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1 gacloud@gate.sinica.edu.tw NSC H MY2 2010/7/ /2/16

3 Taiwanese Journal of Sociology, June 2011, 46: Latent Healthcare Utilization Classification and Objective Health Measures Ly-yun CHANG Institute of Siciology, Academia Sinica Meng-li YANG Center for Survey Research, Academia Sinica Jing-yun JHAO Institute of Siciology, Academia Sinica Abstract Health measures sit at the core of health inequality studies. Although objective, medical care utilization is seldom used as a measure of health status because of the unavailability of data and the obscure relationship between medical care utilization and health. A latent profile analysis technique was used to classify medical care utilization, and in turn to investigate the validity of different utilization types as ranked measures of general health. Data were taken from Large Health Insurance Dataset of 2000 (LHID 2000) and the National Health Interview Survey for 2000 (n=923,892). Four membership groups were identified: zero utilization, outpatient visits only, short term hospitalized, and heavy users. Discrepancies between latent types and self-reported health data from a National Health Interview Survey (n=19,732) were noted in terms of age, gender, education, employment status, and income. The validity of classification as a rank order of health status and potential applications are discussed. Keywords: Health measures, health care utilization, health disparities, latent profile analysis

4 210 Dracup, Moser, Eisenberg, Meischke, Alonzo and Braslow 1995; Van der Meer, Van den Bos and Mackenbach 1996; Dunlop, Coyte and McIsaac 2000; Van der Heyden, Demarest, Tafforeau, Van Oyen 2003; Ahmad, Dag and Kurt 2004; Deri 2005; Curtis and MacMinn

5 latent profile analysis latent class cluster analysis finite mixture model Vermunt and Magidson 2002 membership identification Bergner 1985; Bergner and Rothman 1987

6 Activities of Daily Living Katz, Ford, Moskowitz, Jackson and Jaffe 1963 Sickness Impact Profile Bergner, Bobbitt, Carter and Gilson 1981 Nottingham Health Profile Hunt, McEwen and McKenna 1985 SF36 Ware 1988 Physical Performance Test Guralnik, Branch, Cummings and Curb 1989 Health Utility Index Mark III HUI3 Furlong, Feeny, Torrance, Goldsmith, DePauw, Zhu, Denton and Boyle 1998 McHorney 1997; Garratt, Schmidt, Mackintosh and Fitzpatrick 2002; Lindeboom and Van Doorslaer 2004; Terwee, Bot, De Boer, Van der Windt, Knol, Dekker, Bouter and De Vet

7 213 Johnston, Propper and Shields 2009 Krause and Jay 1994; Crossley and Kennedy 2002; Singh- Manoux, Martikainen, Ferrie, Zins, Marmot and Goldberg 2006 Bound 1991 Lindeboom and Van Doorslaer 2004 Culter Lleras-Muney National Health Interview Survey 20 20

8 214 Idler and Benyamini 1997; DeSalvo, Bloser, Reynolds, He and Muntner 2006; Huisman, Lenthe and Mackenbach 2007 Baker, Stabile and Deri 2004; Subramanian and Ertel 2008 Krause and Jay 1994 Leinonen, Heikkinen and Jylhä 1998 Suls, Marco and Tobin 1991 vignettes Baker 2004

9 215 Theory of reasoned action Fishbein and Ajzen 1975 Kleinman, Kunstadter and Gale 1974; Kleinman

10 216 unobserved variable distribution of health levels a unique metric paradoxically % 2000

11 ID ID ID ID ID , % ,040

12 NHIS 2001: 5 19, % %

13 % 45, % % 4.67% 表 1 全民健康保險承保抽樣歸人檔 2001 年樣本與 2001 國民健康訪問調查樣本之各變項描述統計人口變項承保歸人檔健康調查醫療利用指標變項承保歸人檔健康調查 (20.28) (17.73) (14.03) (14.87) % 50.36% % 1.56% 52.37% % 4.67% (4.31) (10.55) (5.38) ( ) ,892 19, ,892 19,588

