台灣物理治療人力之地理分布變化－1997至2006年

The Trend of Geographic Distribution of Physical Therapy Human Resource in Taiwan-1997-2006

胡慶文(Hing-Man Wu) ； 楊政峰(Jeng-Feng Yang) ； 周偉倪(Willy Chou) ； 阮惠群(Hui-Chun Juan) ； 高凡修(Fan-Shiu Kao) ； 林文德(Wen-Der Lin)

《物理治療》 34卷4期 (2009/08) Pp. 219-226

摘要

目的：瞭解全民健保開辦十年來不同都市化地區物理治療人力分布的變化情形及其影響因素，以提供物理治療人力政策之決策參考。方法：本研究以台灣地區368鄉鎮市區為研究單位，分析物理治療人力在1997-2006年的十年間變化情形。資料來源分別為行政院衛生署之「醫療院所執業醫事人員數按地區別分類表」及內政部之「鄉鎮市區戶口人數」。鄉鎮市區以都市化程度分為都會、城鎮、鄉村及偏遠地區四種，並比較不同都市化地區的物理治療人力分布變化情形，最後並以複迴歸分析十年間物理治療人力增減的相關因素。結果：全國每十萬人口物理治療人力數自1997年的5.9人增加至2006年的16.5人，其中以都會地區增加最多，偏遠地區最少。物理治療人力於醫院執業的比例自1997年的75%下降至2006年的59%；物理治療師占率由66%降至63%，而無物理治療人力的鄉鎮市區數則減少37個，吉尼係數由0.64減為0.44。被迴歸分析發現，某一鄉鎮市區原有的物理治療人力數愈多、都市化程度愈高、醫師人力增加愈多，其物理治療人力數的增加愈多。結論：1997-2006的十年間，台灣地區物理治療人力數大幅增加，無物理治療人力的地區顯著減少，且物理治療人力之分布略有改善，但此改善大部分來自原有物理治療人力較多、都市化程度較高及醫師密度增加較多的地區，顯示物理治療人力分布仍有改善空間。

關鍵字

物理治療 ； 吉尼係數 ； 人力分布

並列摘要

Objbctive: The aim of this study is to describe the change in distribution of health human resources (HHR) in physical therapy ten years after the introduction of National Health Insurance in Taiwan, and to analyze the factor associated with this change, in order to make better policy on human resources allocation. Methods: This study used 368 primary administrative units (county, towns, city, and district) as the study units, and analyzed the HHR in physical therapy across these units from 1997 to 2006. The information about HHR in physical therapy came from the HEIR registry statistics maintained by the Department of Health, and the population information came from district resident statistics provided by the Ministry of Interior. All study units were classified into one of 4 groups according to the degree of urbanization, then 5 distributional measures, including HEIR ratio, the number of units without HI-IR in physical therapy, percentage of HHR practiced in hospital, the percentage of physical therapy to HHR in physical therapy, and Gini coefficient, are calculated to reflect the HEIR distribution in each urbanization group. Finally, a multiple regression was conducted to analyze the factors associated with the change of HEIR in physical therapy in this previous decade. Results: The HHR ratio in physical therapy rose from 5.9 per 100,000 population in 1997 to 16.5 in 2006, the number of units without physical therapy HHR dropped from 212 to 175, and the percentage of HEIR in physical therapy practiced in hospital and the percentage of physical therapists to all HEIR in physical therapy dropped from 75% to 59%, and from 66% to 63%, respectively. Overall, the Gini coefficient reduced from 0.64 to 0.44, indicating the geographical distribution of physical therapy HHR improved over the decade. Nevertheless, the increase in physical therapy HEIR is more likely to occur in the units which had more physical therapy HHR previously, located in more urbanized area, and had higher physician to population ratio. Conclusions: During 1997-2006, physical therapy increased dramatically and distributed more equally. However, the fact that near half of primary administrative units had no physical therapy HIIR, and that increase in physical therapy HHR occurred in more urbanized area, should urge policy maker to take geographical distribution in physical therapy HEIR into account.

並列關鍵字

Physical therapy ； Gini coefficient ； Geographical distribution