台灣地區醫事人力配置對死亡率影響－1998至2007年縱貫性研究

The Effects of Healthcare Staffing on Mortality Rate in Taiwan－A Longitudinal Analysis from 1998 to 2007

楊雅君(Ya-Chu Yang)

指導教授 ： 張肇松

高雄醫學大學/健康科學院/醫務管理學研究所/碩士(2009年)

摘要

研究背景與目的：過去國外研究指出，醫師人力供給對於人民健康有正向之影響，因此本研究想探討台灣地區醫事人力配置與死亡率之間的關係。

研究方法：蒐集台灣369 個鄉鎮1998 年至2007 年共十年的醫事人力數(西醫師、牙醫師、中醫師、護理師、護助產士、其他醫事人員)與死亡率等資料，資料來源於行政院衛生署歷年各縣市執業醫事人員數統計表；人口社經變項包含人口密度、平均每戶可支配所得、原住民人口比例、教育程度、失業率與老化指數等，則源於內政部所設立之中華民國統計資料庫。統計分析分成橫斷與縱貫，橫斷分析採用迴歸分析中的最小平方法(OLS)，而縱貫分析則使用OLS 模式與廣益估計方程式(generalized estimating equation, GEE)去檢視醫事人力配置對死亡率之影響。

研究結果：橫斷性統計分析結果顯示，除護助產士外醫事人力配置與死亡率呈現統計上顯著負向關係；而在縱貫性GEE 模式我們發現每千人口西醫師數及牙醫師數與粗死亡率呈現統計上顯著負向關係，當每千人口西醫師數、牙醫師數各增加一位，粗死亡率各下降0.4%(p<0.05)與4.8%(p<0.05)。

結論：在台灣，西醫師數及牙醫師數人力配置與死亡率呈現負向關係，而牙醫師密度相較於西醫師密度對於死亡率有較好的預測能力，這可能代表著醫療資源分布不均問題而非牙醫師直接對死亡率之影響。

關鍵字

醫事人力死亡率西醫師 ； 牙醫師

並列摘要

Objective: Literature review shows that physician supply has a positive effect on population health. This study was aimed to investigate the relationship between healthcare staffing and mortality rate in Taiwan.

Method: Data of healthcare staffing (physician, Chinese medical physician, dentist, RN, LVN, and other health staffs) and mortality rate of 368 townships in Taiwan from
1998 to 2007 were retrieved from the yearly Bulletin of Manpower Statistics, Department of Health. Socioeconomic status including population density, average household income, racial/ethnic composition, education, unemployment rate and aging index were obtained from National Statistics, Department of Internal Affair, Taiwan. Statistical analysis including ordinary least squares (OLS) model for cross-sectional analysis and generalized estimating equation (GEE) model for longitudinal analysis were performed to study the effect of healthcare staffing on the mortality rate.

Results: Our results showed that there was a significantly negative association between all kinds of healthcare staff, except LVN, and the mortality rate in cross sectional analysis using OLS model. In the longitudinal analysis with GEE model, we found the number of physician and dentist per thousand were negatively associated with the crude mortality rate among 368 townships. Increasing the number of physicians and dentist by one per thousand will decrease the mortality rate by 0.4% (p<0.05) and
4.8% ( p<0.05), respectively.

Conclusions: The physician and dentist supply have a negative effect on mortality rate in Taiwan. The dentist density has a better prediction on mortality rate than the physician,
which might represent uneven distribution of healthcare staffing, and rather than a true effect on mortality.

並列關鍵字

healthcare staffing ； mortality rate ； physician ； dentist

參考文獻

中文文獻

孔吉文(1989)。台灣地區山地鄉平地鄉嬰兒死亡率輿醫師密度相關之研究。國立台灣大學公共衛生研究所碩士論文，未出版，台北。

江東亮(1992)。公元二千年臺灣地區醫師人力的供給與地理分布之推計。臺灣醫誌91, 109-116。

江東亮(1995)。台灣地區的醫師人力政策：1945-1994。中華衛誌14(5), 383-391。

行政院衛生署(2007)。醫療設施、醫事人力現況及醫療服務。