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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

Abstracts


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。

Parallel abstracts


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.

References


衛生福利部統計處:民國101年醫療機構現況及醫院醫療服務量統計分析。 https://dep.mohw.gov.tw/DOS/np-1864-113.html。引用2016/11/09。Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan). The status of medical organizations and hospitals' medical service volume statistics: numbers of hospitals and clinics, 2012. Available at: https://dep.mohw.gov.tw/DOS/np-1864-113.html. Accessed November 9, 2016. [In Chinese]
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衛生福利部全民健康保險會:全民健康保險醫療費用總額支付制度問答輯。http://www.mohw.gov.tw/CHT/NHIC/DM1_P.aspx?f_list_no=516&fod_list_no=5192&doc_no=680&rn=781221593。引用2009/07/01。National Health Insurance Committee, Ministry of Health and Welfare, R.O.C. (Taiwan). Q&A concerning National Health Insurance's total payment system for medical expenses. Available at: http://www.mohw.gov.tw/CHT/NHIC/DM1_P.aspx?f_list_no=516&fod_list_no=5192&doc_no=680&rn=781221593. Accessed July 1, 2009. [In Chinese]
陳惠芳、謝明娟、陳俞成(2006)。全民健保實施前後醫院財務面經營績效之研究。嘉南學報(人文類)。32,303-31。
王錦旺(2006)。總額支付制度對醫院績效之影響─以南部地區級以上醫院為例。南台科技大學企業管理研究所=Department of Business Administration, Southern Taiwan University of Science and Technology。

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