| 摘要: | 研究背景：
台灣人口快速老化，為更有效率分配有限的健保資源，須深入了解老年人口的醫療需求與如何使用健保資源。
研究目的：
(1)描述台灣老年人口使用全民健保的現況。
(2)利用Apriori演算法探討老年人口慢性疾病與年齡、性別及生活圈的關聯性。
研究方法：
(1)研究母體為2010年台灣65歲以上人口，本研究以隨機抽樣方式自國衛局所提供之「全民健康保險學術資料庫」抽取1,239,836位老人於2010/1/1至12/31使用全民健保的門診資料 (樣本數佔台灣全體65歲以上人口的50%)，研究變項包含: 年齡、性別、地區、生活圈、醫療層級、疾病、就診次數與金額。
(2)利用Apriori演算法分析老年人口六大慢性疾病關聯性。
研究結果：
(1)2010年台灣65歲以上老人平均就診次數為28.54次，比2010年全體國民來得高(14.59次)。
(2)生活圈中，離島的平均就診次數(34.38次)為最高，但其申請健保費用為最低。
(3)老年人前三大罹患疾病：自發性高血壓(6.67%)、糖尿病(5.80%)與急性上呼吸道感染(3.76%)。
(4)高血壓盛行率為六大慢性疾病之冠，其分別盛行率：年齡為75至 84歲最高(60.26%)，性別為女性最高(57.82%)，生活圈為離島最高(60.31%)。
(5)心臟疾病、腦血管疾病與腎臟疾病，這三種慢性病都隨著年齡盛行率逐漸升高，提醒民眾心臟疾病、腦血管疾病與腎臟疾病保護應從年輕做起。
(6)本關聯規則顯示高血壓與六大死因中其他慢性病有密切相關，有心臟疾病、腦血管疾病、糖尿病、肝臟病變及腎臟病變。
研究結論：
整體而言，台灣老年人口使用醫療資源較全體國民頻繁，且隨著年齡增加，老年人口對於醫療資源需求也會越來越高，尤其在循環與骨骼肌肉系統這兩大疾病系統分類為高峰。從健保支出方面，申請健保給付費用隨著年齡上升而逐漸增加，80至84歲達到最頂點
就地理區位而言，台北地區、中部地區是申請健保給付相對較多的區域
以生活圈來看，都會與一般生活圈的申請健保給付費部分比離島高上許多。醫療機構的決策者可參考此研究結果，可以進行未來財務預算規畫或醫療資源的分配。
BACKGROUND: The population of Taiwan is aging rapidly. To efficiently allocate limited health care resources, it is important to have a comprehensive understanding of the health care needs of the older population in Taiwan.
OBJECTIVE: (1) To describe the patterns of older people’s use of health care services in Taiwan under the National Health Insurance (NHI) program, and (2) to examine associations between chronic medical conditions and socio-demographic characteristics (i.e., age, gender and life style) among older population in Taiwan using Apriori algorithm.
METHODS: (1) The study population was defined as people aged 65 years and older in Taiwan in 2010. This study utilized a random sample from the National Health Insurance Research Database provided by the National Health Research Institutes, sampling information of using the NHI from 1,231,897 elderly people (the sample was 50% of elderly population over 65 years old in Taiwan) from January 1, 2010 to December 31, 2010. The variables of our experiment including age, gender, region, life circles, medical level, disease, clinic visits and cost. (2) Applying apriori algorithm to investigate the relevance of the six major chronic diseases of elderly population.
RESULTS: In 2010, (1) the average number of visits of elderly population is 28.54 times, which is higher than the average number of visits of all citizens (14.59 times). (2) Among all life circles, the average number of visits of off-shore island life circles (34.38 times) was the highest, but the application fee for health insurance of off-shore island life circles was the lowest. (3) The first three major disease of elderly population were: Spontaneously Hypertensive (6.67%), Diabetes (5.80%), and Acute Upper Respir Tract Infection (3.76%). (4) The prevalence of hypertension was the highest of the six major chronic diseases. For those between 75 and 84 years old has the highest prevalence of hypertension (60.26%), the prevalence of hypertension of females was higher than that of males (57.82%), and the off-shore island life circles has the highest prevalence of hypertension among others (60.31%).
(5) The prevalence of heart disease, cerebrovascular disease and renal disease were gradually increased with age. People should prevent heart disease, cerebrovascular disease and renal disease as soon as possible.(6) The association rules showed that hypertension was highly associated with other five chronic diseases, including heart disease, cerebrovascular disease, diabetes, liver disease and renal disease.
CONCLUSIONS: In Taiwan, the utilization of medical resources of older population was more frequently than all citizens, and was gradually increased with age. The demand of medical resources of older population was much higher, especially in circulation and musculoskeletal system. In terms of medical expenditure, application fee of NHI gradually increased with age, and reached a peak at age between 80 and 84. In terms of geographical regions, application fee of NHI is relatively higher in the Taipei and the Central region. In life styles, application fee of NHI of the metropolitan and the general life circles were much higher than the off-shore island. Decision makers of medical institutions can utilize the research results of this study to improve future budget planning and allocation of health care resources. |
