- 學位論文
高雄市偏遠地區低收入戶就醫障礙之研究
Inaccessibility of Medical Services for Low-income Residents in Rural Areas in Kaohsiung
摘要
低收入戶在社會上已屬於弱勢族群，而因台灣地區快速都市化的發展，使得城鄉差距愈加顯著，居住在偏遠地區的低收入戶者，更是弱勢中的弱勢。偏遠地區因天然地形之故，地理位置位處偏僻，村落散落各處，在地理環境的限制下，交通往來相當不便，加上文化價值差異與經濟困窘、人口外移、居民多為老年或弱勢者、醫療認知不足、醫療資源分配不均，在醫療資源普遍不足之下，偏遠地區低收入戶者與都會區相比，在健康水準上有顯著的差異，因為醫療的不可近性，在維持健康上實屬不易。而低收入戶在建保上雖有福保身分，得以減免醫療費用負擔，然而自費醫療、看護費、就醫交通費仍是障礙所在。 本研究為瞭解偏遠地區低收入戶民眾之醫療行為及醫療可近性，與低收入戶者對於促成尋求醫療上所面臨的困境與看法，來作為相關單位在規劃偏遠醫療以及政府政策之參考。本研究先以量化方式進行二手資料分析，研究結果發現，在卡方檢定下，僅在能力因素（低收類別）與需求因素（健康狀況）有顯著差異；在多重回應交叉分析下，除了在距離跟交通的困擾與文獻符合，其他的部分無法以量化研究來概括說明。另外，進一步研究為訪談研究，研究者與十位服務偏遠地區低收入戶之醫療、社會工作、社區工作、慈善單位等專業人員，進行質性訪談來瞭解箇中差異。研究發現，因為社會網絡的介入，提供資源與人力的陪伴，以及全民健康保險山地離島地區醫療給付效益提昇計畫（IDS）的落實，讓偏遠地區低收入戶者在醫療上獲得了協助，而減少了就醫障礙，對低收入戶就醫實施是相當重要的；也發現社會工作者在提供服務與連結資源，對於低收入戶者有相當重要的影響。
並列摘要
The increasing urbanization in Taiwan has intensified urban-rural economic disparities, so that low-income individuals residing in rural areas have become even more disadvantaged. Because most residents in rural areas are either aged or low-income, they have low cultural capital and socio-economic status as well as insufficient medical knowledge. In addition, inherent to rural locations are such issues as the spatial distribution of rural settlement, inadequate transportation, and unequal distribution of medical resources, which make it even more difficult for rural residents to access medical resources and maintain good health, resulting in notable discrepancies in health between rural and urban residents. Although the premium for National Health Insurance for low-income households are subsided by the government and some health expenses waived, expenses for copayment, nursing care, and transportation are still barriers to medical accessibility. The purpose of this study is to investigate the medical behaviors, medical perspectives, and access to medical services of low-income residents in rural areas. The results may serve as references for the government to provide medical services and tailor medical care policies. The first stage of the present study involved quantitatively analyzing secondary data. The results of the Chi-square test indicated a significant difference in factors of ability (low-income) and needs (health condition). Cross-tabulations of multiple response analysis showed barriers of distance and transportation. These quantitative analyses accorded only partially with those of related studies. Qualitative interviews were conducted with ten professionals serving low-income residents in rural areas, including medical workers, social workers, community workers, and charity workers. This study calls attention to the need for social networks, resources, and personnel. Moreover, in addition to calling for provision of medical care services and related resources, the findings show the pivotal impact of implementation of an Integrated Delivery System (IDS) on overcoming barriers to medical accessibility for low-income residents in rural areas.
參考文獻
延伸閱讀
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