病人跨區住院與醫療區資源分佈之探討

A Study of Cross-Region Admission and the Distribution of Regional Inpatient Care Resources

陳珮青(Pei-Ching Chen) ； 楊銘欽(Ming-Chin Yang) ； 江東亮(Tung-Liang Chiang) ； 鄭守夏(Shou-Hsia Cheng)

《台灣公共衛生雜誌》 22卷1期 (2003/02) Pp. 27-32

https://doi.org/10.6288/TJPH2003-22-01-04

摘要

目標：本研究旨在分析住院病人之跨區就醫情形與各醫療區內醫療資源分佈之關係。方法：本研究針對評鑑為地區教學以上層級的醫院，選取四種常見疾病的出院病人為研究對象，以電話訪問的方式進行問卷調查，共完訪4,945人。本研究係以病人居住地與其所住醫院是否落於醫療網所定義之相同醫療區，判斷是否為跨區住院，並利用複迴歸分析，檢視病患跨區就醫比例與當地醫療資源之關係。結果：在1999年底，各醫療區間每萬人口西醫師數最高與最低差距2.3倍。四種疾病別的跨區稍有差異，合併計算平均跨區住院比例為13.3%。跨區住院比例最高者為雲林醫療區63.8%，最低為花蓮醫療區2.0%。以逐步複迴歸進行分析發現，跨區住院比例與醫療區每萬人口急性一般病休數、以及醫院評鑑等級等醫療資源有相關。結論：由於跨區住院與醫療資源分布息息相關，對於當地資源相對不足且跨區比例明顯偏高的地區，建議配合第四期醫療網的區域規劃，在政策上給予特別的協助。

關鍵字

醫療資源,跨區,住院,療區

並列摘要

Objectives: This study aimed to analyze the current situation of cross-region admission in Taiwan, and to examine its association with regional health care resources. Methods: Data for the analysis was taken from a survey of patients discharged from teaching hospitals with four selected diagnoses: stroke, diabetes, Cesarean Section, and appendectomy. A total of 4,945 persons were successfully interviewed via telephone. Cross-region was identified when the patients' residential region differed from that of the hospital he/she was admitted to, Multiple regression models were employed to examine the association between cross-region admission and regional health care resources. Results: In 1999, the physician (and acute care ward) population ratio of the most abundant region was 2.3 times of that of the poorest region. The cross-region admission rates in the four conditions varied. The overall proportion of cross-region admissions was 13.3% nationwide with the highest proportion in Yun-lin region (63.8%) and the lowest one in Hua-lian region (2%). Results from multiple regression analyses showed that acute care ward population ratios and having higher accredited hospitals were the major factors associated with the proportion of cross region admission. Conclusions: Cross-region admission is associated with the abundance of regional inpatient care resources. The study suggests that the government may need to provide special assistance to regions with very high rate of cross-region admission in the 4th Medical Care Network Program.

並列關鍵字

health care resources, cross-region, inpatient, medical region

參考文獻

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行政院衛生署(1996)。「建立醫療網第三期計畫」（核定本）。台北:行政院衛生署。

行政院衛生署(1999)。八十八年台灣地區公私立醫療機構及其他醫事機構現況統計表。台北:行政院衛生署。