保險對預防保健服務之影響：全民健保下之婦女抹片檢查

政府於民國八十四年七月起提供三十歲以上婦女每年一次免費抹片檢查，但抹片檢查利用率仍偏低。本文利用國衛院的國民健康訪問調查(NHIS)資料，探討台灣地區婦女在健保之後對抹片篩檢就醫決策的影響因素。結果發現六十歲以上之高齡者、小學教育程度者、未婚及從未有生產經驗者的受檢率顯著較低，有婦科疾病史、曾做過乳房檢查者的受檢率顯著較高；而居住地都市化程度高低和受檢率呈顯著負相關；個人是否有工作、所得高低、居住區域等因素和檢查與否無關聯。意味全民健保制度在婦女抹片檢查服務上已達到除去個人所得財務障礙、提昇醫療服務可近性、降低就醫機會成本等貢獻。
關鍵字：全民健康保險、子宮頸抹片篩檢、子宮頸癌、利用率
The Impact of Insurance on Preventive Health Care Services:
Pap-Smear Test under National Health Insurance
Abstract
The National Health Insurance program provided free annual cervical cancer screening for women above 30 years of age since July 1995. However, the utilization rate of pap-smear test is still low. In this study, we use the survey of national health interview from National Health Research Institutes to investigate the factors which affect the utilization of pap-smear screening under NHI. Generally, women who are above 60 years of age, less educated, unmarried and without birth experience have lower utilization rates, while ever had gynecological disease and had the mammography test have higher utilization rates. The degree of urbanization is significant and negatively related to the screens. Moreover, employment status, income and geographic locations have no impact on the pap-smear test. It means that the implementation of NHI has eliminated the financial barriers, enhanced the accessibility and reduced the opportunity cost of taking pap-smear test.
Keywords: national health insurance; pap-smear test; cervical cancer; utilization rate