- 學位論文
台灣地區婦產科專科醫院醫療服務市場趨勢變化: 區域差異和服務項目延伸及成效探討
Market Trends of OBS/GYN Specialty Hospitals in Taiwan： The Study on the Performance of Regional Differences and Extension Services
摘要
中文摘要 研究目的 本研究旨在探討國人婦產科醫療就醫特性，並針對婦產專科醫院興起在婦產科醫療市場佔率變化的影響及醫療資源利用情形進行分析。藉此瞭解各層級婦產科醫療服務市場的差異比較，以提供經營者擬訂正確的經營策略，進而鞏固醫療市場佔有率。 研究方法 本研究使用健保資料庫次級資料。採用回溯性縱貫式研究設計，資料期間為1997到 2010年。以全國婦產科之住院人口為樣本，並以婦產科之自然產、剖腹產、子宮切除與卵巢切除四種常見醫療處置病人為分析對象。首先用趨勢分析法探討婦產專科醫院與非婦產專科醫院的醫療服務利用人數市場佔率及趨勢變化。再來採用邏輯斯迴歸分析四種醫療處置照護品質之影響因子。最後採用線性迴歸分析探討婦產科四種醫療處置之住院天數及醫療費用影響因子及資源利用情形。 研究結果 婦產專科醫院在產科之醫療服務利用率呈現顯著線性增加趨勢，非婦產專科醫院及基層診所則呈現顯著線性減少趨勢。在婦科醫療服務利用率方面，婦產專科醫院、醫學中心及區域醫院則呈現線性增加趨勢，地區醫院及基層診所呈現顯著線性減少趨勢。 醫療照護品質方面，婦產專科醫院在剖腹產的倂發症發生率比非專科醫院高1.13倍，但自然生產、子宮切除與卵巢切除的倂發症發生率都是專科醫院比較低。在住院天數方面，專科醫院自然產、剖腹產、子宮切除及卵巢切除手術當次住院的平均天數皆較非專科醫院為低。而在醫療費用方面，專科醫院自然產當次住院的平均醫療費用27,119 點較非專科醫院為高，其他剖腹產、子宮切除、卵巢切除手術當次住院的平均醫療費用皆較非專科醫院為低。 結論和建議 本論文的結果顯示，婦產專科醫院以醫療照護品質佳、醫療資源利用少的優勢表現在產科醫療服務市場有絕對競爭優勢，但在婦科醫療服務市場佔率仍以區域級以上醫院為主，在政府人口政策措施尚無法改善少子化現象情況下，婦產專科醫院可再強化婦科醫療服務，提升婦科市場服務利用率。以婦產科專科化的經營優勢及成本效益，應可為現今多數處於競爭弱勢的婦產科診所轉型學習的標竿。 關鍵字 自然產、剖腹產、子宮切除、卵巢切除、婦產科專科醫院、醫療服務利用
並列摘要
Abstract Purpose The study aims to discuss how people use the OBS/GYN healthcare service and analyze the market share of the OBS/GYN Specialty Hospitals and the medical resource utilization. The different levels of the market of OBS/GYN service will be compared to provide hospital managers the suitable managing strategies and consolidate the medical market share. Methods The study uses the secondary data in the National Health Insurance Research Database and the retrospective and longitudinal study. The period of the secondary data is from 1997 to 2010. The sample is the national number of hospitalized patients of OBS/GYN, focusing on the OBS/GYN patients with the following medical services, including normal spontaneous delivery, Cesarean delivery, hysterectomy and oophorectomy. The trend analysis approach is adopted to discuss the market share of the medical service and the trend variation between the OBS/GYN Specialty Hospitals and the General Hospitals. The four factors of the healthcare quality are analyzed through the logistic regression analysis. The linear regression analysis is later adopted to discuss the hospital length of stays of the four medical care services with their impact factors and the medical resource utilization. Results In the GYN medical service utilization, the OBS/GYN Specialty Hospitals show a linear increase, while the General Hospitals and other clinics show a linear decrease. In the OBS medical service utilization, the OBS/GYN Specialty Hospitals, the medical centers and the local hospitals show a trend of linear increase, while the local hospitals and the clinics show a linear decrease. In healthcare quality, the occurrence rate of complication in Cesarean delivery in the OBS/GYN Specialty Hospitals is 1.13 times higher than that of the General Hospitals; however, the General Hospitals have lower occurrence rate of complication in normal spontaneous delivery, hysterectomy and oophorectomy. In the hospital length of stays, the Specialty Hospitals have shorter hospital length of stays than the General Hospitals in normal spontaneous delivery, Cesarean delivery, hysterectomy and oophorectomy services. In the medical expenses of the Specialty Hospitals, the average charge of the normal spontaneous delivery in hospital stay is NT$27,119, which is higher than that of the General Hospitals, while in Cesarean delivery, hysterectomy and oophorectomy the average charge is lower than that of the General Hospitals. Conclusion The study concludes that the dominant advantage of the OBS/GYN Specialty Hospitals in the medical market share is the healthcare quality and less medical resources utilization. The current medical market share of the OBS medical service still focuses on the regional hospitals. The government's policy still cannot handle the low-birth rate. The OBS/GYN Specialty Hospital can improve their OBS medical service to increase their medical service utilization. Learning from the specialization of OBS/GYN, including the advantages of management and the cost control, the general OBS/GYN clinics can improve their less advantageous position in the market. Keyword NSD, CS, OBS/GYN Specialty Hospitals, Normal spontaneous delivery, Cesarean delivery, hysterectomy, oophorectomy, Healthcare utilization.