牙醫總額支付制度實施後牙醫人力分布變化與牙醫醫療資源配置相關因素探討

The Research for Dentist Distribution and Variation factors in Dental Global Budget System

鄭光雄(Kuang-Hsiung Cheng)

指導教授 ： 黃純德 ； 藍守仁

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2003年)

摘要

中文摘要
本研究目的，為瞭解自1998年，牙醫實施總額支付制度後，至2002年間，台灣牙醫師人力變化與資源的分布及無牙醫師鄉鎮的狀況。研究材料，取材自1998至2002 年牙醫健保申報資料，其中1998年22，460，669筆，1999年22，866，125筆，2000年23，045，282筆，2001年24，390，269筆，2002年25，178，786筆合計五年 117，941，131筆。每一年區分為一時段，共有五時段，同時，將台灣分成六個健保分區，23個縣市，359個鄉鎮市區(不含金馬地區)來計算，牙醫師人力、醫療申請點數、就醫人數、就診次數、牙醫師人口比、每十萬人口牙醫師數，在鄉鎮市區的分布變化情形。研究結果: 1998-2002年，人口自然成長率年平均0.75﹪，牙醫師年平均成長率4.25﹪，明顯地，牙醫師人力供需，會逐年漸進，趨向平衡。牙醫市場將會有飽和甚至過飽和現象。在台灣，牙醫師人力地理分布不均是事實。城鄉之間，牙醫師服務人口數，差距很大。以2001年嘉義縣1: 7562與2001年台北市1: 1247，二者相差近6倍，在2001年，全國有66個無牙醫師鄉鎮。健保醫療耗用情形:在牙醫師服務人口數少的鄉鎮市區，其申請的點數較高；在牙醫師服務人口數多的鄉鎮市區，其申請點數較低。資源利用不平均，醫療資源仍集中在都市化程度較高的鄉鎮市區。在1998-2001年健保醫療資源有50﹪是使用於牙醫師服務人口數小於2500的鄉鎮市區。牙醫醫事人力流動的誘因，市場的力量是牙醫師人力配置不合理的主因。無牙醫師鄉鎮個數，逐年增加。2001年後，政策面介入，費用協定委員會在牙醫總額中，明訂專款專用，已明顯的使無牙醫師鄉鎮個數減少，僅剩45個(表2)。牙醫醫療資源利用更趨平均。
關鍵字:牙醫師(Dentist) 人力(manpower)

關鍵字

牙醫師 ； 人力

並列摘要

ABSTRACT
The purpose of this study is to understand the changes of dentist manpower distribution, distribution of dental medical resource and towns and villages that have no dentists. The material of this study is collected from the data of dental medical fee from the Bureau of Health Insurance in the year of 1998, 1999, 2000，2001 and 2002. In 1998 there were 22，460，669 pieces, in 1999 there were 22，866，125 pieces, in 2000 there were 23，045，282 pieces in 2001 there were 24，390，269 pieces and in 2002 there were 25，178，786 pieces .。All together there were117，941，131 pieces in 5 years。 One year is treated as one period, the total is 5 periods. There are six health insurance districts in Taiwan. The number of county and city is 23, the number of townships is 359 ( It is not included the area of Kinmen and Matsu ). The dental medical fee, number of patients , number of visitations , the ratio of dentists and patients , the number of dentists in the population of 100,000, and the variation in the country and in the city. The result of this study has shown that the population growth is 0.75 % per year , the ratio of dentist growth is 4.25% annually. It is obvious that supply and demand will gradually be equal. The dentist market will be saturated or over-saturated. It is a fact that the location of dentists is not fairly distributed. The differences in the ratio of dentists and patients between the city and the country is huge. In Chiai County in 2001. the ratio was 1: 7562. In Taipei City in 2001，the ratio was 1 : 1247. The discrepancy between these two figures is 1: 6. In 2001 the number of no dentist available in the country was 66. The dental medical fee is higher in the country that has less dentist visitations ?The dental medical fee is less in
iii the area that has more dentists visitations. The dental medical resource is concentrated in urbanized areas. About 50% of health insurance supplementary fee was used in the area that the ratio of dentist and patient was less than 1 : 2500 during 1998~2001. The incentive of manpower variation depends much on the power of dentists’ market. The number of non-dentist available in the country is increasing each year starting from 2001, a policy which stipulates that the total of dentist supplementary fee must be used for its specified purpose only, it has caused the number of non-dentist available in the country is decreasing. Dental medical resources will be distributed equally in the country and in the city.
key word : Dentist manpower

並列關鍵字

Dentist ； manpower

參考文獻

參考文獻 　

1.Healthy People 2000. U.S.Department of Health and Human Services， Public Health Service．

2.馮茂倉。牙醫門診總額支付制度對牙醫健保醫療資源分配的影響。﹝碩士論文﹞。高雄：高雄醫學大學口腔衛生科學研究所；2002。

3.陳孝平。影響全民健康保險醫療費用因素之探討。供給面1999 行政院衛生署委託研究計劃。盧瑞芬、謝啟瑞。醫療經濟學。台北:學富出版社；2000。

4.行政院衛生署網站http//www.doh.gov .tw/