病患重複急診就醫相關因素之探討-以北台灣為例

Exploring the Factors Influencing Patients Readmitted to Emergency Department for Medical Services-A Study of Northern Taiwan

曹修幸(Hsiu-Hsing Tsao)

指導教授 ： 林恆慶

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(2004年)

摘要

依據國外研究結果顯示，常在醫院急診室發生推趕病患的情況。急診室是掌握急症病患生命的第一線，就醫病患與家屬皆期望醫療提供者能提供最及時與最適當的診斷及相關處置，但國內的轉診系統尚未落實，亦無相關執法單位監督與管理，當病患到達醫院尋求緊急醫療時，是否因為醫院經營生存壓力，而將預期不具經濟誘因的病患推趕至其他醫院，造成病患重複急診就醫的情形？由於該現象的發生，不但降低病患醫療的可近性，並危害病患就醫權益與生命安全；醫療服務提供者也因病患重複就醫，而造成醫療資源的浪費及行政成本的耗用，更嚴重影響整體醫療系統的完整性。 本研究以為國家衛生研究院「2001年全民健康保險學術研究資料庫」之次級資料，作為分析之基礎，藉由瞭解該時段內北台灣地區相同診斷重複急診就醫之情形，在「同日重複就醫一次以上」、「不同卡號」與「相同診斷」三個條件篩選後，分析與醫院特質、病患特質之相關性，以進一步推論「推趕病患」的現象。 本研究的結果顯示：病患與醫院特質的確會造成病患在相同診斷的情形下，同日重複急診就醫，醫學中心、公立醫院接收較多其他醫院醫治過之病患，病患第二次就醫以台北醫療區域及桃園醫療區域為就醫主要選擇，且第二次就醫之用藥金額、診療金額與合計金額皆高於第一次就醫費用。但由於以資料庫分析，無法確認是「醫院主動」推趕病患而造成病患重複就醫至其他醫院就醫的情形，或是因為國內特有的就醫文化：民眾的「Dr. shopping」，「病患主動」所造成的重複就醫。 基於醫療領域仍存有相當大的灰色地帶，與醫病雙方因資訊不對等所產生的鴻溝，且國內對於「推趕病患」（patient dumping）這個名詞仍屬陌生，我國全民健康保險對於醫療上的弱勢族群有其相關配套措施，相較於美國私人健康保險體系之下，國內醫療弱勢族群在就醫可近性上，發生推趕病患的情形並不像美國醫療市場上顯現的特別突兀，但現行轉診制度並未落實，且醫療分級功能不彰的情形之下，衛生主管機關宜重新審視衛生政策在設計上的完整性，與相關配套措施的協調性，使全體國民享有公平及完善的醫療服務，並全面提升優質醫療文化。

關鍵字

推趕病患 ； 重複急診就醫 ； 轉診系統

並列摘要

Foreign studies show that patient dumping situation occur often in the emergence rooms in the hospitals. Since the hospital emergence rooms are the very first front line to save the life of patients , for both the patients and the family, it is desired that the medication service providers offer the best timing and proper cares needed to the patients. However, due to the instability of domestic referral system practice and lacking of management and supervising from the legal enforcement unit, would the patient dumping situation happens when a patient expected with less means arrives at the emergence room for help and then is dumped by the hospital to another because of the business competition nature between hospitals? This dumping situation also leads to the readmitted emergence room phenomena to occur. Because the phenomena not only lowdown the accessibility of medication and affects the medication rights of the patient, all the medication service providers are also affected for the wasting of both medication resources and administration cost because the above readmitted phenomena , worst of all ,it severely damages the all medication service system. This research tries to understand northern Taiwan area in year 2001the readmitting phenomena, by suing the “2001 national health insurance research database” year 2001section as secondary data for the analysis base, to see how it is associated with the factors of hospital’s specialization, doctors’ specialty and the characters of the patients. And this research may come to the conclusion of existing of patient dumping situation. This study reveals that the characters of the patients and of the hospitals indeed cause the act of the same patients to re-admitted to different hospitals for emergency department for medication service even under the same diagnoses in the same day. Both the medical centers and public hospitals accept more such patients who have been to other hospitals for the first treatment, and the hospitals preferred choices for such patients for the secondary treatment are Taipei and Taoyuan medic medical area . However, due to the data-base analysis methodology used in this study, it cannot be identified whether the repeated medication phenomena is activated by the hospital’s “patient dumping” or caused by the special chrematistics─doctor shopping, rooted in our culture. Because of the exiting large gray area in medication field and the information gap between the patients and the hospitals, also added the fact that patient dumping is still an unfamiliar vocabulary to the people here, in terns of medication accessibility due to the nation-wide insurance system for the less-resourced weaks, the patient dumping phenomena here is not as obvious as in medication markets in the States. Nevertheless, surrounded by the unsettle of referral system and under the ill-functioned medication rating system, the Medication Bureau should re-exam all the aspect and the when designing the healthy policy and the coordination of concerning packages in order to benefit all our people fairly in full aspect medication service and also to promote well-quality medication culture.

並列關鍵字

patient dumping ； Readmitted to Emergency Department ； referral system

參考文獻

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