臺灣自費醫療使用者的人口特徵與階層化現象

Demographic Characteristics and Stratification of Self-paid Medical Users in Taiwan

全民健保讓絕大多數的臺灣居民享有基本的健康照顧，同時，民眾尚能透過自費醫療的方式，取得更多且更好的醫療服務。然而，此舉讓醫療淪為一種商品，也遭受醫療階層化的批評。遺憾的是，學界對自費醫療使用者的就醫經驗與花費項目並沒有太多深入的分析，也尚未清楚地界定醫療的階層化現象。因此，我們嘗試整理出社會上不同階級的人們對自費醫療的使用，是否有明顯的差別或特定的模式？進一步，也將探討造成這些差別的影響因素與其背後的社會意涵。根據我們分析蒐集資料的結果顯示，使用自費醫療者在性別上並無太大差異，在年齡上以青壯年者居多。在就醫行為的自費部分，使用不給付項目並未存在明顯的階層化現象；但高主觀階級與職業地位中上者會想要升級病床。至於非就醫行為的自費部分，階層化的情形就明顯了：職業地位、教育程度、主觀階級與收入較高者，傾向在健保健檢的基礎上額外自費，甚至參加自費健檢與購買醫療保險；但主觀階級的影響卻不見得與健保健檢相關的兩個變項上有明顯關連。因此，我們或可聲稱，臺灣在自費醫療，尤其非就醫行為的部分，是有階層化現象的。這樣的情況不僅會擴張到就醫行為，更可能加劇醫療商化，導致臺灣民眾的健康不平等更加惡化。

Although basic health care has been provided by Taiwan National Health Insurance (NHI), people still have access to further health care through self-paid medical (SPM). It has made health care a commodity and has been criticized for medical stratification. However, the SPM users' medical experiences and expenditures have not received much attention by academic community in Taiwan, and the medical stratification has not been investigated thoroughly yet. Because of this, we try to figure out if there are significant differences or specific patterns for the users of SPM by different classes, and further to discuss the possible factors and the social implications. According to our data analyses, most of the SPM users are young adults and there is no gender difference among them. For the medical treatment in SPM, there is no stratified difference in the use of the not-in-benefit package, but for those who with higher subjective class and occupational status tend to upgrade their hospital beds. By contrast, for the non-medical treatment in SPM, users' stratification is quite obvious. Users with higher occupational status, education level, subjective class, and income are more likely to pay more for health examination, even participate in self-paid health examination, and purchase medical insurance. Therefore, we argue that Taiwan's SPM, especially true for the part of non-medical treatment, is stratified. Such a situation may not only affect the medical treatment, but also intensify the medical commercialization and worsen health inequality in Taiwan.