臺灣中醫師人力之地理分布趨勢分析

中醫於全民健康保險開辦時即納入給付，傳統醫療納入全民健保是全世界健康保險極為少見。臺灣各鄉鎮中醫師人力地理分布是否均衡，是提供可近性中醫醫療服務之關鍵，也攸關健康保險制度之公平性。因此本研究的主要目的在探討臺灣中醫師人力之地理分布趨勢及其影響因素。本研究以1997年至2017年共21年為觀察的時間，並以經濟學的GINI係數作為研究工具，將台灣地區所有中醫師作為研究母群體。利用行政院衛生福利部統計處網站及內政部戶政司統計處網站於2018年年底公布之全國中醫師人數及全國各鄉鎮區人口與全國總人口數之資料進行分析，來瞭解台灣地區中醫師人力之地理分布趨勢。研究結果發現，中醫師GINI係數值自1997年到2017年大約呈現穩定趨勢，顯示中醫師人力在地理分布有逐年改善之現象，但由於都會區域仍有較多的中醫醫療需求之吸力，使得大多數中醫師人力之地理分布仍集中在都會地區，雖然有長庚大學、義守大學與慈濟大學等大學在北部、南部及東部相繼設立中醫學系，但中醫師人力之地理分布改善仍相當有限，而以廣義估計方程式來評估影響各業務組分區內中醫師人力分布之GINI係數值，結果顯示各個健保業務組分區與健保浮動點值對於中醫師地理分布有顯著之影響，但健保總額浮動點值對於中醫師人力地理均衡分布之改善仍相當薄弱。結論與建議，中醫師人力在地理分布雖有改善趨勢，但偏鄉及離島中醫師人力依然處於不足，若要迅速改善中醫醫療服務之可近性，可考慮運用公立醫院之中醫醫療資源使之直接投入，或調整健保業務組區域結構範圍，或各區業務組之浮動點值加入各區內偏鄉差距及地理位置差異之因素，以規劃或分配較為適當或合理的健保點值以鼓勵中醫師前往偏鄉地區執業，促使中醫師之地理分布能趨於平均，以保障民眾之健康。

關鍵字

中醫；醫師人力；地理分布；總額預算； GINI係數

並列摘要

Traditional Chinese medicine has long been part of benefit package since the start of National Health Insurance Program, which frankly speaking, is quite rare for any health insurance around the world. The issues of balanced geographical distribution of traditional Chinese medicine practitioners in various townships and villages in Taiwan and the adequate access to nearby medical service are the key to ensure the fairness of the health insurance system. Therefore, the primary objective of this study was to explore the trend of distribution of traditional Chinese medicine practitioners in Taiwan and their underlying influential factors. The research would observe the time period from 1997 to 2017, a total of 21 years, with the help of using GINI coefficient from economics as the research tool, where all traditional Chinese medicine practitioners in Taiwan were included as the sample population. This study would base its understanding of the geographical distribution of traditional Chinese medicine practitioners on the statistical data of the number of traditional Chinese medicine practitioners, the population of all townships and villages and the total national population published on the website of the Statistics Department of Ministry of Health and Welfare of Executive Yuan and the Department of Household Registration of Ministry of Interior in 2018. The study result found that GINI coefficient of traditional Chinese medicine practitioners showed a steady trend from 1997 to 2017, indicating an annual improvement to overall geographical distribution of these personnel, even though there is still a greater demand of such service in metropolitan areas for these physicians to concentrate in the cities. Although with the help of Chang Gung University, I-Shou University and Tzi-Chi University to establish department of traditional Chinese medicine in Northern, Southern and Eastern Taiwan, the degree of improvement is still somewhat limited. By using the Generalized Estimating Equations (GEE) to evaluate factors influencing GINI coefficient of geographical distribution of traditional Chinese medicine practitioners in each business sector, the result showed that business sectorization and the floating point value of expenditure cap had significant impact, as the total health insurance floating point did little to improve such geographical distribution of personnel. In conclusion and recommendation, despite a slight improvement in the geographical distribution of traditional Chinese medicine practitioners, there is still the issue of inadequate personnel to cover remote areas and even offshore islands. To quickly improve the access of such medical service in these areas, it is possible to consider using the public hospital system and resource to directly establish traditional Chinese medical service, re-adjust the regional business sector structure of the health insurance program or allocate more appropriate health insurance floating point to these remote areas, to encourage these practitioners to evenly re-locate to these places to guarantee better health to the public.