台北無家者健康狀況與醫療利用：橫斷式訪問調查

Abstract

在台灣，無家可歸（homelessness）仍是一個尚待深入研究的領域。雖然國外的許多研究已經指出：無家者（people experiencing homelessness, PEH）在醫療保健服務獲得上，面臨著許多障礙；但台灣全民健康保險制度提供了一個獨特的研究機會，在大幅降低了取得醫療服務的財務障礙之後，是否仍存在著其他未知的醫療保健服務取得障礙。本研究旨在探討無家者取得醫療保健服務的公共衛生議題，以橫斷式調查研究探索他們的一般健康狀況和醫療保健利用特性，並與一般社區民眾進行比較。本研究使用信度、效度均已確立之中文化問卷做為測量工具：十二項目健康生活品質短表（Short form-12 items health survey, SF-12）調查和2013年衛福部所設計之國民健康訪問調查問卷。這些問卷由台北地區的成年無家者和年齡、性別頻率配對之社區對照組自行填寫。本研究結果顯示：與社區對照者比較，我們發現就算控制了干擾因素，無家者的一般生理健康仍顯著較差，無家者在過去一年住院的風險也顯著較高。同時無家者在過去三年間接受新冠肺炎疫苗、季節性流感疫苗與免費的癌症篩檢服務也都顯著較少。因此，雖然台灣的全民健康保險給付涵蓋範圍廣泛，大幅降低了醫療保健服務取得的財務障礙，但對無家者而言，仍然存在著其他取得障礙。本調查研究的結果，將為台灣公共衛生當局提供實證，針對無家者等弱勢群體的需求，發展出一套獨特公共衛生政策與介入計劃，並為降低弱勢族群獲取適當醫療服務障礙的全球政策，提供深入見解。

Homelessness in Taiwan is an under-investigated research field. While studies in other countries have demonstrated that people experiencing homelessness (PEH) face barriers to accessing healthcare, Taiwan’s universal healthcare system provides a unique opportunity to study barriers to accessing care when healthcare is almost completely financially covered. The following study aims to establish that homelessness is a public health issue, investigating the health status and healthcare utilization of people experiencing homelessness compared to the general Taiwanese population. A 24-item cross-sectional survey was administered assessing general health status and healthcare utilization to a target group of people experiencing homelessness in Taipei and a group of counterparts for comparison from the general population. Compared to the community residents, the self-reported physical health of PEH was significantly worse, but their mental health did not differ significantly. PEH were more likely to have been hospitalized in the past year than community residents, and less likely to have received any COVID-19 vaccine, seasonal flu vaccine, or a free cancer screening in the past three years. These differences in healthcare utilization patterns under a universal healthcare coverage system suggest that PEH face non-financial barriers to accessing care, especially when the need is not urgent. Further research identifying and addressing barriers to accessing healthcare for people experiencing homelessness is imperative in order to reach true universal healthcare access for all.