22卷1期

• Link 原著 Original Article
• 無規律性運動中老年人運動介入成效評估研究An Effectiveness Study of Exercise Intervention Among Elderly Adults Without Regular Exercise
• 張蓓貞、吳麗貞、彭淑美
  Rei-Jen Chang, Lee-Chen Wu, Shu-Mni Peng
• 中老年人 ； 運動介入 ； 體適能
  elderly adults ; exercise intervention ; physical fitness
• 無
  Objectives: The purpose of this study was to evaluate the effectiveness of exercise intervention regarding exercise attitudes and physical fitness among elderly adults without regular exercise. Methods: The researchers utilized a quasi-experimental design. The study subjects were elderly adults with the age of 55 to 74 and recruited from the Shihlin district of Taipei. Participants without regular exercise were divided into intervention and non-intervention groups. Subjects in the intervention group attended a 12-week exercise program, while subjects in the non-intervention group did not attend. The measures included a structured questionnaire and physical fitness test. Repeated-measures ANOV A tests were employed to evaluate the impact of exercise intervention. Results: After the 12-week exercise program, the total score of exercise attitude in intervention group was changed from 36.2 to 41.1 (P
• 1-9
• 10.6288/TJPH2003-22-01-01

• Link 原著 Original Article
• 地區剝奪程度、個人社經地位與臺灣男性成人的吸菸行為Area Deprivation, Socioeconomic Status, and Smoking Behavior Among Male Adults in Taiwan
• 李宜家、林慧淳、江東亮
  I-Cha Lee, Huey-Chwen Lin, Tung-Liang Chiang
• 地區剝奪程度 ； 社經地位 ； 吸菸行為
  area deprivation ; socioeconomic status ; smoking behavior
• 目標：分析臺灣男性成人吸菸行為與個人社經地位及地區剝奪程度的關係。方法：個人吸菸行為與社經地位資料來自「一九九四年國民醫療保健調查」，其２０歲以上男性樣本共3821人。我們以「十五至十七不在學率」與「初級行業人口比例」兩成分指標，建構地區剝奪指數；成分指資料來源為「中華民國七十九年臺閩地區戶口及住宅普查報告」。結果：1994年臺灣20以上男性吸菸率為55.6％。就個人社經地位而言，教育程度越低越容易吸菸（勝算比為2.46至3.47，95％信賴區間為2.03至4.37）；藍領階級比高階日領階級容易吸菸（勝算比為1.36，９５％信賴區間為1.09至1.7）。就地區剝奪程度而言，高剝奪地區的性成人吸菸率高於低剝奪地區(1.46，95％信賴區間為1.12至1.90)。結論：地區剝奪程度與個人社經地位臺灣男性成人是否吸菸之重要決定因素。
  Objectives: This study aims to examine differences in smoking behavior among Taiwanese male adults by socioeconomic status and area deprivation. Methods: Data on smoking behavior and individual socioeconomic characteristics came from the” 1994 National Health Interview Survey of Taiwan”. The total sample of males above 20 years old was 3821. By using data from “The 1990 Population Census and Housing of Taiwan- Fukien Area” we developed a deprivation index of area, which consists of the proportion of agricultural labor and the proportion of no schooling 15-17 year olds. Logistic regression was used to determine whether socioeconomic status and area deprivation have a bearing on smoking or not. Results: 55.6% of males were current smokers in Taiwan in 1994. Current smoking was significantly prevalent in low levels of education (OR ranged from 2.46 to 3.47; 95%CI from 2.03 to 4.37); the smoking rate was significantly higher in the blue-collar group than in the white-collar group (OR=I.36; 95% CI=I.09 to 1.70). Area deprivation was also significantly associated with male smoking; those who lived in the highly deprived area had a higher smoking rate than those in the lowly deprived area (OR=1.46; 95%CI=1. 12 to 1.90). Conclusions: Both of area deprivation and socioeconomic status were important in determining the smoking behavior of male adults in Taiwan.
