新設立醫院對鄰近醫院初診病患來源影響之研究

The impact of new hospital on a neighbor hospital’s new patients in Taichung county

施雅文(Ya-Wen Shih)

指導教授 ： 洪錦墩

中臺科技大學/管理學院/醫護管理研究所/碩士(2008年)

摘要

目的：中大型醫療機構設立勢必對區域醫療服務市場產生影響，近年台灣中部地區醫院之新設與擴充甚多，對此區域內鄰近之醫療機構造成影響程度值得加以評估，由於初診病患數量多寡是醫療機構服務量是否能夠繼續成長的重要指標，因此針對新設立醫療機構對鄰近醫療機構初診病患來源造成之影響更應深入分析探討。本研究之研究目的在瞭解新設立醫院對鄰近個案醫院初診病患來源之影響，包含分析初診病患的個人特質、疾病類型、居住地分佈、醫療費用與利用之變化，研究結果將有助於瞭解新設立醫院對鄰近醫院所產生之影響。
研究方法：本研究是以個案醫院所提供的初診與複診病患資料庫並蒐集醫院2005年至2007年門診急診病患醫療服務利用資料來進行統計分析及比較，運用差異中之差異的配對t檢定來檢定2005年至2006年初診病患月就醫人次差值與2006年至2007年的初診病患月就醫人次差值，探討初診病患的個人特質、疾病類型、居住地分佈、醫療費用與利用之變化是否有顯著性的差異，並以迴歸模型方式分析初診病患醫療費用的變化情形。
研究結果：研究結果發現，新設立醫院前後至個案醫院就診之初診病患的平均年齡由34歲變為32歲有年輕化的趨勢，以21~30歲的病患佔23~27%為最多；在就醫科別部分，以內科、外科、小兒科、婦產科與骨科為主佔約79%；在疾病診斷以不明情況下一些症候群、中毒損傷與呼吸系統疾病為主佔約50%；健保案件申報以西醫急診為主佔43%。初診病患平均回診次數由0.90次減少至0.75次；初診病患佔整體門診百分比從2.80%降至2.56%；以迴歸分析的結果發現在控制初診病患性別、年齡、就醫科別、處方給藥日數與健保案件分類後，新醫院設立後對初診病患的醫療費用影響為醫令用藥費用是下降，而醫令診療費用與總醫療費用是增加的情形。
結論與建議：個案醫院來自新設立醫院所在鄉鎮的初診病患人數有下降的趨勢，由此可見初診病患會因為考量就醫交通方便，所以會前往新醫院就醫。個案醫院應可加強醫療服務市場定位與區隔，如重點醫療科別行銷及強化東勢、石岡與卓蘭區域初診病患開拓，避免與新醫院客源重疊。在部分重點科別之品質競爭應是個案醫院可行之策略，可考慮地緣可近性優勢開設與老年及慢性病等相關醫療門診，並提供相關醫療服務，使醫院受新設立醫療機構之影響能降到最低。

關鍵字

新醫院 ； 初診病患 ； 醫療服務市場

並列摘要

Objective: The establishment of major medical institutions is bound to have an impact on the market of regional medical services in recent years. Recently there are so many hospitals in central Taiwan set up and expanded that it’s worth assessing how many effects that will make on the area. The number of newly diagnosed patients is an important indicator of the amount of medical bodies that how much effects they can afford and decide whether they can continue to grow or not. Therefore, the influence should be discussed and analyzed in between the newly established medical institutions and newly diagnosed patients. The purpose of this study is to understand the relationship between the new hospital in the nearby hospital and newly diagnosed patients. The sources, including analysis of the personal characteristics of newly diagnosed patients, the disease type, place of residence distribution, medical costs and changes. The results of the study will help to understand the impact that the new hospital to nearby hospitals.

Methods: This study is based on the data of the newly diagnosed patients and the information of out-patient medical services that is for emergency patients from 2005 to 2007. Using the difference in different pairs of t Test, we tested and compared the different numbers of two periods, 2005-2006 and 2006-2007. The margin from 2005-2006 and 2006-2007, we discussed and analyzed those factors and they are the personal characteristics of newly diagnosed patients, the disease type, place of residence distribution, medical expenses. And the uses were significant changes in the differences, and analyze the changes in the cost of medical cases of newly diagnosed patients by regression model mode.

Results: The results found that the average age of newly diagnosed patients is as the hospital before and after the establishment of new cases to the hospital from 34-year-old into a 32-year-old younger trend, with 23-27% of 21 to 30-year-old patients accounting for most. For other parts of the medicine to medicine, about 79 percent is mainly for surgery, pediatrics, obstetrics, gynaecology and orthopaedic. For diagnosis of the disease, unknown circumstances syndrome, injury and poisoning, respiratory diseases are mainly accounted for about 50 percent. For health insurance declaration of emergency cases, Western medicine mainly accounted for 43 percent. Newly diagnosed patients with an average of up to reduce the number by 0.90 times to 0.75 times the total out-patient newly diagnosed patients percentage from 2.80% to 2.56%; regression analysis found that newly diagnosed patients in the control of sex, age, other medical and prescription the number of health-care administration and classification cases, the new hospitals to set up after the initial impact of a patient''s medical expenses for the medical treatment costs are reduced and the medical treatment fees and medical costs is to increase the overall situation.

Conclusions and recommendations: The establishment of new cases in hospitals from the hospital where the township number of newly diagnosed patients with a downward trend, this shows that newly diagnosed patients because of considerations for medical treatment easily accessible, so will go to the new hospital. The hospital should be able to strengthen the medical service market positioning and segmentation, such as the focus of medical divisions and strengthen the marketing potential East, Shek Okazaki newly diagnosed patients with Zhuolan regional development, to avoid overlapping with the new hospital source. In some divisions focused on the quality of competition should be a feasible strategy for the hospital, may consider the geographical advantage can be created with nearly the elderly and chronically ill, and other related medical clinics and provide medical services to the hospital by the newly established medical institutions to drop the effect of to the minimum.

並列關鍵字

New hospitals ； Healthcare services market ； First visit patients

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