帛琉健康照護基金轉診至臺灣病人醫療利用之探討

Abstract

本研究分析帛琉健康照護基金（Palau Healthcare Fund, HCF）轉介病人轉診到臺灣接受治療之醫療利用情形，探討近年轉診疾病結構與就診科別分布之變化，並比較不同疾病類別及合作醫院間之差異。研究資料來源為 HCF 轉診行政紀錄，納入 2023 至 2024 年間經轉診委員會核准並實際赴臺就醫之轉診個案，共計 368 人次。 研究結果顯示，整體平均等候天數為 39.5 天，平均住院天數為 8.7 天，平均住院以外停留天數為 21.7 天，其中 41 人次僅接受門診治療。轉診疾病以惡性腫瘤最多（28.3%），其次為心血管疾病（21.2%）及骨科疾病（17.4%）。就診科別分布以心臟內科及心血管外科最多（21.5%），其次為骨科（17.7%）、泌尿科（11.4%）及婦產科（10.1%）。各就診科別及主要疾病類別之醫療利用狀況均呈現顯著差異。 新光吳火獅紀念醫院接 231 人次（62.8%），馬偕紀念醫院接 129 人次（35.1%），兩家醫院合計承接 98.1% 之轉診個案。兩院轉診病人於年齡分布、主要疾病類別及就診科別結構上呈現顯著差異，顯示兩家醫院在轉診體系中承接之病例組成與臨床功能定位存在系統性差異。 整體而言，帛琉轉診到臺灣之醫療個案以高負擔慢性疾病為主。各醫療利用指標之高度變異，顯示轉診制度除病例數外，亦需關注疾病組成、治療型態與醫院別之影響。未來可透過疾病別與醫院別醫療利用指標之系統性監測，以提升制度之長期可持續性。

This study examines medical utilization among patients referred from the Republic of Palau to Taiwan under the Palau Healthcare Fund (HCF), focusing on recent changes in disease patterns and clinical specialty distribution, as well as differences across disease categories and referral hospitals. Administrative records of approved referrals between 2023 and 2024 were analyzed, including a total of 368 cases. The results showed that the mean waiting time was 39.5 days, the mean length of hospital stay was 8.7 days, and the mean number of non-inpatient days was 21.7 days. A total of 41 cases received outpatient care only. The most common referral categories were malignant neoplasms (28.3%), cardiovascular diseases (21.2%), and orthopedic conditions (17.4%). In terms of specialty distribution, cardiology and cardiovascular surgery accounted for the largest proportion (21.5%), followed by orthopedics (17.7%), urology (11.4%), and obstetrics and gynecology (10.1%). Medical utilization differed significantly across clinical specialties and major disease categories. Shin Kong Wu Ho-Su Memorial Hospital received 231 referrals (62.8%), while Mackay Memorial Hospital received 129 referrals (35.1%), together accounting for 98.1% of all cases. Patients referred to the two hospitals differed significantly in age distribution, primary diagnoses, and specialty distribution, indicating systematic differences in case mix and functional roles within the referral system. Overall, referrals to Taiwan mainly involved high-burden chronic diseases. Substantial variation across medical utilization indicators indicates that referral policies should consider not only referral volume but also disease composition, treatment patterns, and hospital characteristics. Future referral planning may benefit from systematic monitoring of disease- and hospital-specific utilization indicators to enhance the long-term sustainability of the system.