpatient Service of the National Health Insurance among the People with Intellectual Disability

目的：本研究希望透過探討智能障礙者之中醫門診利用情形，了解智能障礙者在中醫醫療照護的利用情形，提供未來在制定智能障礙者照護及福利時，有一參考依據。方法：本研究使用2008年至2011年全民健保資料庫之承保資料檔、門診處方及治療明細檔、醫事機構基本資料檔等檔案，將主、次診斷依據國際疾病分類ICD-9-CM碼為317至319者，以及就醫科別代碼為60（中醫科）者定義為研究對象，並使用統計軟體SAS9.3版進行分析。結果：本研究樣本2008年至2011年使用中醫之智能障礙者平均每人每年中醫門診就醫次數為6.1至6.2次，平均每人每年中醫門診就醫費用為3,668.5元至3,597.5元，且以女性、年齡越大者、投保地區之中南區業務組，免部分負擔者，其中醫門診利用情形較高。結論：本研究發現研究對象於2008年至2011年使用中醫之智能障礙者，其中醫門診醫療利用情形高於全人口之平均值，因此建議政府及相關單位，在未來制訂與提供智能障礙者相關醫療服務政策與資源規劃時，可參考智能障礙者在中醫門診利用之情形，並能將資源有效管理與利用。

Objective: The purpose of this study was to explore the outpatient utilization of Chinese medicine between people with intellectual disabilities and the general public, and the affecting factors. Methods: This study used the national health insurance (NHI) outpatient claim data of insurers from January 1, 2008, to December 31, 2011. The ambulatory care expenditures by visits data of Chinese medicine department (CM) were selected and analyzed. The Subject with intellectual disabilities was defined as anyone who had a primary, secondary or tertiary diagnosis of ICD-9-CM code 317-319 during at least three outpatient visits, otherwise was defined as the general public. Results: The results showed that from 2008 to 2011, the prevalence of CM among ID were between 24.3%-25.1%, and that of the general public were 32.1%-33.6%. After logistic regression analysis, the factors influencing the use of CM outpatient clinics in this study were gender, age, area insured, amount insured and copayment status. Conclusion: This study found that the outpatient utilization of Chinese medicine of the intellectual disabilities is higher than the general public, the average annual utilization and expenses of the outpatient utilization of CM with the intellectual disabilities are higher than that of the general public. It shows that the Chinese medicine clinic has certainly influence on the choice and utilization of the medical treatment for the intellectual disabilities and its family members.