以系統動態學探討臺灣老年醫學專科醫師供需之研究

Abstract

面對日漸增加的老年人口，台灣地區自1994年開始進入高齡化社會，預計2018年增加至14.0 %的高齡社會，2026年將會達到20.1 %的超高齡社會，老年醫療照護有其需要。然而，老年醫學專科醫師人力是否足以配合老年醫學需求量的變化，目前尚無相關性的系統分析討論。 本研究之人口數據及醫師人力資料取得，來自台灣老年學暨老年醫學會及全國醫師聯合公會，透過相關文獻與數據的蒐集，利用系統動態學方法及VENSIM電腦軟體描繪因果迴路圖，對於老年醫學科醫師人力供需之相關影響因素，以質性分析討論，若以含65歲以上人口其中的百分之三十需要醫療照護，參照美國老年醫學會人力中心推計，每位老年醫學專科醫師需照顧老年人口700位，計算出台灣需要1,155位老年醫學專科醫師，而目前僅有828位，故每位老年醫學專科醫師需照顧老年人口976位。 其中各種影響因素的因果迴路圖，可模擬出增強型和平衡型迴路，並嘗試將各迴路作綜合思考。本研究亦提出建議，可作為相關決策單位參考，以期對於台灣當前老年醫療環境有所貢獻。

In an era of increasing geriatric population, Taiwan's 65- and-over population is on course to go from being an“aging society”in 1994, 7% of population are 65 years old or older, to an “aged society”in which 14% or more of its population are 65 years old in 2018. It is estimated that Taiwan would become a “super-aged society, 20% of the population 65 years old or over, by 2026. The geriatric medical healthcare is mandatory. However, whether the changing of geriatric workforce is compatible with the increasing of geriatric healthcare, there is few relevant systematic or narrative review currently. Data of population and geriatric workforce were obtained from Taiwan gerontology and geriatric society, Taiwan medical association. Gathering data and references cited, we developed system dynamics modeling for Taiwan geriatric workforce and depicted the causal-loop diagram using Vensim software. The relevant influencing factors of demand and supply side of geriatric workforce are analysed qualitatively. According to the American Geriatrics Society’s Geriatrics workforce policy studies center (GWPS), it is projected that approximately 30% of the 65 plus patient population will need to be cared for by a geriatrician and that each geriatrician can care for a patient panel of 700 older adults. Based on these assumption applied in this research, 1,155 geriatrician are needed. As on 2013, there were 828 certified geriatricians currently. Each geriatrician would care for 976 older adults. We summarize the key factors influencing the relative attractiveness to be a geriatrician, we depicted each factor’s reinforcing causal feedback loop or balancing causal feedback loop respectively. As a comprehensive thinking, we try to put every causal feedback loop together to have a discussion. Relevant solutions are suggested in this study in reference to policy maker and decision maker. We hope that this study is contributed to current geriatric healthcare environment.