台灣民眾對居住於台灣的非本國籍人士使用公共醫療服務之態度及其相關因素

Abstract

研究背景：在如今的全球化時代，國際性的人口遷徙移動是越來越普遍的現象，居住並生活在台灣的人民，也有許多是非本國籍人士。雖然他們只要符合健保法的投保條件，就有資格使用我國健保，但非本國籍人士加入健保之議題仍不時為社會大眾所討論，成為時事焦點，而社會大眾對於醫療照護政策的態度偏好，又可能成為支持或阻礙政策改革的重要因素。國外曾針對此議題探討影響公眾態度的相關因素，發現各國在不同的政策或文化背景之下，有不同的結果，但國內仍缺乏相關文獻，因而對於台灣民眾對居住於台灣的非本國籍人士使用公共醫療服務之態度其相關因素尚不瞭解。 研究目的：瞭解台灣民眾對於居住於台灣的非本國籍人士使用公共醫療服務之態度，並探討其相關因素。 研究方法：本研究以「台灣社會變遷基本調查計畫2011第六期第二次：健康組」作為研究工具，選取於該調查計畫問卷「題目C5a.請問您是否同意住在台灣的每個人，就算沒有台灣的身份證，都應該可以使用公共醫療保健服務(例如：健保)？」選擇「非常同意」、「同意」、「不同意」、「非常不同意」之受訪者為研究對象，分析研究對象對於居住於台灣的非本國籍人士使用公共醫療服務態度之情形，並分析其相關因素，自變項分為社會經濟因素、價值觀、健康相關的狀況等三類；控制變項為個人特質。 研究結果： 1.不同意居住於台灣的非本國籍人士使用公共醫療保健服務者占65.5%；同意者則占34.5%。 2.教育程度、提高健保費的意願、對健康照護系統的滿意度、對健康照護系統的信任度、年齡，皆會影響個人是否同意居住於台灣的非本國籍人士使用公共醫療保健服務之態度。在教育程度方面，國中、高中職、專科以上持同意態度的機會分別為國小(含)以下組的0.561倍、0.673倍與0.464倍。在提高健保費的意願方面，願意提高健保費者持同意態度的機會為不願意提高健保費者的1.590倍。在對健康照護系統的滿意度方面，認為非常滿意或很滿意者持同意態度的機會為不滿意者的1.502倍。在對健康照護系統的信任度方面，信任者、有些信任者持同意態度的機會分別為不信任者的1.494倍與1.405倍。在年齡方面，中年組(40-59歲)與老年組(>60歲) 持同意態度的機會分別年輕組(18-39歲)的0.569倍與0.457倍。 結論：研究結果顯示，不同意居住於台灣的非本國籍人士使用公共醫療保健服務者為大多數。而教育程度較低者、願意提高健保費者、對健康照護系統非常滿意或很滿意者、對健康照護系統有些信任或信任者，以及年齡較輕者，較傾向同意居住於台灣的非本國籍人士使用公共醫療保健服務。建議未來研究可以加入有關政治意識形態、族群或社會脈絡因素等相關變項，探討其對於本議題所持態度的影響以及與其他變項間的相對重要性。 關鍵字：公眾態度、非本國籍人士、非公民、公共醫療服務、台灣社會變遷基本調查計畫

Background: In the era of globalization nowadays, international migration is accelerating and many people who stay or live in Taiwan are not Taiwanese citizens. Although they are eligible to use Taiwan's National Health Insurance as long as they meet the requirements set out by the health insurance law, the discussions on non-citizens enrolling in the National Health Insurance have been brought up from time to time and this topic has now become the center of current affairs. Public preference for health care policies may be an important factor in supporting or hindering a policy reform. Studies found varied results in different countries under various policies or cultural backgrounds, but relevant studies in Taiwan are still lacking. Objective: To understand Taiwanese people’s attitudes toward the use of public health care services by non-citizens living in Taiwan and to explore the relevant factors connected to their perception. Method: This study used the 'Taiwan Social Change Survey 2011, Phase 6, Wave 2: Health Group' as the research base and selected 'Question C5a. Do you agree that everyone living in Taiwan should be able to use public health care services (e.g. National Health Insurance) even if they do not have a national identity card?' from the questionnaire. Those who chose 'strongly agree', 'agree', 'disagree', and 'strongly disagree' were the subjects of this study, and analysis was performed on these people’s attitudes and perceptions on non-citizens living in Taiwan using public healthcare services and the related factors associated with their attitude. Results: 1.Those who disagreed with non-citizens living in Taiwan using public healthcare services accounted for 65.5%; those who agreed accounted for 34.5%. 2.Factors including education level, willingness to increase National Health Insurance premiums, level of satisfaction with the health care system, level of trust in the health care system, and age were related to one's attitude towards non-citizens living in Taiwan using public healthcare services. Respondents with a junior high school, senior high school, or a college degree or above were less likely to agree with the abovementioned statement in comparison to respondents with an elementary school degree (OR=0.561, 0.673, and 0.464, respectively). Those who were willing to increase health insurance premiums were more likely to agree with the statement than those who were unwilling to have increased premiums (OR=1.590). Those who were satisfied with the healthcare system were more likely to agree with non-citizens using healthcare than those who were dissatisfied (OR=1.502). Those who trusted, or somewhat trusted the healthcare system were more likely to agree with non-citizens in Taiwan using the healthcare system than those who did not trust the system (OR= 1.494 and 1.405, respectively). In terms of age, the middle-aged group, aged 40-59, and the elderly group, aged >60, were much less likely to agree with the statement than the younger group, aged 18-59, with the OR being 0.569 and 0.457 respectively. Conclusion: This study showed that most Taiwanese people disagreed that non-citizens living in Taiwan can use public healthcare services. Those who were less educated, willing to increase health insurance premiums, satisfied with the healthcare system, trust the healthcare system or younger people were more likely to agree with non-citizens living in Taiwan using public healthcare services. For further research on this issue, factors such as political ideology, ethnicity, or social context factors can be included in the future. Keywords: public attitudes, non-nationals, non-citizens, public health care services, Taiwan Social Change Survey