• 10-16
• 10.6288/TJPH2003-22-01-02

• Link 原著 Original Article
• 生活型態與健檢婦女髖骨骨質密度的關係Association Between Lifestyle and Hipbone Mineral Density in Women Participating in Health Checkups
• 韓文蕙、張玨、祁維廉
  Wen-Hui Han, Chueh Chang, Wei-Lain Chi
• 骨質疏鬆 ； 運動 ； 生活型態 ； 骨質密度 ； 橫斷性研究
  osteoporosis ; exercise ; lifestyle ; bone mineral density ; cross-sectional survey
• 目標：本研究之目的在探討生活型態因素與婦女髖骨骨質密度的關係。方法：本研究利用橫斷性研究設計，自2000年9月至2001年4月在台北市某一健檢中心，以骨質密度篩檢(DEXA方法)及自填式問卷調查二種方式收集資料，分析樣本包括313位未停經婦女，及96位頻臨停經或停經婦女。結果：無論停經與否，對婦女而言，年齡均與髖骨骨質密度呈顯著的負相關性。未停經婦女的髖骨骨質密度與身高、體重呈顯著的正相關性，未停經婦女目前有中度運動的其髖骨骨質密度顯著高於稀少運動或輕度運動者；而停經婦女的髖骨骨質密度則僅與身高呈正相關，而與停經年數呈負相關。飲食、吸菸、或飲酒並未顯出對髖骨骨質密度的顯著相關性。結論：雖然橫斷性研究的本質限制了本研究針對研究發現進行因果關係的推論，本研究發現仍支持運動習慣對髖骨骨質密度是有益的；而目前的運動習慣似乎較過去的運動習慣更有助益，且此種助益似乎在未停經婦女的族群中較為明顯。
  Objectives: To investigate the relationship between lifestyle and hipbone mineral density (HBMD) in women. Methods: A cross-sectional study was conducted among 313 pre-menopausal and 96 peri/post-menopausal women who participated in health checkups between Septembers 2000and April 2001. Information on lifestyle and HBMD (gm/cm2) was collected through a self-administered questionnaire and dual-energy X-ray absorptiometry (DEXA), respectively. Results: Age shows an inverse relationship with HBMD in the subjects. Compared with pre-menopausal women with rare or light exercise, women with moderate exercise had higher HBMD. A higher HBMD was also significantly associated with higher body weight and height. For pri / post-menopausal women, HBMD was positively associated with body height, but was negatively associated with number of years since menstruation ceased. Diet, smoking, and alcohol consumption showed no association with HBMD in both groups. Conclusions: Although the cross-sectional design precludes the causal inference between exercise and HBMD, our data tend to support the beneficial effects of recent exercise, a modifiable lifestyle, on HBMD, which seems to be more noticeable in pre-menopausal women than in peri/post-menopausal women.
