全民健康保險實施後花蓮偏遠地區民眾醫療可近性之探討

The Study of Health Care Accessibility in Remote Areas of Hualien County after the Launching of National Health Insurance Program

張慈桂(Tzu-Kuei Chang) ； 李燕鳴(Yin-Ming Li) ； 蕭正光(Cheng-Kuang Shaw)

《慈濟醫學雜誌》 10卷3期 (1998/09) Pp. 201-209

https://doi.org/10.6440/TZUCMJ.199809.0201

摘要

全民健康保險的開辦是我國衛生政策的重要里程碑。但就醫的公平性與醫療資源的分佈息息相關，如果不具備醫療資源，空有健康保險，民眾無法接受醫療照護。本研究之目的在於瞭解偏遠地區民眾之醫療行為及醫療可近性。以立意抽樣方式選取花蓮縣三個山地鄉(秀林鄉、萬榮鄉、卓溪鄉)及豐濱鄉四個偏遠地區作為研究區域，再選取花蓮市、玉里鎮、光復鄉、壽豐鄉作為對照區域，收集民眾之醫療行為、醫療利用及可近性之資料。總共回收18歲以上民眾之有效樣本799份，結果發現偏遠地區民眾有較高的醫療需求，並有較高之門診、急診及住院醫療利用，但在醫療可近性方面，離民眾最近的醫療機構為衛生所/群醫中心，但民眾最常就醫的場所卻為私人診所，有較多偏遠地區民眾認為就醫不方便(40.1%比14.5%)，而在就醫時間上，需花費較對照地區2.3倍之時間才能獲得醫療照護。儘管如此，偏遠地區民眾對全民健保卻有較高的滿意度(66.2%比45.7%)。雖然偏遠地區民眾在取得醫療資源的可近性上，存有不方便之處，但全民健保的實施對偏遠地區民眾仍是重要的健康保障，民眾普遍呈現較高的滿意度。

關鍵字

醫療可近性 ； 偏遠地區 ； 健康保險

並列摘要

The National Health Insurance Program is ont of the most important health welfare policies in Taiwan. However, equity of medical care is associated with distribution of medical resources. Without the availability of medical care, even people with health insurance can’t access the care they need. To evaluate the behavior of seeking medical care and accessibility of medical care in remote areas of Taiwan, for townships in remote areas of Hualien County (Wan-Jung, Chuo-Chi, Hsin-Lin, Feng-Pin) and four nearby townships (Hualien, Kuang-Fu, Shou-Feng, Yu-Li), used as controls, were selected. A random sampling of 799 people over age 18 was conducted. The results showed that people in remote areas had more medical needs and higher utilization of out-patient, emergency and in-patient care. In addition, although most people in remote areas felt the Public Health Station and Public Group-Practice Center were located close to them, the most frequently used medical institute was private clinics. More people in remote areas felt that medical care was in convenient (40.1% vs 14.5% in townships) and they spent more time (2.3 fold) seeking medical care. However, people in remote areas had higher satisfaction with the National Health Insurance Program (66.2%vs 45.7% in townships). Barrier to medical care still exist in remote areas, but the National Health Insurance Pro-gram provides important support for people in remote areas and there is higher satisfaction with the program in remote areas than in nearby control townships.

並列關鍵字

health care access ； romote area ； health insurance