全民健康保險制度下之民眾就醫：感冒及慢性病

為了釐清全民健保實施後，醫療費用不斷上升是否受到民眾小病卻愛上大醫院影響，並進一步探討影響民眾選擇就醫層級之因素為何，本文利用九十年國民健康訪問調查之問卷資料，挑選18歲以上曾因感冒或慢性病就醫的樣本，搭配多項式logit模型進行實證分析。研究結果發現，民眾在罹患感冒及慢性病時，並不一定愛上大醫院，上大醫院者確實有部分是因為健康狀況不好。此外，在全民健保實施後，去除了就醫的財務障礙，使得所得對於就醫層級的選擇不具有顯著的影響力，而就醫可近性可能是民眾選擇就醫層級的主要影響因素。
關鍵字：全民健保，就醫層級、多項式logit模型
Health Care Use under National Health Insurance System:
Cold and Chronic Disease
With the implementation of NHI (national health insurance), many people ascribed the rapid increase of medical expenses to that people liked to go to academic hospitals and regional hospitals (so called big hospitals) only for less severe illness. This study uses a multinomial logit model to examine the factors that determine individuals’ choice of medical institutions and to provide some answers. Data were selected from a nationwide questionnaire survey. People of ages over 18 who ever went to hospitals for cold or chronic disease were included. The results show that people do not necessarily like to go to big hospitals when they have less severe illness. Some of those who went to big hospitals did have an unfavorable health condition. Since financial obstacle for medical treatment has been removed after the implementation of NHI, income has no significant influence on the choice of medical institutions. Moreover, medical accessibility may be playing an important role for the choice of medical institutions.
Keywords: NHI, choice of medical institutions, multinomial logit