• 17 - 26
• 10.6288/TJPH2003-22-01-03

• Link 原著 Original Article
• 病人跨區住院與醫療區資源分佈之探討A Study of Cross-Region Admission and the Distribution of Regional Inpatient Care Resources
• 陳珮青、楊銘欽、江東亮、鄭守夏
  Pei-Ching Chen, Ming-Chin Yang, Tung-Liang Chiang, Shou-Hsia Cheng
• 醫療資源 ； 跨區 ； 住院 ； 療區
  health care resources ; cross-region ; inpatient ; medical region
• 目標：本研究旨在分析住院病人之跨區就醫情形與各醫療區內醫療資源分佈之關係。方法：本研究針對評鑑為地區教學以上層級的醫院，選取四種常見疾病的出院病人為研究對象，以電話訪問的方式進行問卷調查，共完訪4,945人。本研究係以病人居住地與其所住醫院是否落於醫療網所定義之相同醫療區，判斷是否為跨區住院，並利用複迴歸分析，檢視病患跨區就醫比例與當地醫療資源之關係。結果：在1999年底，各醫療區間每萬人口西醫師數最高與最低差距2.3倍。四種疾病別的跨區稍有差異，合併計算平均跨區住院比例為13.3%。跨區住院比例最高者為雲林醫療區63.8%，最低為花蓮醫療區2.0%。以逐步複迴歸進行分析發現，跨區住院比例與醫療區每萬人口急性一般病休數、以及醫院評鑑等級等醫療資源有相關。結論：由於跨區住院與醫療資源分布息息相關，對於當地資源相對不足且跨區比例明顯偏高的地區，建議配合第四期醫療網的區域規劃，在政策上給予特別的協助。
  Objectives: This study aimed to analyze the current situation of cross-region admission in Taiwan, and to examine its association with regional health care resources. Methods: Data for the analysis was taken from a survey of patients discharged from teaching hospitals with four selected diagnoses: stroke, diabetes, Cesarean Section, and appendectomy. A total of 4,945 persons were successfully interviewed via telephone. Cross-region was identified when the patients' residential region differed from that of the hospital he/she was admitted to, Multiple regression models were employed to examine the association between cross-region admission and regional health care resources. Results: In 1999, the physician (and acute care ward) population ratio of the most abundant region was 2.3 times of that of the poorest region. The cross-region admission rates in the four conditions varied. The overall proportion of cross-region admissions was 13.3% nationwide with the highest proportion in Yun-lin region (63.8%) and the lowest one in Hua-lian region (2%). Results from multiple regression analyses showed that acute care ward population ratios and having higher accredited hospitals were the major factors associated with the proportion of cross region admission. Conclusions: Cross-region admission is associated with the abundance of regional inpatient care resources. The study suggests that the government may need to provide special assistance to regions with very high rate of cross-region admission in the 4th Medical Care Network Program.
• 27 - 32
• 10.6288/TJPH2003-22-01-04

• Link 原著 Original Article
• 醫療消費者及醫療提供者對全民健保新制門診藥品部分負擔的認知；態度及行為之研究The Perception, Attitude, and Behavior of Health Services Consumers and Providers Under National Health Insurance Outpatient Prescription Drug Co-Payment Program in Taiwan
• 林惠雯、薛亞聖
  Hui-Wen Lin, Ya-Seng Hsueh
• 門診藥品；部分負擔；健康保險；使用者付費
  outpatient prescription drugs ; co-payment ; health insurance ; user charge
• 目標：瞭解民國88年實施新制門診藥品部分負擔之後，民眾及醫師對此制度之認知、態度及行為，並比較民眾與醫師兩者意見之差異。方法：分別以台灣地區就醫民眾及有執業之西醫師(不含牙醫)為研究對象，經隨機抽樣分別進行電訪及郵寄問卷調查。就醫民眾電訪完成有效問卷946份，醫師部分隨機抽取4,113位醫師為樣本，最後得有效問卷688份(回收率16.7%)。經適合度檢定，就醫民眾問卷與健保局投保人口分佈無顯著差異，樣本具代表性。結果：就醫民眾調查結果，新制部份負擔實施近1年半，尚部分負擔；約七成的就醫民眾可以接受看門診拿藥要付藥品的民眾只有4.6%。醫師調查結果，多數醫師(85.5%)對門診藥品部分負擔表示支持的能度；有89.4%認為藥品浪費嚴重；61.1%醫師會受門診藥品部分負擔的影響而建議病人減少用藥。結論：就醫民眾普遍認為藥品浪費嚴重，並能接受新制藥品項部分負擔制度。雖然就醫民眾在認知、態度上支持新制部分負擔，但是對減少就醫、拿藥的效果卻不高，反而是醫師自認愛影響的比率較高，可見部分負擔雖然是作用在民眾身上，但是影響較深的卻是醫師。
  Objectives: The purpose of this research is to understand the perception, attitude and behavior of patients and health care providers under the new Outpatient Prescription Drugs Co-payment policy of the National Health Insurance (NHI) Program. Methods: This research uses two sources of data. One is a nation-wide random sampling telephone interview with CA TI (Computer aided telephone interview) system for the patients. The other set of data is from a random sampling survey with self-administered questionnaire. We got 946 valid respondents by telephone interview. The response rate is 16.7% for the physicians. Results: There is still one-fifth of patients who don't know this new policy. There are about 70% of patients who can accept this policy. 60%patients consider that waste of drug is serious. Only 4.56% patients have asked physicians to prescribe fewer drugs, and 11.57% reported they have made fewer visits to the doctors. Regarding whether physicians will change prescriptions pattern because of the new outpatient prescription co-payment policy, 61.1 % physicians reported they tended to suggest fewer drugs. Conclusion: Most patients can accept this policy but few of them will reduce visiting doctors and buy less drugs. Therefore, outpatient prescription co-payment policy influences physicians more than patients.
