偏遠地區醫院經營之策略-以中部某地區醫院為例

研究背景與目的：偏遠地區的人口結構老化程度高於都會地區，年輕族群大都外移，老年人口比例偏高，但因醫療資源分布不均，以本研究個案醫院所在地南投縣為例，幅員廣大且多山區地形，境內沒有醫學中心，只有2家區域醫院及8家地區醫院。留在縣內的大多是經濟較弱勢的老人及小孩，因為交通不便，降低了民眾就醫的可近性；因人口老化及人口分布較分散，對醫院的經營也是一項挑戰；另，面對外部醫療政策的變遷及各層級醫院的相互競爭，使得位於偏遠地區的地區醫院經營更是面臨挑戰。本研究以位於台灣中部南投縣境內一地區醫院為例，從內部與外部環境的改變，分析偏遠地區之地區醫院的經營成效，探討偏遠地區醫院經營之困境與衝擊。本研究個案醫院是由醫界、地方人士等40多人共同出資籌設合夥設立，是當時南投縣竹山鎮境內第一家具規模的綜合型醫療機構，1999年經歷921大地震的衝擊，在院長的帶領下走過最艱困的時期，因為合夥人制，也為該院的經營帶來許多的挑戰。研究方法：本研究採個案研究法，收集台灣健康照護體系的演進、全民健保制度、醫療社團法人等文獻，運用個案研究法，藉由半結構式深度訪談收集有效的資料，描繪個案醫院的發展、探究過往的策略，以強弱危機分析(SWOT Analysis)個案醫院做出研究。研究結果：傳統的醫院以急性醫療照護為主，因本研究個案醫院院長及早發現竹山當地老年人口比例偏高，甚至不少獨居的長者，故將本研究個案醫院定位以社區醫療為主，自2007年承接經濟部「銀髮族U-Care計畫」起，透過醫療服務與資訊科技的結合，成立遠距照護中心，並有專責護理人員，提供長者與醫護人員便利的雙向互動，減少舟車勞頓之苦，提升長者疾病自主管理的能力。個案醫院面對周遭大城市裡大醫院的競爭，院長嘗試將醫院轉型，從被動式等待患者到院就醫，主動走入社區推動預防醫學。合夥人制，限制醫院永續發展，多年來對於將盈餘投入設備更新與添購新的儀器的意見多有分歧，以至於醫院發展受限，將現有制度改制為醫療社團法人，對於醫院之發展及永續經營將有所助益，也是當務之急必要的策略之一。結論：面對人口結構的改變，低出生率、人口老化、平均餘命延長等現實狀況，地區醫院除了提供既定的醫療服務外，應該可以轉向以預防醫學、長期照顧服務為發展重點；地區醫院在第一階段先為民眾守護健康變得相對重要，從慢性疾病的控制與防範到長期照護。地區醫院應該發揮原有的優勢，特別是在城鄉差距，愈偏遠的鄉鎮地區，地區醫院被賦予社區防護網的使命，更應該發揮其可近性與其特色。

關鍵字

偏遠地區；地區醫院；遠距照護；醫療社團法人

並列摘要

Background and objectives: The population structure of the remote areas is aging higher than that of the metropolitan areas. Most of the young ethnic groups are moving out. The proportion of the elderly population is relatively high. However, due to the uneven distribution of medical resources, taking Nantou County, the hospital where the case of this study is located, as an example. There are no medical centers in the country, only 2 regional hospitals and 8 district hospitals. Most of the people staying in the county are economically disadvantaged elderly and children, because of inconvenient transportation, which reduces the accessibility of the public to medical treatment; due to the aging population and scattered population distribution, it is also a challenge to the operation of the hospital; in addition, facing Changes in external medical policies and the competition among hospitals at all levels make the operation of regional hospitals in remote areas even more challenging. This study takes a district hospital located in Nantou County, Central Taiwan as an example. It analyzes the operating results of regional hospitals in remote areas from the changes of internal and external environments, and explores the dilemmas and impacts of hospital operations in remote areas. The case hospital in this study was funded by more than 40 people, including the medical community and local people, to establish a partnership. It was the first furniture-scale comprehensive medical institution in Zhushan Township, Nantou County at that time. It experienced the impact of the 921 earthquake in 1999. Under the leadership of the most difficult period, the partnership system also brought many challenges to the operation of the hospital. Methods: This study adopts a case study method to collect Taiwan's health care system evolution, national health insurance system, medical association legal person and other literatures. It collects effective data through semi-structured in-depth interviews to describe the development of case hospitals and explore the past strategy through with SWOT Analysis. Results: Hospitals mainly focus on acute medical care. The hospital in this study is positioned as community-based because the director of the hospital in this study early discovered that the local elderly population in Zhushan Township is relatively high, and even many elderly people living alone. Since 2007 the hospital undertook the “Silver-haired U-Care Project” of the Ministry of Economic Affairs and a long-term care center with dedicated nursing staffs to provide convenient two-way interaction between the elders and the medical staff was established by the combination of medical services and information technology to reduce the suffering of boating and enhance the ability of the elderly to manage their own diseases. The superintendent of the hospital in this study tries to transform waiting passively for patients to go to the hospital into actively entered the community to promote preventive medicine. The partnership system restricts the sustainable development of the hospital. Over the years, there have been many differences of opinion on surplus investment in equipment updates and the purchase of new equipment, so that the development of the hospital is limited. For the development of the hospital and sustainable operation, it is one of the most urgent and necessary strategies to restructure into a medical corporation. Conclusion: Faced with changes in the population structure, low birth rate, aging population, and longer life expectancy, district hospitals should be able to shift to focusing on preventive medicine and long-term care services. it becomes relatively important to protect the health of the people, from the control and prevention of chronic diseases to long-term care. District hospitals should take advantage of their original advantages, especially in the rural and urban areas, and the more remote rural areas, regional hospitals are given the mission of community protection nets, and they should also play their accessibility and characteristics.