10卷2期

• Link 原著 Original Article
• 農民健康保險對農民醫療消費行為的影響The Impacts of Farmers' Health Insurance on the Demand of Farmers for Health Care
• 江東亮、蘇春蘭
  Tung-Liang Chiang, Cheng-Lan Su
• 無
  Health Insurance ; Accessibility of Health Services ; Health Services Needs and Demand
• 為分析農民健康保險對農民醫療消費行為的影響，本研究立意選取台中縣外埔與新社兩鄉農會會員，於1988年年初進行問卷訪視，共收集201名樣本資料，訪視完成率達50.3%。基本上，外埔與新社兩鄉農會會員的社會人口特性相當接近；最大不同是外埔鄉農會會員必須加入農民健康保險，而89.8%的新社農會會員沒有任何健康保險。本研究利用複迴歸分析方法控制健康狀況和其他重要影響因素後，發現：(1)有健康保險的農民利用西醫門診的可能性以及自服中藥的可能性分別為沒有使康保險農民的2.03倍和1.59倍，但是自服西藥的可能性則為0.69倍；和(2)有健康保險的農民利用西醫門診的次數及自服中藥的天數較沒有使康保險的農民分別顯著增加20.3%和32.2%，但是自服西藥的天數則顯著減少27.5%。根據研究結果，本文進一步探討健康保險對農民醫療行為組合的影響，以及未來的研究與政策方向。
  This study examined the impact of the Farmers' Health Insurance on the use of heatlth services by the farmer. The data for the analysis came from a household interview survey of 201 members from two farmers' associations, Way-Pwu and Shin-Sheh, in Taichung county in early 1988 (response rate of 50.3%). Members of the two farmers' associations were similar in distribution of sociodemographic characteristics, except that Way-Pwu members were compulsorily enrolled in the Farmers' Health Insurance and 89.8% Shin-Sheh members were uninsured. After controlling for health needs and other important factors by using the method of multiple regression analysis, this study found that (1) the insured farmers, compared with the uninsured farmers, were 2.03 times more likely to have at least one physician visit, 1.59 times more likely to be a user of nonprescription herb drugs, and 0.69 times more likely to be a user of nonprescription western drugs; and (2) the insured farmers used 20.3% more physician visits and 32.2% more self-medication days with western drugs than the uninsured farmers. Based on the findings, this paper discussed how health insurance affected the pattern of utilizing different types of health services as well as research and policy implications for Farmers' Health Insurance.
• 79 - 88
• 10.6288/JNPHARC1990-10-02-01

• Link 原著 Original Article
• 健康行為的家族聚集Familial Aggregation of Health Behaviors
• 李瑋珠、楊志良
  Wei-Chu Chie, Chih-Liang Yaung
• 無
  Health Behavior ; Family Relationship ; Family Size ; Urbanization
• 本研究為探討屬於「生活型態」類健康行為的家於聚集性，及都市化程度與家庭結構對此一眾集性的影響，據以作為醫療保健政策與計畫的參考，分別以立意取樣後的分層系統抽樣，在台北縣貢寮鄉貢寮、龍門二村（代表鄉村社區）訪問了核心家庭28戶，擴大家庭26戶；台北縣新莊市頭前、化成二里（代表衛星城市）訪問了核心家庭26戶，擴大家庭19戶；台北市松山區敦厚、六藝二里（代表大都市）訪問了核心家庭31戶，擴大家庭25戶，家中18歲以上一同居住的成人均接受多項健康行為問卷訪問。家族聚集之分析以無母數之Kruskal Wallis檢定及一方分類之變異數分析，分不同都市化程度家庭結構為之。結果發現飲食及鹽份攝取出現較高的家族聚集；此外無論何種都市化程度，「擴大家庭」健康行為的家族聚集性均較「核心家庭」顯著，與理論預測相符；而對核心家庭而言，不同都市化程度之間沒有明顯的差異，對擴大家庭而言；「衛星城市」的家族聚集性最低，「大都市」則最高。本研究討論了此結果的可能原因，並就「家庭」在健康行為上的重要，對醫療保健政策與計畫提出建議。
  The purpose of this study was to investigate the familial aggregation of life styles, the influences of urbanization and family structure, and to give suggestions on health policies according to the results. Purposeful and systematic sampling were used to draw 28 nuclear and 26 extended families in a rural area, 26 nuclear and 19 extended families in a satellite city, plus 31 nuclear and 25 extended families in a metropolitan area. All members over 18 years of age were interviewed. The familial aggregation was analysed with Kruskal-Wallis test and one-way ANOVA. The results showed that: (1) diet and salt-intake behaviors had higher familial aggregation, (2) the tendency of aggregation was higher in the extended families, (3) for the nuclear families there were no differences among different urbanization levels, (4) for the extended families, the aggregation of the satellite city was the lowest, while that of the metropolitan area was the highest. The possible causes are discussed, and some suggestions for health policies are proposed.
• 89 - 97
• 10.6288/JNPHARC1990-10-02-02