• 33 - 42
• 10.6288/TJPH2003-22-01-05

• Link 原著 Original Article
• 最佳適合保險費率模式之建立及推估未來15年全民健保財務收支Establishing Optimum Premium Prediction Model and National HealthinSurance Financial Revenue and Expenditure
• 蘇喜、蕭世槐、莊逸洲
  Syi Su, Shih-Huai Hsiao, Yi-Chow Tsung
• 全民健康保險 ； 費率 ； 醫療費用支出估
  Health Insurance ; Premium ; Medical Expense ; Predication
• 目標：本研究以全民健保實施以來之經驗資料，根據經驗及文獻資料建立醫療費用支出及保費精算樣式，並根據經驗資料配合各項精算假設，利用此模型在各項精假設，利用此模型在各項假設組合之下精算未來15年全民健康醫療支出與保費費率。方法：本研究為一橫斷性研究，以全民健保自實施以來之經驗資料，經由支出面詳細分析其各年齡別及性別之住院利用、手術利用、急診利用、中醫、西醫、牙醫門診利用模式等，並以人口成長趨勢作為以上各種醫療費用支出及保費收入之客觀估計。結果：根據本研究結果，醫療總支出在2001年達到3,568億元，健保費率將在2005年達到法定之6%上限。在各項影響因素中，以利用率變化之影響最大。以平均眷口數0.88人、醫療費用成長率為10%為例：在利用率成長為2%時，2003年即可超過法定上限。結論：本研究於受限於以1996、1997年全民健康保險醫療利用資料來推論未來15年的健保費率與醫療費用支出，本研究預估之準確性可能會受到中央健保局是否採取能抑制利用率上升各類措施及民眾就醫行為改變之影響，此部份之準確性仍待時間的驗證。惟本研究以各年齡別及性別之住院利用、手術利用、急診利用、中醫、西醫、牙醫門診利用率等六個因素所建立之費率與醫療費用支出預測模型，可提供相關單位依據實際所需，擬定各種不同的假設後，投入該模式，即可推算出未來收支及保險費率，此為該模式最大貢獻。
  Objective: This study set up the actuarial model to estimate the reasonable annual premium rates within fifteen years from 200 I, based on the assumptions according to several empirical experiences and references. Method: This is a cross-sectional study. The premium and medical expense models were established by incorporating the empirical data such as inpatient care, surgical operation services, outpatient care, ambulatory care, Chinese herb medicine, dentistry, and several assumptions under adjusted gender and age, and population growth trend. Result: The result showed that the total medical expenditure would be over 356.8 billion NTD in 2001 and the premium rate would exceed the 6%,according to the criteria of adjustment of premium rate empowered by the National Health Insurance Law, in 2005. Besides the average number of dependents is assumed to be 0.88 from March, 1998Law, in 2005. Besides the average number of dependents is assumed to be 0.88 from March, 1998onward, health care expenditure increases at rates 10%, the premium rate would exceed 6% in 2003.Conclusion: The research has covered two years' empirical data since the implementation of the National Health Insurance Program, the precision rate of predicting premium rate and medical expense in 15 years from 2001 may be effected by the NHl's medical expense control approaches and changing of people's utilization behaviors. It still needs some time to improve. In brief, the contribution of the prediction model of premium and medical expense models could provide to calculate the medical expenses and receipts based on different assumptions by administration unit and researcher. (Taiwan J Public Health.
