距離和就診次數之關聯性探討-以高雄市兩間具城鄉差距之牙醫診所為例

近年來因為牙醫師之需求量增加以及健保制度下牙醫職業之誘因增強，台灣牙醫人力逐年正成長。但台灣城鄉差距的狀況，反而使醫療資源分配極度不均。有鑒於城鄉差距及偏遠地區牙醫人力缺乏之現象，本研究希望針對距離此一因素，初探就醫便利性對患者就診之影響。在台灣全部22個縣市中，希望能擇一在轄內即能呈現”城鄉差距”此一特色之縣市，最後經考量選定高雄市為研究目標。因應高雄市地理及人口分佈之獨特性，分別自高雄市於2011前縣市合併前原高雄市及原高雄縣各選取一具代表性之院所。患者資料就其初診病歷之資料中依診所院內使用之Dr.Cooper北昕資訊牙醫醫療管理系統於初診患者掛號時產生之流水號尾數為1者作隨機採樣，排除執業醫師至醫療站以支援方式定點執業及社區巡迴服務。就病歷登載患者之性別、年齡、和抽樣診所之距離，以及就診次數作分析，探討在不同獨立變項間的關聯性，並關注距離是否為就醫行為相關的顯著變因。本次研究假設患者之就醫意願和患者與抽樣診所間的距離有關聯性，而和患者之性別及患者之年齡無關。研究結果發現1.就診患者均以離診所最近，其所在之行政區為最大宗。2.距離和就診次數有距離則越低者，就診次數越高之趨勢。3.相較於距離此一因素，年齡和性別兩因素對就診次數並無顯著關聯性。4.原高雄市診所之平均就診次數大於原高雄縣診所，但兩診所之經營模式不盡相同，故不一定是因距離所導致。

關鍵字

城鄉差距；高雄市；距離；就診行為

並列摘要

In recent years, due to the increasing demand for dentists and the increasing incentives for the dentist profession under the health insurance system, the number of dentists in Taiwan has been growing year by year. However, the gap between urban and rural areas in Taiwan has made the distribution of medical resources extremely uneven. In view of the urban-rural gap and the lack of dentist manpower in remote areas, this study hopes to focus on the factor of distance and explore the impact of the convenience of medical treatment on patients. Among all the 22 counties and cities in Taiwan, I hope to choose one that can show the characteristics of "urban-rural gap" within its jurisdiction, and finally select Kaohsiung City as the research target after consideration. In response to the uniqueness of Kaohsiung's geographical and population distribution, one representative hospital was selected from the former Kaohsiung City and the former Kaohsiung County before the merger of the former counties and cities in Kaohsiung City in 2011. The patient's data will be randomly sampled according to the Dr. Cooper Beixin Information Dental Medical Management System used in the clinic for the first-diagnosed patient's serial number when the first-diagnosed patient is registered as 1 in the data of their first-diagnosed medical records. Fixed-point practice and community tour services. Analyze the gender, age, and distance of the sampled clinics and the number of visits in the medical records, explore the correlation between different independent variables, and pay attention to whether the distance is a significant variable related to the medical behavior. This study assumes that the patient's willingness to seek medical treatment is related to the distance between the patient and the sampled clinic, and has nothing to do with the patient's gender and the patient's age. The results of the study found that 1. The number of patients who visited the clinic was the closest to the clinic, and the administrative region where they were located was the largest. 2. The lower the distance and the number of visits, the lower the distance, the higher the number of visits. 3. Compared with the factor of distance, the two factors of age and gender have no significant correlation with the number of visits. 4. The average number of visits in the original Kaohsiung City Clinic is greater than that of the original Kaohsiung County Clinic, but the business models of the two clinics are not the same, so it is not necessarily caused by the distance.