群體醫療執業中心對醫療可近性的影響

The Impact of Group Practice Centers on Access to Health Care

江東亮(Tung-Liang Chiang) ； 楊志良(Chih-Liang Yaung) ； 丁志音(Chih-Yin Lew Ting)

《中華民國公共衛生學會雜誌》 10卷5期 (1991/12) Pp. 260-268

https://doi.org/10.6288/JNPHARC1991-10-05-06

摘要

為提高醫療可近性，衛生署於民國72年起試辦「群體醫療執業中心計畫」，初期共成立12所群體醫療執業中心。為評估群體醫療執業中心對醫療可近性的影響本研究採單組前後测設計，矜群體醫療執業中心開辦前及開辦一年後以家庭訪視方法向此12所群體醫療執業中心所在鄉鎮居民收集研究資料，共有4811戶同時完成前利與復測兩次訪視。結果顯示：(1)與論成人或小孩生病，受訪家戶期望的第一步處理為赴外鄉鎮就醫的比率都顯著降低，(2)就受訪戶成員於受訪前一個月內的醫療服務利用情形而言，前測時衛生所提供3.5%的服務量，其他合格西醫師提供63.8%的服務量，但後則時群體醫療執業中心提供了22.0%的服務量，而其他合格西醫師提供的服務量則減為44.6%，以及(3)在主觀評價上，無論是距離、技術、藥效和服務態度，民眾大都感到滿意或非常滿意。因此，可以肯定群體醫療執業中心對提高醫療可近性的貢獻。但另一方面，本研究亦發現有無使康保險以及不同社會經濟地位間醫療服務利用的差距並未減少，因此建議醫療政策應重視民眾的就醫能力，特別是健康保險的問題。

關鍵字

群體醫療執業中心 ； 醫療可近性 ； 病人滿足感

並列摘要

In order to increase access to health care the Department of Health, Executive Yuan, launched the group practice centers program in 1983. At the very beginning, 12 group practice centers (GPCs) were set up in 12 townships. This study intended to evaluate the impact of these 12 GPCs on access to health care. The data for the analysis came from an interview of 4811 households about the opening of the GPCs and one year later. The results of the study indicate that: (1) The proportion of households who preferred seeking first care from providers practicing in townships other than where they lived significantly decreased after the operating of GPCs. (2) Health stations provided 3.5% of total ser Vices demanded by the community prior to the opening of GPCs, but one year later GPCs provided 22.0% of total services. During the same period the proportion of services provided by other physicians decreased from 63.8% to 44.6%. (3) Most of households interviewed were satisfied with the GPCs in terms of geographic access and technical and personal management. Accordingly, the contribution of GPCs to increasing access to health care is conclusive. However, because this study also found that the gaps in health services utilization between having and not having health insurance and between different socioeconomic groups remained after the implementation of GPCs program, health care policy thus shall pay attention to enabling factors including health insurance.

並列關鍵字

group practice center ； access to health care ； patients satifaction