14 latent class models latent class cluster analysis manifest variable 1 McLachlan and Peel

15 221 DeSarbo, Benedetto, Jedidi and Song 2006 Desarbo, Jedidi and Sinha 2001 Ruto, Garrod and Scarpa 2008 Scarpa and Thiene 2005 Wade, Crosby and Martin BIC Bayes information criterion BIC CAIC consistent Akaike s information criterion Bozdogan 1987 Fraley and Raftery 1998 BIC CAIC log-likelihood BIC CAIC Jedidi, Harsharanjeet and DeSarbo 1997 BIC CAIC Jedidi et al BIC

16 222 BIC BIC 2 表 2 潛在側圖分析之模型適配度 : 承保抽樣歸人檔 2001 年全年就醫紀錄 N=923,892 模型各組所占人數 % Entropy BIC 第一組第二組第三組第四組第五組第六組 R-squared BIC CAIC posterior probability entropy R-squared 1 classification table Vermunt and

17 223 Magidson 2005: % Pastor, Barron, Miller and Davis ,850 86,923 55,746 16,373 表 3 潛在側圖分析模型分組與機率分組交叉表 : 承保抽樣歸人檔 2001 年全年就醫紀錄模型分組機率分組第一組第二組第三組第四組機率分組總和第一組 764, , , (99.80%) (0.18%) (0.00%) (0.03%) (100%) (99.96%) (1.55%) (0.00%) (1.19%) 第二組 0 85, , (0.00%) (100.00%) (0.00%) (0.00%) (100%) (0.00%) ( 98.45%) (0.00%) (0.00%) 第三組 , , (0.07%) (0.00%) (98.74%) (1.18%) (100%) (0.01%) (0.00%) (97.18%) (3.97%) 第四組 , , , (1.39%) (0.00%) (9.06%) (89.55%) (100%) (0.03%) (0.00%) (2.82%) (94.84%) 模型分組人數 764,850 86,923 55,746 16, ,892 1

18 , , % % Q1 75 Q , % Q1 Q , %

19 225 表 4 潛在四組之各項指標與人口變項 : 承保抽樣歸人檔 2001 年全年就醫紀錄零就醫組門診使用組短期住院組重度使用組總和 86, ,850 55,746 16, ,892 (9.41%) (82.79%) (6.03%) (1.77%) (100.00%) (0.000) (11.980) (14.383) (36.065) (14.033) Q Q % 0.00% 24.18% 5.92% 1.56% 0.00% 0.00% 63.19% 62.41% 4.92% (0.000) (0.000) (3.220) (66.373) (10.550) Q Q % 35.02% 65.03% 88.97% 34.49% % 16.78% 40.35% 77.18% 17.69% (0.000) (0.660) (1.150) (1.478) (0.740) Q Q % 35.19% 50.98% 50.19% 42.79% 49.30% (15.931) (19.989) (24.051) (21.600) (20.278) Q Q Q1 25 Q3 75

20 % 55, % 16, % % 62.41%

21 % 35% 65% 89% 0% 16.8% 40.4% 77.2%

22 / / %

23 % Case and Paxson 2005 表 5 門診使用組再依慢性病及七大疾病分組後之門診次數與人口變項分布情形無慢性病七大疾病慢性病及七大疾病總和 480, ,428 16, , ,850 (62.77%) (20.45%) (2.21%) (14.57%) (100.00%) (9.293) (12.100) (10.881) (14.575) (11.980) Q Q Q % 55.16% 49.51% 51.29% 50.98% (16.921) (19.130) (18.965) (16.297) (19.989) Q Q Q Q1 25 Q2 50 Q3 75

