背景：為提升台灣糖尿病照護品質，健保局於民國90年11月推出以糖尿病共同照護為基礎的論質計酬計畫，但是數據顯示醫師與病患參與率仍有相當的差異。
目的：首先想瞭解糖尿病病患參與論質計酬計畫是否有社會不平等現象？其次想比較在不同計畫推動策略下，上述社會不平等現象是否有所不同？
方法：資料來源為2005年中區健保局醫療申報與承保資料。本研究以病患投保金額、投保類別與戶籍所在地之都市化程度作為社經位置指標之測量。參與率之不平等梯度以線性迴歸斜率與勝算比來表示。控制變項包括病人、醫師、區域院所與院所特徵。最後比較台中縣與台中市兩個不同推動策略地區之參與率不平等梯度是否有所差異。
結果：個人層次社經指標顯示：投保金額高者參與率較高，投保類別較高參與率也較，出現正相關社會不平等梯度現象。相反地，區位層次社經指標顯示：患者戶籍所在地都市化程度越低者反而加入率愈高，出現負相關社會不平等梯度現象。進一步比較不同推動策略縣市的參與率發現：以基層診所為主的台中縣，戶籍地在較低都市化程度地區反而有較高參與率；反之，以大型教學醫院為主的台中市，戶籍地在較低都市化程度地區參與率較低。
結論：以不同社經指標分析糖尿病論質計酬計畫參與率的社會不平等梯度現象會有不同的結果。透過有效的推動策略，戶籍地在較低都市化程度地區還是可以有較高參與率。本研究結論：政策介入可以消弭加入有效糖尿病照護管理計畫的健康不平等現象。

Background: To promote the quality of diabetes care, the National Health Insurance of Taiwan (NHI) initiated the shared care model of quality-based payment program for diabetes shared care in November, 2001. Nevertheless, studies revealed great variations in participation rates among physicians and patients.
Objectives: First, to examine if there were social inequalities in participation rates among diabetic patients. Second, to contrast the patterns of social inequalities in participation rates by regions with different policies in promoting the participation.
Methods: The claims data of the year 2005 were obtained from the Central Region Branch, Bureau of National Health Insurance (BNHI). Two individual level (i.e., level of premium and occupation category) and one contextual level (i.e., level of urbanization of residence place) of measures of socioeconomic position (SEP) were used. The liner regressions slopes and odds ratios were used to indicate the gradient of social inequalities of participation rates. Control variables included characteristics of patients, physicians, clinics and hospitals. We further compared the patterns of social inequalities between Taichung city and county with different policies in promoting the program.
Results: Individual level indicators revealed that diabetic patients with higher premium and occupational category had higher participation rates (a positive association). On the contrary, contextual level indicator showed that diabetic patients live in places with lower level of urbanization had higher participation rates (a negative association). Taichung country, with policy focused on local clinics, had negative association between level of urbanization with participation rates. On the other hand, Taichung city, with policy focused on hospitals and medical centers, had positive association between levels of urbanization with participation rates.
Conclusions: Different indicators of SEP might result in different patterns of social inequalities in participation rates. Through effective promoting policies diabetic patients live in lower level of urbanization areas could still have higher participation rates for quality-based payment program. This study concluded that interventions could reduce the social inequalities in participating effective diabetic care programs.

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