• 43 - 54
• 10.6288/TJPH2003-22-01-06

• Link 原著 Original Article
• 醫院員工對薪酬公平的認知與其工作態度關係之探討Relationship Between Hospital Employees' Perception of Compensation Equity and Work Attitudes
• 黃仲毅、黃國哲、湯澡薰、楊銘欽、楊哲銘、張維容、張蕙芝
  Chung-I Huang, Kuo-Cherh Huang, Chao-Hsiun Tang, Ming-Chin Yang, Che-Ming Yang, Wei-Jung Chang, Hui-Chih Chang
• 薪酬公平認知 ； 工作態度 ； 醫院員工
  ?rerceptlOn oJ compensation equity?;?Work attitude?;?Hospital employee
• 目標：以往研究已證實薪酬在員工的心目中極為重要。醫療服務業是個就生產投入及產品輸出方面而言，有其獨特性的產業。就醫療院所而言，員工間薪酬差異頗大，例如醫師和行政人員間之薪酬差異可能達數十倍之多；就薪酬管理的內部公平來看，可能使員工對薪酬的公平性認知有所質疑，進而影響其工作態度。本研究的目的係在探討醫院員工對薪酬公平的認知，及其工作態度間的關係，且特別注重在不同類別員醫檢人員、藥事人員、及行政人員等五類員工。以結構式問卷採普查方式進行調查，共發出問卷2,000份，回收之有效問卷1,286份，回收率達64.3%。然而資料檔建立及重整後發現，因醫師之回收率僅有30%(發出321份問卷，回收97份)，且經卡方檢定後發現回覆之樣本醫師無法代表母群體醫師，故將醫師剔除，僅針對護理人員、醫檢人員、藥事人員、及行政人員等四類員工做進一步的統計分析。最後之有效樣本數為1,189，回收率為62.5%。重整之資料進一步以SPSS10.0統計軟體進行統計分析，使用之統計方法包括描述性統計、單因子變異數分析、相關分析、及逐步複迴歸分析等。結果：薪酬制度的公平性認知受到薪酬制度本身健全與否、年齡、教育程度、婚姻狀況、工作部門、本院年資、職務別、及對薪酬公平認知程度的顯著影響。在控制員工個人因素及薪酬制度本身因素後，分析結果顯示員工對薪酬公平的認知程度，對其工作滿意等之工作態度評值也較低。擔任主管職務的醫院員工相較於非主管職務的員工而言，對薪酬制度公平性的認可程度較高，其工作態度的評值也較高。結論：實證結果顯示不同的醫院員工因素(如年齡、工作部門、職務別等)，對員工的薪酬公平認知程度及其工作態度有顯著的顯響力，另一方面，員工的工作態度亦受到其對薪酬公平的認知程度之影響。研究結果應對醫院經營管理階層及人事主管，在薪酬制度的制定上有所助益。
  Objectives: Compensation is widely acknowledged as an important feature of a job in the eyes of employees. Health care is a special industry in which compensation among employees differs greatly. The difference in compensation has an impact on employees' perception of job equity which may influence their work attitude and the quality of care provided. This study aimed to examine the relationship between hospital employees' perception of compensation equity and their work attitude. Methods: The study poulation included employees from one private regional teaching hospital and one municipal hospital in Taipei City. A structured questionnaire was sent to of 2,000 questionnaires were distributed with 1,286 questionnaires being returned; an overall response rate of 64. of 2,000 questionnaires were distributed with 1,286 questionnaires being returned; an overall response rate of 64. 3%. The response rate of physicians was only 30%(97/321), and the result of Chi-square test indicated that the responding physicians could not represent the study population of physicians. As a result, physicians were not included in follow-up statistical analyses. The final sample size was 1,189, and the response rate was 62.5%.Descriotive statistics, ANOV A, correlation analysis, and multiple regression analysis were used in data analysis. Results: The results indicated that hospital employees' perception of compensation equity varies significantly according to personal characteristics, such as age and specialty. The design of the compensation system also has effects on employees' perception of compensation equity. Employees' work attitude differs by personal characteristics as welt Controlling for personal characteristics and the design of the compensation system, employees' work attitude was found significantly positively related to their perception of compensation equity. Compared to administrative staff, nurses had a more negative perception of compensation e9uity and worse work attitudes. Being a supervisor exerted positive influences on employees’ perception of compensation equity and work attitude. Conclusions: Employees' work attitude was influenced by their perception of compensation eqlity, along with personal characteristics such as age and specialty. With this understanding, hospital administrators can design a more acceptable compensation system that will produce satisfactory and productive employees. Consequently, the quality of care provided and the health of people in Taiwan would be improved.