24 % *9.29= 表 6 門診使用組中無慢性病也無七大疾病者三等級的門診次數與人口變項分布情形 1-10 次次次總和 305, ,853 24, ,118 (63.71%) (31.21%) (5.07%) (100.00%) (2.753) (4.746) (9.145) (9.293) Q Q Q % 57.64% 54.36% 49.59% (15.840) (17.686) (20.663) (16.921) Q Q Q Q1 25 Q2 50 Q3 75

25 % % %

26 % 17.6% 23.7% 0.8% % 30.5% 25.8% 32.37% 6.12% %- 55% 19%-20% 24%-29.5% 1%

27 233 表年國民健康訪問調查當月就醫資料分類結果 : 依承保抽樣歸人檔 2001 年就醫紀錄檔同月份資料之分析結果零就醫組使用一次使用多次門診組門診組重度使用組總和 11,354 3,443 4, ,588 (57.96%) (17.58%) (23.69%) (0.77%) (100.00%) (0.000) (0.000) (1.786) (4.572) (1.715) Q Q % 0.00% 0.00% 14.67% 0.11% 0.00% 0.00% 0.00% 56.67% 0.43% (0.000) (0.000) (0.000) (6.779) (0.797) Q Q % 46.74% 53.33% 57.34% 40.67% 50.36% (16.561) (18.029) (18.637) (19.225) (17.735) Q1 25 Q

28 234 表 8 行為面的健康分組與主觀自評健康狀況 :2001 年國民健康訪問調查樣本自評健康重度使用組行為面健康分組使用多次使用一次樣本數零就醫組門診組門診組不好 4.09% % % 35.23% % 32.67% 11.48% 5.63% 3.72% 6.12% 普通 0.90% 29.35% % % % 38.00% 40.10% 33.66% 28.75% 32.37% 好 0.36% 21.49% 17.75% % % 12.00% 23.40% 26.05% 26.89% 25.80% 很好 0.37% 16.60% 17.06% 65.98% % 17.33% 25.02% 34.65% 40.65% 35.71% 樣本數 150 4,641 3,443 11,354 19, % 23.69% 17.58% 57.96% % % % % % % 2 (9) = **

29 235 multinomial logistic regression 表 9 行為面的健康分組與主觀自評健康狀況之關係 : 多項式邏輯對數 1 分析零就醫且自評不好使用一次門診且自評不好使用多次門診且自評很好重度使用且自評好或很好 * * (0.106) (0.154) (0.063) (0.333) 0.023*** 0.029*** *** (0.003) (0.005) (0.002) (0.010) *** * 0.033** 0.114* (0.015) (0.021) (0.010) (0.046) ** (0.158) (0.225) (0.103) (0.487) * ** 0.060** (0.034) (0.050) (0.022) (0.100) *** *** *** *** (0.264) (0.395) (0.152) (0.741) N=19,588 * p<.05, ** p<.01, *** p<

30 ***

32 % 50%

33 239 Cutler Lleras-Muney 2006 Johnston 2009 Baker 2004

34 240 附錄 2001 年國民健康訪問調查完訪年月次數分布完訪年月完訪樣本數百分比 , , , ,

35 241 NHIS NHIS : (4): LHID : (2): : (I) SF-36 22(6): Ahmad, Al-Windi, Elmfeldt Dag and Svardsudd Kurt, 2004, The Influence of Sociodemographic Characteristics on Health Care Utilization in a Swedish Municipality. Upsala Journal of Medical Sciences 109: Baker, Michael, Mark Stabile and Catherine Deri, 2004, What Do Self- Reported, Objective, Measures of Health Measure? The Journal of Human Resources 39(4): Bergner, Marilyn et al., 1981, The Sickness Impact Profile: Development

