台灣診所之歇業與存活研究及其相關因素探討－以2000年至2010年新設西醫診所研究為例

Taiwan's new clinic closures (survivals) and their associated determinants: 2000 to 2010

蔣靜怡(Rica Ching-Yi Chiang) ； 郎慧珠(Hui-Chu Lang)

《台灣公共衛生雜誌》 36卷6期 (2017/12) Pp. 626-639

https://doi.org/10.6288/TJPH201736105110

摘要

目標：探討西醫診所存活趨勢並提供相關經營建言。方法：資料來源有二：1.2000-2010年國衛院「全民健康學術研究資料庫」。2.主計處「中華民國統計資訊網」之縣市社經指標。研究範圍排除外島、中醫與牙醫診所，統計分析以存活曲線（Survival Curve）以及Cox比例風險分析模式（Cox Proportional Hazard Model）探討各專科診所及縣市別之存活情況與生存風險。結果：西元2000-2010年新增加西醫診所7,347家，有5,361家存活，1,986家最終歇業。研究顯示西醫診所於經營約第700天皆進入歇業/存活之關鍵決定。歇業幅度最高之前三名科別：不分科（37.5%）、家醫科（33.9%）與復健科（28.7%）。存活診所其醫師較為年輕、醫事人員編制較大，診所收入點數與就診人次較高。歇業幅度最高之前三名縣市為雲林（41.3%）、台東（39.1%）與苗栗（37.0%）。結論：西醫診所經營前期700天為歇業/存活關鍵，等同為「診所黃金生存七百天」。家醫科歇業率居各專科診所之冠。台灣診所高歇業率地區多屬非都會區，與國外文獻指出歇業多發生於大城市的結果相異。

關鍵字

診所 ； 歇業 ； 專科診所 ； 存活曲線 ； 市場競爭

並列摘要

Objectives: This study aimed to determine the survival trends in Taiwan clinics. We expect the results to provide important information for practitioners and the government for their operation and health policy making. Methods: We used 2000-2010 NHI claim data and statistics from the Statistical Bureau, National Statistics of Taiwan. Clinics located in outlying islands, as well as Chinese physicians and dentists, were excluded from this research. Survival curves and Cox regression were used to analyze the trends in clinic closures and explore the factors influencing the survival of clinics during the study period. Results: A total of 7,347 clinics were initiated between 2000 and 2010. Among the clinics, 5,361 remained open and 1,986 closed. The survival curve indicated that 7,347 clinics had significantly decreased after the 700th day of operations. The top 3 closure specialties were general medicine (37.5%), family medicine (33.9%), and rehabilitation medicine clinics (28.7%). The age of physicians, number of staff members, income, and clinic visits were significant determinants associated with closure. The top 3 counties of clinic closures were Yun-Lin, Tai-Tung, and Miao-Li counties. Conclusions: Between 2000 and 2010, of the 7,347 initiated clinics studied, closures occurred after the 700th day of operations. The highest three specialties of closure were general medicine, family medicine, and rehabilitation medicine.

並列關鍵字

clinics ； closures ； specialist clinics ； survival curve ； market competition

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