• 55 - 68
• 10.6288/TJPH2003-22-01-07

• Link 原著 Original Article
• 論病例計酬實施前後全股（髖）關節置換術病患出院後30日內的再住院情形The Changes in Readmission Rate Within 30 Days After Total Hip Replacement before and After the Implementation of a Case-Based Prospective Payment System
• 簡麗年、吳肖琪
  Li-Nien Chien, Shiao-Chi Wu
• 全股（髖）關節置換術 ； 論病例計酬 ； 醫療品質 ； 再住院
  THR(Total hip replacement) ; CPS(Case Payment System) ; medical quality ; readmissionrate
• 目標：探論病例計酬實施後，全股(髖)關節置換術病患出院後30日內再住院的變化情形，及相關因素。方法：全股(髖)關節置換手術於民國86年11月實施論病例計酬支付制度，研究利用全國性健保申報次級資料，以86年1月至10月(實施前，2,550人次)與87年1月至89年11月(實施後，人11,884人次)進行單側置換者為研究對象。結果：論病例計酬實施前，病患30日內的再住院為每百人10.08人次，實施後為11.29人次，無統計上顯著增加。進一步以迴歸分析控制其他干擾因子後，發現制度實施後30日內的再住院顯著增加(OR=1.31)。其他相關因子方面，男性、年齡愈大、疾病嚴重度嚴重高者，發生機率愈高。位在東部地區、權屬別為公立、評鑑等級別為地區醫院、年服務量低的醫院與醫師，其病患發生再住院的危險性也較高。病患住院日愈長、住院期間發生併發症，30日內的再住院率較高，而住院期復健治療次數愈多反而愈低。結論：論病例計酬實施後，30日內的再住院率有顯著增加，相關單位在費用控制下應致力維持民眾就醫品質，如加強低服務量醫院與醫師品質監控，以減少病患出院後再住院的發生。
  Objectives: The goals of this study are to investigate the changes in readmission rate within30-day of THR (Total hip replacement) before and after the implementation of CPS (Case Payment System) and its related factors. Methods: The Bureau of National Health Insurance implemented the case payment for THR in November 1997. The outcome was analyzed according to the claimed database of national health insurance data of 2,550 patients with THR before CPS (from Jan 1997to Oct 1997), and 11,884 patients with THR after CPS (from Jan 1998 to Nov 2000). Results: The30-day readmission rates were 10.08% and 11.29% before and after CPS implementation. According to the logistic regression model, 30-day readmission rate increased significantly after the implementation of CPS (OR= 1.31). This study revealed that being male, older; having more seventy, LOS (length of stay) and in-hospital complications were found to be positively and significantly related to the 3D-day readmission rate after THR. However it was negatively influenced by the medical centers, hospital and physician volume, and inpatient rehabilitation. Conclusion: The study found that the 3D-day readmission rate significantly increased after implementing CPS. This effect should be noted. It is important to maintain medical quality when cost-control mechanisms are implemented. For example, NHI should monitor medical quality of hospitals and physicians with lower volumes.
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• 10.6288/TJPH2003-22-01-08