36 242 and Final Revision of a Health Status Measure. Medical Care 19(8): Bergner, Marilyn, 1985, Measurement of Health Status. Medical Care 23(5): Bergner, Marilyn, and Margaret L. Rothman, 1987, Health Status Measures: An Overview and Guide for Selection. Annual Review of Public Health 8: Bound, John, 1991, Self-Reported versus Objective Measures of Health in Retirement Models. The Journal of Human Resources 26(1): Bozdogan, Hamparsum, 1987, Model Selection and Akaike s Information Criteria (AIC): The General Theory and Its Analytical Extensions. Psychometrika 52: Case, Anne C. and Christina Paxson, 2005, Sex Differences in Morbidity and Mortality. Demography 42(2): Crossley, Thomas F. and Steven Kennedy, 2002, The Reliability of Self- Assessed Health Status. Journal of Health Economics 21(4): Curtis, Lori J. and William J. MacMinn, 2008, Health Care Utilization in Canada: Twenty-Five Years of Evidence. Canadian Public Policy 34(1): Cutler, David M. and Adriana Lleras-Muney, 2006, Education and Health: Evaluating Theories and Evidence. NBER Working Paper, No Cambridge, MA: National Bureau of Economic Research. Deri, Catherine, 2005, Social Networks and Health Service Utilization. Journal of Health Economics 24(6): DeSalvo, Karen B. et al., 2006, Mortality Prediction with a Single General

37 243 Self-Rated Health Question: A Meta-Analysis. Journal of General Internal Medicine 21(3): DeSarbo, Wayne S. et al., 2006, Identifying Sources of Heterogeneity for Empirically Deriving Strategic Types: A Constrained Finite-Mixture Structural-Equation Methodology. Management Science 52: DeSarbo, Wayne S., Kamel Jedidi and Indrajit Sinha, 2001, Customer Value Analysis in a Heterogeneous Market. Strategic Management Journal 22: Dracup, Kathleen et al., 1995, Causes of Delay in Seeking Treatment for Heart Attack Symptoms. Social Science & Medicine 40(3): Dunlop, Sheryl, Peter C. Coyte and Warren McIsaac, 2000, Socio-Economic Status and the Utilisation of Physicians Services: Results from the Canadian National Population Health Survey. Social Science & Medicine 51(1): Fishbein, Martin and Icek Ajzen, 1975, Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley Pub. Co. Fraley, C. and A. E. Raftery, 1998, How Many Clusters? Which Clustering Method? Answers via Model-Based Cluster Analysis. Technical Report, No Seattle: Department of Statistics, University of Washington. Furlong, William et al., 1998, Multiplicative Multi-Attribute Utility Function for the Health Utilities Index Mark 3 (HUI3) System: A Technical Report. CHEPA Working Paper Series, No Hamilton, Canada: Centre for Health Economics and Policy Analysis, McMaster University.

38 244 Garratt, Andrew et al., 2002, Quality of Life Measurement: Bibliographic Study of Patient Assessed Health Outcome Measures. British Mesical Journal 324: Guralnik, Jack M. et al., 1989, Physical Performance Measures in Aging Research. The Journal of Gerontology 44(5): M141-M146. Huisman, Martijn, Frank van Lenthe and Johan Mackenbach, 2007, The Predictive Ability of Self-Assessed Health for Mortality in Different Educational Groups. International Journal of Epidemiology 36(6): Hunt, S. M., J. McEwen and S. P. McKenna, 1985, Measuring Health Status: A New Tool for Clinicians and Epidemiologists. The Journal of the Royal College of General Practioners 35: Idler, Ellen L. and Yael Benyamini, 1997, Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies. Journal of Health and Social Behavior 38: Jedidi, Kamel, Harsharanjeet S. Jagpal and Wayne S. DeSarbo, 1997, STEMM: A General Finite Mixture Structural Equation Model. Journal of Classification 13: Johnston, David W., Carol Propper and Michael A. Shields, 2009, Comparing Subjective and Objective Measures of Health: Evidence from Hypertension for the Income/Health Gradient. Journal of Health Economics 28: Katz, Sidney et al., 1963, Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. The Journal of the American Medical Association 185(12):