• Link 原著 Original Article
• 實際基層醫療保健指數於不同門診之比較A Comparison of the Empirical Primary Care Index among Different Out-Patient Clinics
• 李龍騰、陳慶餘、賴美淑、謝維銓
  Long-Teng Lee, Chiang-Yu Chen, Mei-Shu Lai, Wei-Chuan Hsieh
• 無
  Indexing ; Primary Health Care
• 評估門診基層醫療保健工作程度的方法很多，其中以實際基層醫療保健指數(Empirical Primary Care Index)較為簡單。本研究嘗試以此指數比較台大醫院家庭醫學科、內科、外科普通門診，某公司醫務所綜合門診，與台北縣三芝鄉衛生所等五種不同類型門診實際執行基層醫療保健工作的差異情形。結果發現統計上達顯著水準，其中以三芝鄉衛生所之平均指數最高，與其實際擔負基層醫療保健之功能相符合。 Weiner與Starfield所發展使用之實際基層醫療保健指數使用在國內作為衡量基層醫療保健工作程度的可行性很高，但其適用性基於社會、文化背景之不同，仍須作更進一步的探討。
  There are many methods for the assessment of primary care attainment of office- based clinics, among those the Empirical Primary Care Index is a simpler one. This study applied this index to five different type of clinics: The National Taiwan University Hospital Department of Family Medicine, the Department of Surgery and Internal Medicine, MioLi Health Center of the Chinese Petroleum Company, and the San-Chih Health Station to compare the differences between their primary care attainment. The results showed that there were significantly statistical differences. The San-Chih Health Station had the highest average index and it was consistent with its liability to primary care function. It seems to be promising to apply the Empirical Primary Care Index, developed by Weiner and Starfield, for the evaluation of primary care achievement in this country. It still requires further investigation for its suitability owing to the differences of cultural and social backgrounds between United States and Republic of China.
• 98 - 103
• 10.6288/JNPHARC1990-10-02-03

• Link 原著 Original Article
• 美國芝加哥區養老院病人住院診治費用之分析Components of Hospital Charges for Acute Care of Nursing Home Patients in Chicago, U. S. A.
• 許清曉、許玉麗
  Clement C. S. Hsu, Yui-Li Hsu
• 無
  Cost and Cost Analysis ; Nursing Homes ; Infection ; Complications ; Death
• 吾等於1984年至1985年間在芝加哥一社區教學醫院對326名養老院病人之急診住院做一前瞻性的研究，調查其診斷、治療結果以及各項住院費用。入院天數之中間值為9.5天，住院費用則為7,285美金，而每天費用為813美金。住院費用中房間費佔35%，而8%則花在靜脈注射用抗生素。 住院時有感染之病人(n=194)比無感染者(n=132)住院天數加長兩天，而每天費用則高出22%。在有感染病人當中，發生合併症者之住院費用比無合併症者高出26%；死亡病患之費用比生存病患者高出35%。”不可復甦”之醫囑並沒有減低住院費。欲防止醫院醫療費用之不斷高漲，醫界需要對生命品質極低而成本效益惡劣之病人是否繼續診療之問題訂立適當的指引。
  Hospital charges, clinical features and outcome in 326 nursing home patients admitted for acute care were prospectively studied for 1984 and 1985 at a community teaching hospital in Chicago. The median length of stay was 9.5 days, and the median total hospital charge and charge per day were $7,285 and $813, respectively. The basic room charge accounted for 35% of the total, while antimicrobial therapy accounted for 8% of the charges. Patients with infections (n=194) stayed a median length of 2 days longer and incurred daily charges 22% higher than those for patients in the noninfection group (n=132). For patients with infection, the occurrence of major complications (17.5%) and death (16.5%) were associated with higher per day charges of 26% and 35%, respectively ”Do not resuscitate” orders were not significantly associated with lower hospitalization costs. To control the high cost of hospital care, guidelines are needed for the management of patients in situations where the quality of life is very low and the cost-benefit ratio is minimum.
• 104 - 113
• 10.6288/JNPHARC1990-10-02-04

• Link 原著 Original Article
• 1988年高雄地區登革熱流行與氣候之相關Association between Dengue Outbreak and Weather in Southern Taiwan, 1988
• 盧勝男、陳田柏、 鐘瓊玲
  Sheng-Nan Lu, Tyen-Po Chen, Chung-Ling Chung
• 無
  Dengue ; Precipitation ; Temperature
• 為了解雨量及氣溫對登革熱病例數改變的影響，於民國77年7月1日至11月30日收集高雄醫學院附設醫院急診室每天全部病患和成人發燒病患的病例數，並以成人腹痛病患為對照組，此外從中央氣象局取得同時段每日的雨量和平均氣溫，加以分析。結果發現全部病患和成人發燒病患的每日病例數於9月初起開始增加，而11月下旬逐漸減少。成人發燒病患的每日病例數在下雨後的第18天有顯著增加，而在平均氣溫降至攝氏25度以下後的第五天減少。本研究結果顯示氣候變化可作為日後預估登革熱流行、選擇最佳防治時機、調配醫療資源及評估防治成效的參考。
  To identify the effects of rainfall and temperature on changes of dengue cases, parameters such as numbers of total patients, adults with fever and adults with abdominal pain from Emergency Service of the Kaohsiung Medical College Hospital, daily precipitation and mean temperatures of Kaohsiung City from July 1st to November 30th were analyzed. Using adult cases of abdominal pain as a control, total emergent patients and adult patients with fever increased from the beginning of September and decreased after late November. The adult febrile cases significantly increased at the 18th day after rainy days and decreased from the 5th day after mean temperature less than 25?. Our results indicated that the weather could be used as a reference guide for outbreak prediction, medical care resource allocation during dengue outbreak and evaluation effectiveness of its control.
• 114 - 119
• 10.6288/JNPHARC1990-10-02-05