偏遠地區整合型醫療服務經營模式(IDS)對偏遠地區醫療利用之影響分析

Assessing the Impact of the Integrated Delivery System on Health Care Utilization in Remote Areas in Taiwan

譚秀芬(Hsiu-Fen Tan) ； 曾弘富(Hung-Fu Tseng)

《福爾摩莎醫務管理雜誌》 1卷1期 (2005/06) Pp. 55-66

https://doi.org/10.6771/FJHA.200506.0055

摘要

目的：中央健康保險局自1999年起實施「偏遠地區整合型醫療服務經營模式(IDS)」。本研究分析山地離島鄕IDS計劃醫療利用情形，討論各計畫的優缺點，藉由本國與其他國家對偏遠地區的經驗綜合建議未來的經營策略。方法：本計劃定嘉義縣之阿里山鄕、大埔鄕及澎湖縣的七美鄕、望安鄕為研究區域。結果：阿里山鄕在計畫實施後，鄕內門診利用有下降的趨勢，鄕內就醫率上升。大埔鄕門診量有上升趨勢。七美鄕的鄕內外門診利用較山地鄕多約10倍，門診費用方面為山地鄕的1.8到2倍。望安鄕鄕內外的門診人次、申報費用、平均每人看診次數是四鄕之冠。結論：對偏遠地區醫療照護的遞送、經營方式有幾項建議：(1)面臨經營困難，必須調整服務形態與內容；(2)醫院的聯盟策略、建立醫療照護網絡；(3)考量財務來源；(4)加強對當地環境的了解；(5)建立人力網絡；(6)建立與當地醫療的合作關係；(7)醫事人力管理；(8)醫療照護依地方的需求而設計；(9)改善交通基礎建設。

關鍵字

偏遠地區 ； 整合型醫療服務經營模式 ； 醫療利用 ； 鄕內就醫率

並列摘要

Objectives: In order to improve the accessibility of healthcare services in remote mountainous areas and offshore islands, the Bureau of National Health Insurance (BNHI) in Taiwan have been implementing an Integrated Delivery System since 1999. The new delivery model has certainly created impact to the local healthcare utilization patterns. In this study, the impacts of different IDS models were analyzed and compared. Finally, domestic as well as international experiences of delivering healthcare services to remote areas were also discussed. Methods: Outpatient claim data of four IDS service areas were extracted from the dataset of BNHI, including Ali Mountain and Dabu Village of Chiayi County and Chimei and Wanan of Punghu County. Healthcare utilization patterns, including total number of in- and out-valliage visists, total amount of outpatient claimed, and proportion of out-village visits, were compared among these four areas during the period from January of 1999 to June of 2001. Results: In Ali-Mountain, there has been no significant change in the total number of visits and amount of outpatient claimed before and after IDS. The number of in-village visits appeared to decrease since the introduction of IDS. However, the proportion of in-village visit increased slightly in the services that have been provided by the IDS in the village. The total number of outpatient visits in Dabu Village has increased from 1000 per year to 350 per months after IDS. However, the proportion of in-village visit did not increase. In Chimei, the total number of visits was ten times higher than that in the mountainous areas, especially among the residents over 65 years old. The total amount of out-patient claimed in Chimei was 1.8 to 2 times higher than that on the mountainous ares. However, there have been only 2000 individuals visiting the IDS clinic, far less than the numbers in the Ali Mountain. The average number of visits per person and the proportion of in-village visits were both higher than those in the mountainous areas. The total number of visits, the amount of out-patient claimed, the average number of visits were the highest in Wanan Village. Conclusions: Base on the evaluation, we suggest that the healthcare delivery and operation system in remote areas should (1) adjust service models and contents if operation encounters difficulties; (2) establish healthcare service network through strategic alliance among hospitals; (3) consider every possible source of financial support; (4) improve the understanding of local environment; (5) build up local personnel network; (6) construct cooperation relationship with local healthcare facility; (7) appropriately manage healthcare professionals; (8) designed localized and customized services; and (9) improve local travel infrastructure.

並列關鍵字

remote area ； integrated delivery system ； healthcare utilization ； proportion of in-village visit