我國嚴重急性呼吸道症候群防治措施之評估

Evaluation of Prevention and Control measures of SARS in Taiwan

王秀英(Wang Shiow-Ing)

指導教授 ： 楊志良 ； 徐慧娟

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2004年)

摘要

本研究之目的在於瞭解我國SARS防治政策與執行狀況，並應用效果、效率、公平及反應力等四個準則，來檢視我國SARS防治措施中的資源動員、隔離檢疫、醫療照護及教育宣導等四個面向，在每個準則下建立符合其意涵的具體指標加以測量，以客觀合理地評估政府防疫作為。
本研究主要是透過文獻探討，蒐集與研究主題相關之資料，再藉由政策評估方法中的指標法進行研究主題的評估工作。研究範圍僅鎖定在2003年3月14日至7月5日這段期間的防疫作為。
本研究主要評估結果如下：
一、資源動員方面：防疫物資的發放主要集中在醫學中心與區域醫院，若以地區別為劃分，則多集中於台北區和高屏區。物資發放不但供應量不足，發放亦未按照可能病例收治與分佈情形公平地分配。專責醫院的設置並未採用有效率的方式進行。民眾普遍認為動員速度太慢。
二、隔離檢疫方面：對遭受隔離的人員掌握情形不佳。入境者管制措施調整方案違反公平意涵。民眾對隔離檢疫之措施抱持正面肯定的態度。我國付出龐大的社會成本，然本研究無法就成本效益加以分析。
三、醫療照護方面：與各國評比表現居中，發燒篩檢站成效良好。投入抗煞多屬層級較高的醫療院所及公立醫院，僅佔全國醫療院所的24.09﹪，並未有效率地運用。離島地區的民眾並未享受到公平的防疫醫療照護。媒體對醫護人員的評價呈現二極，但民眾多抱以正面態度予以肯定。
四、教育宣導方面：五月時仍有一至二成眾未看過相關宣導，且民眾開始不信任宣導內容。政府在宣傳時有公平地考量到語言弱勢者的需求。我國是較早利用電視媒體展開宣傳的國家。
本研究提供了一個可用來評估傳染病防治的架構與指標，並實際就我國SARS防治措施加以衡量。為了使我國傳染病防治政策更趨完善，針對研究結果提出下列建議：
一、遇重大衛生事件或計劃，應設立專門且中立的「評估小組」，進行總體評估檢討。
二、訂定衛生工作分級動員指標與機制，以期在面對突發事件時能迅速劃分處理的層級與權責單位。
三、設置單一的權責機構負責資源的統籌與配送。
四、重新檢視此次SARS防治紓困經費規劃並提出運用情形與成效報告。
五、建立機制，有系統地蒐集防疫資料與保存。
六、結合醫院評鑑制度，強化醫院感染控制。
七、未雨綢繆，事先建置防疫作業準則。

關鍵字

SARS防治 ； 政策評估 ； 指標

並列摘要

This study focuses on the prevention and control measures of SARS in Taiwan. The following four criteria: effectiveness, efficiency, equity and responsiveness are applied to Resource Mobilization, Quarantine, Medical Care and Health Education four dimensions. Under each criterion, concrete indicators were built so as to evaluate the nation’s epidemic control of SARS.
The evaluation of the studied subject, dated from March 14,2003 to July 5, 2003, is conducted with the indicator approach of the policy evaluation method.
Results：
1. Mobilization of medical resources:
The essential infection control supplies are facilitated mainly in medical centers and regional hospitals or areas around Taipei and Kao-Ping branch of Bureau of National Health Insurance. The provision failed not only to reach an ample amount but also to be distributed fairly according to the hospitalizing and spreading of the probable SARS cases. The setup of the SARS referral hospitals wasn’t carried out efficiently. The public generally considered the mobilization should’ve been speeded up.
2. Isolation and infection control:
The management and supervision of people under home quarantine worked poorly. The regulation-adjusted measures for arrival have already perverted justice. Though the public was positive to the policy actions, our society still paid dearly. However, the cost-benefit is not analyzed in this study.
3. Measures for health care:
Our nation’s response to the crisis was under the public’s expectation as compared with other affected areas. The Fever Screening Centers functioned properly. Hospitals which joined in the prevention and control of SARS, were constituted only 24.09% of the nation’s. The medical resource was not utilized efficiently. The islanders haven’t been provided with equal medical attention. The media’s opinions of healthcare workers diverged but the public is positive of their contribution.
4. Public health education:
Ten to twenty percent of the general public did not aware about the conducting lectures of SARS and started to lose their confidence in the promotional materials in May. The different spoken languages in Taiwan were greatly considered when providing guidelines and recommendations. The government coordinated with the media to make public announcements to promote SARS awareness in the relatively early stage.
This study provided a framework and indicators for epidemic control, to apply in the nation’s prevention and control measures of SARS evaluation. The following suggestions are advanced for a better epidemic control:
1. A specific and neutral unit should be designed to provide an overall evaluation when encountering heath issues nationwide.
2.Work out an effective mechanism of determining the administrative level activation when any health issue occurs.
3. Set up a single organ to be responsible to make the distribution of medical resources uniform throughout the country.
4. Reexamine the funds for prevention and control of SARS and bring forward the report of spending and the result.
5. Establish a mechanism to collect and preserve data concerning the epidemic control systematically.
6. Adopt the system of hospital assessment to strengthen the infection control in hospitals.
7. Build up a disease-prevention pamphlet to take necessary precautions.

參考文獻

2.王維恭、高全良(2004)：SARS冠狀病毒。台灣醫學，8(1)：55-61。

3.王振泰、張上淳(2004)：SARS病人的臨床表現與治療。台灣醫學，8(1)：62-69。

10.洪健清、蕭正祥、張上淳(2003)：嚴重急性呼吸道症候群。當代醫學，30(7)：525-534。

15.陳建仁(2003)：從SARS談台灣的應用流行病學教育。台灣流行病學學會會員大會暨學術研討會手冊。

23.蘇顯揚(2003)：SARS影響亞洲國家經濟成長。經濟前瞻，88：40-43。