民眾使用公部門緊急救護服務收費制度探討：以新北市為例

Charge Policy for Using Public Emergency Medical Services: A Case Study of New Taipei City

余旻衛(Min-Wei Yu)

指導教授 ： 黃一峯

共同指導教授 ： 黃琛瑜(Chen-Yu Huang)

淡江大學/商管學院/公共行政學系公共政策碩士在職專班/碩士(2016年)

https://doi.org/10.6846/TKU.2016.00527

摘要

「到院前緊急救護服務」是緊急醫療體系中相當重要的一環，與人民之生命安全息息相關。我國消防法規中明訂「緊急救護」為消防三大任務之一，而現行到院前緊急救護工作主要由各縣市消防局消防人員執行。探究公部門緊急救護資源特質，屬於公共財的一種，具有無排他性、非敵對性，然若資源被過度使用將產生擁擠性，恐造成公共財失靈的危機。近年來新北市緊急救護案件數不斷攀升，歸究其原因發現有部分源自民眾之濫用行為。因此本研究之目的聚焦於瞭解民眾對救護資源使用態度及相關法規政策認知現況、對政府推動救護收費政策之態度與付費意願，及其影響因子為何。
本研究為以居住於新北市且曾經使用過緊急救護服務之民眾為研究對象，並以立意抽樣方式進行調查。收案方式為受訪者自填結構式問卷，收案期間為2016年3月至4月。問卷總計發放300份，最終回收並分析282份問卷，故問卷有效回收率為94%。研究資料透過描述性統計、t檢定、卡方檢定、多元線性迴歸與羅吉斯迴歸等統計方法進行分析。
本研究主要發現包含：（一）受訪者之救護資源使用態度（6~30分）平均總分為24.90分；法規政策認知程度（6~30分）平均總分為21.01分；使用者付費觀念（2~10分）平均總分為7.38分；對政府收費政策可行性態度（3~15分）平均總分為12.26分；另外，有最多受訪者認為非危急患者使用救護資源應付2000元以上（48.2%）、認為可免費（7.1%）的受訪者最少。（二）比起女性，男性對政府收費政策可行性顯著地較不贊同（B =-0.454），而救護資源使用態度（B =0.167）、使用者付費觀念越佳（B =0.306），對收費政策可行性越贊同，且具有顯著影響。（三）個人願付價格分為三種方案，分別為免費與收費、1000元以上與1000元以下、2000元以上與未滿2000元。救護資源使用態度、使用者付費觀念在三種付費方案中皆具有顯著影響，進一步比較兩者在三種收費方案中的影響程度，發現救護資源使用態度在2000元以上與未滿2000元方案中之影響程度最劇（OR=19.87），而使用者付費觀念則在免費與收費方案中有最大的影響（OR=21.07）。

關鍵字

緊急救護服務 ； 使用者付費 ； 公共財 ； 新北市

並列摘要

As an important phase of emergency medical care system, “pre-hospital emergency medical service” is closely related to people's lives and safety. According to Fire Services Act, providing emergency medical service （EMS） is one of three major missions for fire departments, so pre-hospital EMS was mainly delivered by firefighter emergency medical technicians （EMTs） in Taiwan. EMS which offered by government is seen as a public good because its characteristics of non-excludability and non-rivalry. However, the more service is used, the more congestion will be increased. That might cause the crisis of public goods. The number of EMS cases in New Taipei City has risen consistently in recent years partly because services were overused. So the aims of this study were focused on people’s attitudes toward EMS using, degree of related legislation and policy perception, opinions on EMS charging policy feasibility, willingness to pay for EMS and their predictors.
Applying purposive sampling strategies, respondents were recruited from people who lived in New Taipei City and had ever used emergency medical services. 300 structured, self-administered questionnaires were distributed during March and April 2016. A total number of 282 respodents were completed and returned, giving an overall valid response rate of 94%. Descriptive analysis, t-test, chi-square test, multiple linear regression and logistic regression were employed for analysis.
The main findings can be summarized as follows: （1） respondents’ mean scores of EMS using attitudes （total scores: 6~30）, legislation and policy perception degree （6~30）, user charge notion （2~10）, and EMS charging policy feasibility （3~15） were 24.90, 21.01, 7.38, and 12.26 respectively. Moreover, most respondents stated that non-emergency patients who used EMS should pay over NTD 2,000 （48.2%）; in contrast, there were only 7.1% respondents agreed that non-emergency patients could use EMS for free. （2） Compare to female, male did not approve of EMS charging policy feasibility relatively （B =-0.454）. However, respondents’ EMS using attitudes （B =0.167） and user charge notions （B =0.306） had statistically significant positive effect on EMS charging policy feasibility. （3） Three different styles of willing-to-pay programs were discussed, including: free or paid, paid under NTD 1,000 or over, paid under NTD 2,000 or over. Both respondents’ attitudes toward EMS using and notions of user charge increased the odds of charge significantly in all willingness to pay programs; a further comparison of the effect degree of these variables indicated that respondents’ EMS using attitudes had greatest effect on paid under NTD 2,000 or not （OR=19.87）, while their user charge notions had greatest effect on charge or not （OR=21.07）.

並列關鍵字

Emergency Medical Service (EMS) ； user charge ； public goods ； New Taipei City

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