目標：本研究旨在分析高屏地區外籍人士健保加保及醫療利用情形及其影響因素。
方法：本研究採次級資料分析，以中央健康保險局2004年至2007年共119,100人為主要研究對象。利用敘述性統計描述外籍人士健保狀態及醫療利用情況，利用t檢定探討醫療費用和個人特質的差異，如人口學特性、國籍別與保費負擔等。並應用迴歸分析，以羅吉斯迴歸來推估是否使用醫療（包括門診和住院）之機率，以複迴歸預測使用者之醫療費用及就醫次數。
結果：研究對象以21至40歲、女性、有固定工作（於第一類投保單位加保）者居多、收入（投保金額）偏低、工作危險性高、因生產及相關疾病就醫者佔多數。
羅吉斯迴歸結果顯示，男性使用醫療、門診和住院服務的勝算比較女性為低（整體利用勝算比0.636，信賴區間0.616-0.657；門診利用勝算比0.634，信賴區間0.614-0.655；住院利用勝算比0.804，信賴區間0.757-0.853）；來自大陸港澳地區者使用住院醫療的勝算比較其他國籍者為高（勝算比1.184，信賴區間1.124-1.246）、加保時間2-3年者使用醫療和門診服務的勝算比較1年以下者為高（整體利用勝算比5.873，信賴區間5.636-6.119；門診利用勝算比5.886，信賴區間5.649-6.134）、加保時間在3年以上者使用住院醫療的機率是1年以下者的5倍以上（勝算比5.017，信賴區間4.664-5.398）、以第五類低收入被保險人身分加保者使用住院醫療的機率是有固定工作的第一類保險對象的8倍以上（；勝算比8.941，信賴區間5.589-14.305）。
複迴歸分析發現加保期間愈長、來自大陸港澳地區及具有重大傷病的外籍人士，會有顯著較高的門診和住院就醫次數，醫療費用亦相形較高。
結論：性別、年齡、國籍、保險類目、投保身分、投保金額、是否具重大傷病或職業傷病等是影響高屏地區外籍人士醫療利用的因素。建議未來的研究者可再輔以問卷以獲得更完整的相關影響因素，並持續追蹤外籍人士的醫療利用和健康狀態，提供決策者規劃公共衛生措施之參考。

Objectives: The purpose of this study was to analyze the health insurance status and medical utilization and its related factors for foreigners at Kaohsiung-Pingtung area in Taiwan.

Methods: The study used secondary data to attain the research purposes. Data from Bureau of National Health Insurance Kao-Ping Branch between 2004 to 2007 were used. A total of 119,100 cases were analyzed. Descriptive analysis was used to examine foreigners’ health insurance and medical utilization. T -test was used to investigate the differences between medical utilization and personal characteristics, such as demography, nationality and insured payrolls. Regression analysis was applied. Logistic regression was employed to examine whether the foreigners used the services both from inpatients or outpatients. Multiple regressions were applied to predict the medical expenditures and times.

Results: Most of cases were aged from 21 to 40, females, category 1 insured, low income, dangerous work and seeking medical care for pregnancy and maternity care. The results from logistic regression revealed that males had lower odds to use medical care (OR=0.636 CI: 0.616 to 0.657), outpatient care (OR=0.634 CI: 0.614 to 0.655) and inpatient care (OR=0.804 CI: 0.757 to 0.853) compared with females. Insured came from mainland have higher odds to use inpatient care (OR=1.184 CI: 1.124 to 1.246) compared with other countries. People had 2 to 3 insured years used higher medical care (OR=5.873 CI: 5.636 to 6.119) and outpatient care (OR=5.886 CI: 5.649 to 6.314) compared with those whose insured under 1 year. If insured period over 3 years, they would have 5 more times probabilities to inpatient care than whose time under 1 year (OR=5.017 CI: 4.664 to 5.398). Category 5, low-income insured, had more than 8 times probabilities to use inpatient services than category 1 who had stable work. Results from multiple linear regressions indicated longer insured period, came from mainland and catastrophic illnesses patients would have more outpatient and inpatient visiting times significantly. So did the medical expenditures.

Conclusions: Gender, age, nationality, insurers’ category, qualified, the insured payroll, catastrophic illness and occupational accidents were the determination of medical utilization among foreigners at Kaohsiung-Pingtung Area in Taiwan. Future researchers could use questionnaire to get more complete relevant factors and follow the medical utilization and health status of foreigners. To provide the policymakers facilitate the planning of public health interventions.

第一章 緒論 - 1 -
第一節 背景與重要性 - 1 -
第二節 研究動機 - 4 -
第三節 研究目的與研究問題 - 5 -
第二章 文獻探討 - 7 -
第一節 臺灣外籍人士健康保險制度之規範與管理 - 7 -
第二節 就醫行為與醫療利用理論模式 - 15 -
第三節 外籍人士就醫行為及醫療利用影響因素相關實證研究 - 19 -
第三章 研究方法 - 30 -
第一節 研究架構與研究假設 - 30 -
第二節 研究對象與資料來源 - 33 -
第三節 研究變項操作型定義 - 34 -
第四節 資料分析方法 - 37 -
第四章 研究結果 - 39 -
第一節 描述性統計 - 39 -
第二節 推論性統計 - 39 -
第三節 影響高屏地區外籍人士醫療利用之相關因素預測模式 - 62 -
第五章 結論與建議 - 72 -
第一節 研究發現與討論 - 72 -
第二節 研究限制與後續建議 - 80 -
參考文獻 - 82 -

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