西醫基層總額預算制度對高屏區醫療資源分布的影響

The Effects of Global Budget System of primary care on the Distribution of Health Resources in Kao-Ping Areas

方秀媖(Hsiu-Ying Fang)

指導教授 ： 毛莉雯 ； 李建興

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2005年)

摘要

醫療資源的分布均衡與否攸關民眾的就醫公平性，特別是在全民健康保險後，全民理論上應享相同之醫療資源可近性。對於實施總額預算制度是否可促進醫療資源之平均分布，至今國內外文獻仍未有定論，希冀經本研究瞭解西醫基層總額預算制度對高屏區鄉鎮醫療資源分布之影響。並探討影響充足區與缺乏區鄉鎮醫療資源的因素。
本研究設計為回溯性之次級資料分析，利用吉尼係數（Gini-coefficient）、顧至耐指標（Kuznets’indicator）及變異係數（coefficient of variation）三項指標，以測量高屏區鄉鎮基層西醫師數、西醫基層就醫次數及醫療費用之各項分布，在基層總額預算後是否更為平均。
研究結果高屏區之鄉鎮基層西醫師吉尼係數，在西醫基層總額實施前一年平均為0.184，實施後一年平均為0.179，顯著降低0.005，西醫基層就醫次數及醫療費用吉尼係數亦呈現降低，此顯示整體高屏地區醫療資源分布更平均。然而顧至耐指標未普遍降低，顯示個別醫療資源充足區與缺乏區鄉鎮未趨於平均。整體而言，西醫基層總額預算制度對高屏區鄉鎮醫療資源分布更為平均；但未擴及至相對較缺乏區。本研究亦發現影響充足區與缺乏區鄉鎮基層醫師人力之非制度因素，有人口密度及平均每人保費。醫療資源缺乏區可能因人口數、人口密度等非制度因素無法吸引更多的醫師加入。

關鍵字

就醫公平性 ； 吉尼係數 ； 總額預算 ； 顧至耐指標

並列摘要

Objectives: The distribution of health resources influences the equity and accessibility of healthcare for patients. Especially after the implementation of the National Health Insurance program, theoretically, all the population should have the same access to health resources. Previous studies did not conclude consistent findings in whether global budget (GB) system could enhance the distributions of health resources. The present study attempts to evaluate the effects of global budget system of primary care on the equality of health resource distribution in Kao-Ping areas. Methods: The study design was retrospective secondary data analysis. Gini coefficient 、Kuznets’ indicators and coefficient of variation were used to measure distribution equality of primary physicians, clinic visits and expenditures among villages and townships in Kao-Ping areas before and after the GB system. Results: As a whole, the declining values of Gini coefficients indicated that the distributions of health resources in Kao-Ping areas become more equal after the GB system. The average value of Gini for primary physician was 0.184 before the GB system, and changed to 0.179 after GB system, which reached the significant level of declining to 0.005. The values of Gini coefficients for clinic visits and health expenditures also dropped. In terms of Kuznets’ indicator, however, significant disparities of health resource distributions were found between the over-served and under-served areas. Conclusions: The GB system improved the equality of health resources in Kao-Ping areas. However, it was not extended to the areas where health resources are relatively least sufficient. Possible reasons could be the number of population or population density cannot provide strong incentives for primary physicians to practice in remote areas.

並列關鍵字

Gini-coefficient ； Kuznets’ indicator ； Global Budget System ； equity

參考文獻

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