矯正機構收容人在加入全民健康保險前後求醫行為的改變

Changes in Prisoners’ Medical Seeking Behaviors before and after Enrollment in National Health Insurance

背景與目的：2011年全民健康保險修正後，矯正機關收容人被納為第四類被保險人，本研究目的在瞭解收容人之求醫行為、醫療滿意度與自評身體健康程度，在加入全民健保前後的改變。方法：以北部地區某兩所監獄收容人中，在服刑期間經歷過全民健保將收容人納保前、後時期者為研究對象，採用研究者自擬結構式、自填式問卷進行抽樣調查。抽樣方式依收容人編號採系統抽樣，輔以定額抽樣法。資料經蒐集、譯碼及登錄建檔後，以SPSS 20.0軟體進行統計分析。結果：自2014年4月至11月調查共回收有效問卷1,178份，收容人在納入健保後，就醫變得較頻繁，無任何就醫顧慮的比例增加，顧慮費用太高與醫療品質不佳的比例降低，不能及時得到適切醫療的比例減少，因醫療專業不足而無法得到適切醫療的比例減少，平均醫療服務滿意度增加，自評身體健康程度為健康或非常健康的比例上升。結論：整體而言，收容人納入健保後，監所內的醫療品質有所提升，收容人較能得到適切的治療，且滿意度及健康皆有所改善，就醫變得較頻繁，可見收容人納入健保，不僅保障其醫療人權，與國際潮流相符，且收容人之健康也獲得改善，此結果可做為相關單位於政策修訂及宣導時參考。

Background and purpose: With the amendment of National Health Insurance (NHI) Act in 2011, prisoners are eligible for NHI coverage as Type D insurants. The study aimed at assessing the changes in prisoners’ medical seeking behaviors, satisfaction with medical care, and selfperceived health status before and after their enrollment in NHI. Methods: The study adopted a self-administered structured questionnaire to survey prisoners who had medical experiences both before and after enrollment in NHI in two prisons in northern Taiwan. Systematic sampling with quota sampling were applied, and SPSS statistic software were used for data analysis. Results: A total of 1178 valid questionnaires were collected from April to November, 2014. Major results revealed an increase after NHI enrollment, in the frequency of seeking medical help, in the number of prisoners free from any worry, in the degree of overall satisfaction with the provided medical service, and in the number of prisoners rating “good” and “very good” in terms of selfperceived health status. The number of prisoners worrying about medical expense and medical quality, as well as that of prisoners in fear of failing to receive proper medical care due to the lack of needed medical specialists, appeared to decline. Conclusion: The quality of medical care in prisons undergoes improvement after the coverage of prisoners in NHI. Prisoners now enjoy easier access to more adequate treatment. In addition, a rise has been observed in the degree of patient satisfaction, their self-perceived health status and the frequency of seeking medical help. It is therefore obvious that rendering prisoners eligible for NHI coverage not only ensures their rights to medical care but also improve their health in general. The study results can be expected to serve as reference for related policyadjustment and advocacy.