醫療資源與跨區就醫情形探討-以苗栗縣為例

Utilization of medical resources from regional and cross- regional perspective-The Case of the MiaoLi County

戴惠卿(Hui-Ching Tai)

指導教授 ： 李顯章

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2014年)

https://doi.org/10.6831/TMU.2014.00033

摘要

背景：『醫療網計畫』於1985年推行後，台灣醫療資源雖呈現快速成長，但仍存在醫療資源分佈不均的問題，而醫療資源分佈不均，將導致居住在醫療資源匱乏的鄉村或偏遠地區民眾跨區至醫療資源豐富地區就醫之情形。
目的：探討苗栗縣醫療資源分佈與跨區就醫的關係，並進一步分析跨縣市就醫相關因素。
方法：本研究採用次級資料分析，過用國家衛生研究院全民健康保險研究資料庫釋出之2009年~2011年之承保抽様歸人檔為資料來源，以2009年~2011年參與全民健康保險且投保地點為苗栗縣的民眾為研究對象，並以跨苗栗18鄉鎮、三次醫療區及苗栗縣等三個區域劃分方式，分析苗栗跨區就醫情形。
結果：
1.苗栗三種區域跨區門住診比率皆為跨鄉鎮>跨次醫療區>跨縣市，且不論在何種區域別下，其住院跨區皆大於門診跨區。
2.苗栗三種區域別之門住診跨區就醫層級選擇在門診部份以診所最高，地區醫院最低；住院部份則以區域醫院最高，診所最低；且當區域別之範圍愈大醫學中心之門住診跨區率愈高，而地區醫院和診所則相反。
3.苗栗地區民眾跨區門住診以流向鄰近或其它醫療資源較高之地區為主。
4.2009年~2011年三區域之門住診跨區率皆呈上升趨勢，且住院跨區比率之增加大於門診跨區比率，而與過去之研究結果相比，苗栗跨縣市門住診比率較以往增加。
5.苗栗縣門診以65歲以上、中低收入者、居住於海線次醫療區、具急重症病情及地區醫療資源少之跨區機率較高；住院以男性、低收入者、居住於海線次醫療區、非重大傷病者、急重症病情者及及地區醫療資源少之跨區機率較高
結論：基於本研究結果，建議主管機關應就地區之特性及民眾健康需求，再重新評估及規劃當地醫療資源之配置，並應加強輔導當地醫院緊急醫療及重症醫療照護能力之提升，以達醫療資源分配之公平性及可近性，且針對低收入者之醫療照護給予更多之關注及照顧。

關鍵字

苗栗縣 ； 跨區就醫 ； 就醫流向

並列摘要

Background: Since the Medical Care Network Plan was launched by the DePartment of Health in 1985, the medical resources in Taiwan has significantly increased. However, medical resources are still not equally distributed, and an uneven distribution of medical resources often causes PeoPle in rural or remote area with scarce medical resources to seek care form medical resources abundant area.
Objective: This research exPlored the relationshiPs between medical resources and cross-region in MiaoLi County. Related factors for seeking cross-region were also discussed.
Methods: In this study, we used 2009, 2010 and 2011’s National Health Insurance database. Study subjects are selected Miaoli County location for insured PeoPle, 2009 to 2011. The definition of a region and cross-region took into consideration the 18 towns, 3 medical sub-areas, and 25 county areas.
Results:
1. Out-of-area health care utilization based on three geograPhic was shown: 18 towns>3 medical sub-areas >25 county areas; and three geograPhic all shown out-of-area admission utilization was more than out-of-area ambulatory utilization.
2. Out-of-area health care utilization based on four hosPital degree was shown：OutPatient clinics choose to highest, lowest regional hosPitals; inPatient select the highest regional hosPitals, clinics lowest; the outPatient and inPatient cross rate is higher on medical center, and vice versa district hosPitals and clinics ,in the larger regional.
3. PeoPle of Miaoli County sought out-of-area outPatient and inPatient care from areas with abundant medical resources or from adjacent areas
4.The ProPortions out-of-area outPatient and inPatient were highly rising in three geograPhic,in 2009 to 2011, and the ratio in out-of-area outPatient was more than out-of-area inPatient, comPared with the results of Previous studies, the rate of Miaoli counties out-of-area inPatient and outPatient than in the Past increased.
5. PeoPle of Miaoli County seeking out-of-area outPatient services tend to 65 years and older, low-income PeoPle, living in sub-sea line medical district, have acute diseases, major injuries, severe illnesses and lived in lower resources.PeoPle of Miaoli County seeking out-of-area inPatient services tend to Male, age is lower, living in Miaoli sub, low-income PeoPle, living in sub-sea line medical district, have acute diseases, major injuries, severe illnesses and lived in lower resources.
Conclusion:Base on this study finding, suggested that healthcare administration should evaluate the available of health care resources in each regional dePending on the nature and the Public health needs .Intensive remedial local hosPital emergency critical care caPacity in order to achieve a fair allocation of medical resources and the accessibility. It is also suggested that to give more attention and care of the medical care for low-income

並列關鍵字

Miaoli County ； out-of-area health care utilization ； Patient flow

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