嚴重急性呼吸道症候群（SARS）及新冠肺炎（COVID-19）投入資源比較暨推估疫情下可能投入之資源－以某醫學中心與區域醫院為例

Comparison of resources investment for SARS and COVID-19 and the probable investment in epidemic resources - the case of a medical center & regional hospital

林育瑄(Yu-Xuan Lin) ； 戴天亮(Tien-Liang Tai) ； 羅銀秀(Yin-Hsiu Lo) ； 陳惠貞(Hui-Chen Chen) ； 鍾靜江(Ching-Chiang Chung) ； 邱淑芳(Shu-Fang Chiu)

《台灣公共衛生雜誌》 39卷4期 (2020/08) Pp. 397-410

https://doi.org/10.6288/TJPH.202008_39(4).109069

摘要

目標：本研究旨在比較SARS及COVID-19兩疫情資源投入、醫學中心與區域醫院在SARS期間資源投入差異比較分析，及在疫情不同發展階段，推估醫院可能之資源投入（含支出及成本）。方法：採回溯性資料統計，進行不同疫情及不同層級醫院比較及投入資源推估。結果：某醫學中心SARS期間總資源投入為7,034萬元，以設置負壓隔離病房及發燒篩檢站為主要投入資源（約佔總投資50%），而COVID-19期間以防疫物資、醫護人員特別津貼投入較多。而醫學中心與區域醫院投入防疫資源與醫院規模相關性高。另某醫學中心推估新冠肺炎（COVID-19）如發展到最嚴重時期，紫色2階時不含成本分攤會投入約4,304萬元支出，約SARS期間支出61%，如含成本分攤，約投入5,334萬元，約為SARS期間之76%。SARS時期因無類似經驗，突發疫情讓醫院措手不及、且無負壓隔離病房等設施，須大量投入此項資源以收治確診病患，而COVID-19疫情雖嚴峻，因已設置負壓隔離病房等設施，且政府與某醫學中心均採超前部署，至目前為止疫情尚在掌控當中。結論：疫情具有不可預測性，疫情何時結束無法預測，對醫院防疫資源投入的預估有侷限。疫情在某階段時間長短、疫情嚴重度、政府的防疫政策及醫院防疫措施效果均會影響資源投入的金額。而在防疫期間醫院收入減少，如無政府經費挹注，會造成醫院資金周轉問題，政府應作為醫院防疫後盾，適時予以醫院財務支持，以共度難關。

關鍵字

SARS ； COVID-19 ； 投入資源 ； 超前部屬 ； 推估疫情

並列摘要

Objectives: This study aims to compare the resources invested during the SARS and COVID-19 epidemics, analyze and compare resources invested by a medical center and a regional hospital during SARS, and estimate the possible investment of resources (including expenses and costs) by the hospitals in different stages of epidemic development. Methods: Compare the different epidemics and hospitals at different levels based on retrospective data, and estimate the investment of resources. Results: A medical center invested NT$ 70.34 million worth of resources during SARS, mainly for setting up negative-pressure isolation rooms and a fever clinic (accounting for about 50% of the total investment), whereas the investment during COVID-19 is mainly on anti-epidemic supplies and special allowances for healthcare workers. There is a high level of correlation between investment in anti-epidemic resources by a medical center/regional hospital and the scale of a hospital. Moreover, a medical center estimates that when COVID-19 develops to the most severe stage, the investment will be around NT$ 43.04 million (excluding cost allocation), that is about 61% of the expenditure during SARS, and around NT$ 53.34 million (including cost allocation), about 76% of the SARS expenditure, at Purple Level 2 status. At the time of SARS, with no similar experience before, hospitals were caught unprepared upon the sudden outbreak, with no negative-pressure isolation facilities. Immense investment had to be made in this resource to accommodate confirmed cases. Although the COVID-19 epidemic is severe, with the negative-pressure isolation facilities already established and the advance deployment already adopted by both the government and the medical center, the epidemic has been kept in control to date. Conclusions: Due to the unpredictability of the epidemic, the time when the epidemic will end is unpredictable, and this will constrain the hospitals' ability to estimate the investment in anti-epidemic resources. The length of a certain stage of epidemic, the severity of the epidemic, the government's anti-epidemic policy, and the result of the hospitals' implementation of anti-epidemic measures all affect the amount of investment in resources. When combating the epidemic, hospitals will have reduced income, and hospitals may face cash flow problem if no government funding is provided. To give back up for the hospitals' anti-epidemic efforts, the government should provide timely financial support for the hospitals to help them overcome the challenge.

並列關鍵字

SARS ； COVID-19 ； investment of resources ； advance deployment ； epidemic prediction

參考文獻

謝佑珊、林春梅、裘苕莙：重大災害事件後的省思—醫院重大災害應變能力的檢討與準備。榮總護理 2003；20：347-57。doi:10.6142/VGHN.20.4.347。Hsieh YS, Lin CM, Chiu TC. Reflection after disaster - the evaluation and preparedness for the ability of disaster response. VGH Nurs 2003;20:347-57. doi:10.6142/VGHN.20.4.347. [In Chinese: English abstract]

郭浩然：由職業醫學看 SARS 防疫措施。感染控制雜誌 2003；1 3：306-8。d oi:10.6526/ICJ.200310_13(5).0008。Guo HR. Viewing SARS epidemic prevention Measures from occupational medicine. Infect Control J 2003;1 3:306-8. doi:10.6526/ICJ.200310_13(5).0008. [In Chinese]

顏慕庸、王永衛、宋晏仁：台北都會區因應新型流感全球大流行之整備策略。疫情報導 2007；23：17-28。doi:10.6524/EB.200701_23(1).0003。Yen MY, Wong WW, Song YR. The Taipei metropolitan area’s comprehensive strategies in response to novel influenza pandemic. Taiwan Epidemiol Bull 2007;2 3:17-28. doi:10.6524/EB.200701_23(1).0003. [In Chinese]

張琇珺、林恆慶、陳靖宜、陳楚杰：以SARS經驗推估禽流感爆發對醫療利用可能影響之初探。台灣衛誌 2008；27：496-506。doi:10.6288/TJPH2008-27-06-04。Chang HC, Lin HC, Chen CY, Chen CC. A preliminary analysis of the possible influence of H5N1 influenza outbreak on medical utilization-experience from SARS outbreaks. Taiwan J Public Health 2008;27:496-506. doi:10.6288/TJPH2008-27-06-04. [In Chinese: English abstract]

蘇益仁：預測H5N1全球流感的流行—科學的大挑戰。疫情報導 2006；22：11-3。doi:10.6524/EB.200601_22(1).0005。Su IJ. Predicting the H5N1 global influenza epidemic-a big scientific challenge. Taiwan Epidemiol Bull 2006;22:11-3. doi:10.6524/EB.200601_22(1).0005. [In Chinese]