39 245 Kleinman, Arthur et al., eds., 1974, Medicine in Chinese Cultures: Comparative Studies of Health Care in Chinese and Other Societies. Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health. Kleinman, Arthur, 1980, Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkerley: University of California Press. Krause, Neal M. and Gina M. Jay, 1994, What Do Global Self-Rated Health Items Measure? Medical Care 32(9): Leinonen, Raija, Eino Heikkinen and Marja Jylhä, 1998, Self-Rated Health and Self-Assessed Change in Health in Elderly Men and Women A Five-Year Longitudinal Study. Social Science & Medicine 46(4-5): Lindeboom, Maarten and Eddy van Doorslaer, 2004, Cut-Point Shift and Index Shift in Self-Reported Health. Journal of Health Economics 23(6): McHorney, Colleen A., 1997, Generic Health Measurement: Past Accomplishments and a Measurement Paradigm for the 21st Century. Annals of Internal Medicine 127(8): McLachlan, Geoffrey and David Peel, 2000, Finite Mixture Models. NY: John Wiley & Sons Inc. Pastor, Dena A. et al., 2007, A Latent Profile Analysis of College Students Achievement Goal Orientation. Contemporary Educational Psychology 32: Ruto, Eric, Guy Garrod, and Riccardo Scarpa, 2008, Valuing Animal

40 246 Genetic Resources: A Choice Modeling Application to Indigenous Cattle in Kenya. Agricultural Economics 38: Scarpa, Riccardo and Mara Thiene, 2005, Destination Choice Models for Rock Climbing in the Northeastern Alps: A Latent-Class Approach Based on Intensity of Preferences. Land Economics 81: Singh-Manoux, Archana et al., 2006, What Does Self Rated Health Measure? Results from the British Whitehall II and French Gazel Cohort Studies. Journal of Epidemiology & Community Health 60(4): Subramanian, S. V. and Karen Ertel, 2008, Is the Use of Self-Rated Health Measures to Assess Health Inequalities Misleading? International Journal of Epidemiology 37(6): Suls, Jerry, Christine A. Marco and Sheldon Tobin, 1991, The Role of Temporal Comparison, Social Comparison, and Direct Appraisal in the Elderly s Self-Evaluations of Health. Journal of Applied Social Psychology 21(14): Terwee, Caroline B. et al., 2007, Quality Criteria were Proposed for Measurement Properties of Health Status Questionnaires. Journal of Clinical Epidemiology 60: Van der Heyden, J. H. A. et al., 2003, Socio-Economic Differences in the Utilisation of Health Services in Belgium. Health Policy 65: Van der Meer, Joost B. W., Johannes van den Bos and Johan P. Mackenbach, 1996, Socioeconomic Differences in the Utilization of Health Services in a Dutch Population: The Contribution of Health Status. Health Policy 37: l-18. Vermunt, Jeroen K. and Jay Magidson, 2002, Latent Class Cluster Analysis.

41 247 Pp in Applied Latent Class Analysis, edited by Jacques A. Hagenaars and Allan L. McCutcheon. Cambridge: Cambridge University Press. Vermunt, Jeroen K. and Jay Magidson, 2005, Technical Guide for Latent Gold 4.0: Basic and Advanced. MA: Statistical Innovations Inc. Wade, Tracey D., Ross D. Crosby and Nicholas G. Martin, 2006, Use of Latent Profile Analysis to Identify Eating Disorder Phenotypes in an Adult Australian Twin Cohort. Archives of General Psychiatry 63: Ware, John E., 1988, How to Score the Revised MOS Short-Form Health Scale (SF-36). Boston, MA: The Health Institute, New England Medical Center Hospitals.

Microsoft Word - 136專-1 莫藜藜.doc

Microsoft Word - 136專-1 莫藜藜.doc 全民健康保險實施之社會福利意涵莫藜藜前言民國 101 年 1 月開始, 行政院組織改造中的衛生福利部即將正式運作, 其願景是實踐全人照顧, 並以人為中心之衛生福利服務全民健康保險 ( 以下簡稱全民健保 ) 是衛生福利部主要業務之