收容人求醫行為在加入全民健康保險前後的改變

Abstract

研究背景與目的：監獄收容人是否應納入健保，多年來在國內是個重要的議題，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，此時社會中有許多質疑聲浪出現，例如收容人之保險費由政府全額補助，此作法似乎並非大眾所期望，但加入健保後，收容人需自付醫療費用，是否因而減少就醫次數，降低醫療濫用與費用，則需進一步探討。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，在加入全民健康保險前後的改變，並探討其影響因素。 研究方法： 本研究對象為北部地區某兩所監獄收容人中，經歷過全民健康保險前、後時期者，所採用之測量工具為結構式、自填式問卷；採用Anderson醫療服務利用模式，問卷抽樣方式依監所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。 研究結果： 有效問卷共計1178份，結果發現，監獄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，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。以兩種多變項模型分別探討人口學特性與就醫行為、醫療服務滿意度與自評身體健康程度之相關性，結果發現不同監獄的收容人在就醫行為選擇上有顯著差異，41歲以上、收容前自評身體健康程度為不健康、親屬隔週探望者，較傾向選擇打報告申請看診；不同監獄的收容人其就醫頻率有顯著差異；監獄別在醫療服務滿意程度有顯著差異，納入健保後及50歲以上的滿意程度較佳，收容前自評身體健康程度為普通、不健康及非常不健康的滿意程度較差；監獄別在納入健保前後自評身體健康程度有顯著差異，收容前自評身體健康程度為不健康及非常不健康的收容人，其納入健保前後自評身體健康程度較差。 研究結論： 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，且收容人之健康情形，也獲得實質的改善，此結果可做為相關單位於政策修訂及宣導時參考。

Background and objectives: Whether prisoners should be insured to national health insurance (NHI) or not had been an important issue in Taiwan for several years. Eventually, prisoners were insured as 4th category after the amendment of NHI Act in 2011. But there were several points in dispute about this new policy, one is the premium subsidies to prisoners. Is premium subsidies to prisoners reasonable to ordinary people? In other opinion, prisoners have to pay copayment for doctor visiting. May copayment play a barrier to overuse medical care? Furhter evaluation is needed to see the influence of the policy on prisoners. Method: The study employed self-administered structured questionnaire sampling prisoners who had experienced the period of before and after enrolling in NHI in two prisons in northern Taiwan. Systematic sampling with quota sampling were applied, and SPSS statistic software were used for data analysis. Result: Totally 1178 valid questionnaires were analyzed. Major results revealed that there were more frequent doctor visiting, more percentage of doctor visiting without worry, lower percentage of worrying about medical expense and medical quality, lower percentage of not receiving adequate medical care due to insufficient medical profession, increasing patient satisfaction and higher percentage of good or very good health perception after enrolling in NHI. There were significant difference in help-seeking behavior, frequency of doctor visiting, patient satisfaction and self-perceived health between different prisons. Prisoners who were older than 41 years old, poor health perception prior to their current incarceration and having family visiting every 2 weeks tended to request for doctor visiting. Prisoners who were older than 50 years old, self-perceived as moderate, poor and very poor health prior to their current incarceration had lower patient satisfaction. Prisoners who had self-perceived poor and very poor health prior to their current incarceration had poorer self-perceived perception before and after enrolling in NHI. Conclusion: The quality of medical care in prisons improved after enrolling in NHI. Prisoners had easier access to receive adequate treatment. Besides, there were improvement of patient satisfaction, health status and doctor visiting frequency. Thus, the policy that enrolling prisoners in NHI not only ensured prisoners’ right of medical care, align with the current universal trend, but also improved prisoners’ health status. The results of this study could be a reference for policy adjusting and advocating.