- 學位論文
台灣牙醫師2020-2030人力供給與需求預測之探討
The Exploratory Study in Taiwanese Dental Human Resource Projected Demand and Supply For 2020 to 2030.
摘要
牙醫師人力供給與需求推估，不可侷限於現有牙醫師人力的調查，亦需考慮國家衛生醫療、健康保險政策、教育制度、經濟發展、財務狀況、管理與領導…等等因素。本研究參考聯合國人力資源處所發表的人力資源分析發展方向來設計問卷，以英國牙醫師人力預估模式為本研究人力預測推估模式，並與相關各國進行人力培育及訓練制度比較。 本研究以2015年為預估人力基準點，蒐集行政院衛生福利部的公開資料統計，以及WHO、FDI以及其他各國公開統計資料，與2009年黃烱興之研究比較。 目前台灣人口成長已趨緩，未來10年將成為負成長，高齡人口將可達14%以上(圖10)，預估牙周病及假牙需求量將增加，勢必影響台灣牙醫師人力需求。本研究針對台灣地區牙醫師人力之供給與需求提出未來10年預測，主要結果如下： 1.牙醫師供給量近年來(2013~2015)已趨穩定，每年平均以370名(表1)投入市場，增加率為每年2~3％。 2.牙醫學系學生名額，亦趨平衡，近年來(2013~2015)平均畢業生約414名(表14)，其中女性佔42.8%，未來6年畢業生供給量預估為每年380~390名左右，女性有上升的趨勢。 3.國外畢業牙醫師仍佔少數，2009年全國至今只有276位，為全國牙醫師總數之2.5％。 4.台灣牙醫師-萬人口比，為4.9(表5，2009年)，已和日本、義大利、荷蘭相同。高於美國（4.5）、韓國（4.5）、澳洲（4.3）、加拿大（3.5）、英國（3.4）、及法國（3.4）。 5.2009年台北市之牙醫師-萬人口比最高已達9.7，嘉義縣比值最低為1.7，城鄉差距約為5.7倍；2015年北市之牙醫師-萬人口比最高已達11.2，嘉義縣比值最低為2.1，城鄉差距約為5.3倍，比2009年時差距少了0.3倍。 6.3~5年後將面臨牙醫師退休潮，未來10年將有1,617位牙醫師退休。 7.至2030年，若牙醫學系畢業生每年畢業414餘名，台灣人口為負成長，牙醫師-萬人口比將達8.0。若調整退休人數、男女牙醫師工作時數、男女牙醫師比例，並以牙醫師--萬人口比為4.9為目標，2030年牙醫師供給量仍多於實際需要量760位。 8.國民口腔健康第2~3期五年計畫若仍持續第一期五年計畫，所需牙醫師人力將不會顯著增加。 9.牙科健保總額預算，限制了口腔醫療量的成長。高齡人口及牙周病增加，與生育率及齲齒率減少，平衡了牙醫師人力需求。 本研究最大限制為未考慮牙科自費項目、新開發牙科醫療之需求、世界經濟發展對台灣影響以及兩岸醫療政策與人力的變動，以及無法確實考察這13,502位牙醫師的每日工時等因素，這些影響因素均假設穩定下，預測才可成立。 牙醫師人力政策建議如下： 1.牙醫師人力供給，與口腔醫療需求須有定期評估機制，建立人力資源資料庫。 2.加強弱勢族群之口腔醫療服務，經費來源於健保總額之外。 3.台灣牙醫師地區分布不平衡現象仍嚴重，都會區之牙醫師/人口比均已超越歐、美、日，如何輔導牙醫師至醫療人力不足區，應為牙醫師人力重要政策。
並列摘要
The supply and demand of dental manpower should not be limited to the assessment of number of dentists. The financing, policy, dental education and management should be included in the assessment of dental manpower. This protocol will apply the health resource medhods pablish by World Health Organization, England and U.S.A., and investigate the problem encountered in Taiwan dental manpower. The feedback regulation and continuous improvement of dental manpower system will be emphasized. All data were analyzed and compared with compatible international data. The 10-year projection of dentist workforce is recommended. 1.The supply of dentists has been stable in recent years. Each year about 370 new dentists will join dental market, with 2~3% increment. 2.The number of dental students has been stable in recent years (2013~2015). Each year about 414dental students will graduate, 42.8% of them are female, and female will upward in the future. 3.The foreign graduates of dentists have 276 in number, about 2.5% of total Taiwan dentists. 4.In Taiwan, the 2010 dentist-to-10,000 population ratio is 4.9(2009), same as that in Japan, Italy, Netherland, higher than USA (4.5), Korea (4.5), Australia (4.3), Canada (3.5), England (3.4), and France (3.4). 5.In Taiwan, the highest dentist-to-10,000 population ratio is 9.7, located at Taipei. The lowest one is 1.7, located at Chia-I. There is 5.7 times difference. And the highest dentist-to-10,000 population ratio is 11.2, located at Taipei. The lowest one is 2.1, located at Chia-I. There is 5.3 times difference, ratio 0.3 times the difference in 2009. 6.More dentists are going to retire within 3~5 years. There are about 1,617 dentist will retire within 10 years. 7.Up to 2030, if dental students graduate at rate of 414 per year and population growth rate is becoming negative, than dentist-to-10,000 population ratio will be 8.0. To be adjusted by number of retirement, working hours in gender difference, and female proportion, and maintain dentist-to-10,000 population ratio at 4.9, the supply of dentists in 2020 will supercede the actual demand by 760 dentists. 8.The 2nd and 3rd 5-year oral health projects, if the goals are the same as the 1st one, there will not be a great demand for dentist workforce. 9.The global budget of dental expense limits the demand of dentist workforce. Increase of aging group and periodontal disease will be balanced by the decrease of young age group and caries incidence, in term of dentist workforce. The limitation of this study is that the influence of world economics and workforce policy between Taiwan and China was not considered. This study did not estimate the dentist workforce needed for self-paid dental care and handicap dentistry. All projections on dentist workforce are based on these factors maintaining stable in next 10 years. Concerning dentist workforce policy, the following three recommendations are made: 1.Demand and supply study on dental workforce should be on regular base. The database of related workforce variables should be set up. 2.The dental care for the handicap and underserved groups should be improved. The expense should not come from the global budget of national health. 3.The urban and suburban difference for dental workforce needs to be improved by health workforce policy.