中部四縣市社區健康診斷之研究

The Study of Community Health Diagnosis In Four counties of Central Taiwan

莊錦銘(Chuang Chin-Min)

指導教授 ： 龔佩珍 ； 李采娟

亞洲大學/健康學院/健康管理研究所/碩士(2004年)

摘要

隨著台灣社會急速的變遷，衛生問題也由傳染病防治演變成更多元與複雜化，且因縣市的不同，民眾的健康狀況與需求亦有所不同，如何在有限的資源下推動最適切且符合效益的健康促進與疾病預防計劃，「社區健康診斷」佔一重要的地位。故本研究進行中部四縣市民眾健康狀態評估研究，以期能作為「醫療網第四期計畫－新世紀健康照護計畫」在辦理不同的資源整合與促進醫療品質之工作依據。
社區健康診斷研究分三方面進行，一為利用衛生署死亡資料檔、2001年台灣各年齡層男女人口數、國家衛生研究院全民健康保險研究資料庫與問卷調查中部四縣市民眾以取得各種健康狀態指標；二為利用行政院衛生署衛生統計資料與行政院內政部統計資料取得社區資料；三為利用全民健康保險研究資料庫、2001年台灣各年齡層男女人口數與行政院衛生署衛生署統計資料預估醫療及社會服務利用，分析中部四縣市民眾健康問題。
結果得知，台中市有較低死亡率、粗罹病率、身心障礙者、獨居老人與家暴受害者盛行率，及最高之人口成長人數、社會增加率、高齡生育率、粗結婚率、粗離婚率、犯罪發生率、空屋率、遷移率、醫療資源、社會福利機構、都市化程度與醫療利用；台中縣有最佳自覺健康狀態，且其總人口數、依賴人口數與自然增加率最高，社會治安也最佳；彰化縣有最高出生率與生育率，但其有最低遷移率與醫療利用及每十萬人口有最少診所數與病床數；南投縣有最高死亡率、粗罹病率、受虐兒童、身心障礙者、獨居老人、家暴受害者盛行率、老年人口比例、依賴人口比例，且其有最低社會服務利用及每十萬人口有最少醫院家數、醫師、中醫師與牙醫師。
中部四縣市中，台中市有最佳健康狀態，在醫療與社會福利資源及都市化程度上有絕佳的優勢，但其人口成長與遷移及婚姻狀態變動大且自覺健康狀態與社會治安較差。台中縣社會治安最佳，其佔有人口數最多，民眾自覺健康狀態也最佳。彰化縣每十萬人口有較少診所與病床數，其在醫療利用情形也偏低。南投縣有最差健康狀態以及最高人口負擔，但其醫療與社會福利資源反而較缺乏，在社會服務利用率也偏低。

關鍵字

社區健康診斷 ； 社區資源 ； 醫療資源 ； 健康指標

並列摘要

Due to the rapid change of Taiwan’s society, public health management has transformed from mere epidemic prevention to more diverse and complicated issues. In addition, the needs and wants of the public vary according to the public health condition and the composition of the population in individual city or county. The “Community Health Diagnosis” can play a prominent role in achieving effective and efficient health promotion and disease prevention under limited resources. This study evaluates the public’s health condition in three counties and one city in central Taiwan. The results of the study are expected to become the basis for the Fourth-Phase Plan of Medical Care Net: The New Century Health Passport, a plan to incorporate diverse resources and advance the quality of medical care.
The research on Community Health Diagnosis is conducted from three dimensions. The first dimension is to establish indicators for the public health. The data used include public mortality data from the Department of Health (DOH), age and gender distributions of the population in Taiwan in 2001, the national insurance data from the National Health Research Academy and a health survey about the population in the three counties and one city in Taiwan’s central regions. The second dimension is to gain community information using statistical data from DOH and the Department of Interior (DOI). The third dimension is to analyze the health problems among the population in the four studied regions using national insurance data from the National Health Research Academy, age and gender distributions of the population in Taiwan in 2001, and the estimates of medical care and social service utilization from DOH.
The results show that Taichung City has relatively lower mortality and morbidity rates, lower numbers of living-alone elderly and people with physical and mental disability, and lower rate of domestic abuse. On the other hand, Taichung City has the highest population growth rate, society growth rate, birth rate of women older than 35, marriage rate, crime rate, non-occupied housing rate, migration rate, urbanization rate, and medical utilization rate. Taichung City also ranks the highest in medical resources and the numbers of social welfare organizations. Taichung County has the best self-reported health condition and public safety. Moreover, its sizes of the county population and dependent population are the largest and the natural rate of population growth is the highest. Changhwa County has the highest birth and pregnancy rates, but it also has the lowest migration rate, medical care utilization rate, and the lowest number of clinics and hospital beds per 100,000 population. Nantao County has the highest mortality, morbidity and domestic abuse rates, the highest number of abused children, people with physical and mental disability, living-alone elderly, the highest dependent ratio and the proportion of people older than 65. In addition, the county has the lowest social welfare utilization rate, and the lowest numbers of hospitals, doctors, doctors of Chinese medicine, and dentists per 100,000 population.
Among the four counties, Taichung City enjoys the best public health condition, and has the advantage of prevalent medical care, social welfare resources, and urbanization. On the other hand, its considerable fluctuations in population growth, migration and marital stability of the population, and relatively poorer self-reported health condition and public safety are the disadvantages. The Tauchung County has the best public safety and self-reported health. Changhwa County has the lower number of clinics and hospital beds per 100,000 population and medical utilization rate. Nantao County has the worst public health condition and highest dependent ratio. And to make the situation worse, the county has lacked the medical care and social welfare resources and has a low rate of social service utilization

並列關鍵字

community health diagnosis ； community resource ； medical resource ； health indicator

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