醫療資源與病人跨區住院之相關性研究

Abstract

背景： 醫療網計畫實施至今已逾三十五年，全民健康保險實施至今已逾二十五年，然而醫療服務量逐年遞增，全國醫院家數卻逐年遞減，現行各醫療區域內的醫療資源分布是否均衡？與二十年前相比，跨區住院的問題是否有所改善？影響民眾跨區住院因素是否有所改變？以上都是本研究欲探討之範圍。 研究目的： 本研究目的在於比較二十年前後的醫療資源分布與民眾跨區住院情形，並探究影響病人跨區住院因素是否有所差異。研究目的欲了解臺灣現行醫療區資源現況及比較 20 年跨區住院比例差異。再深入探討影響住院病患跨區住院因素並比對 20 年後是否有所差異。 研究方法： 本研究利用與衛生福利部中央健康保險署合作之全民健保病人住院經驗調查，調查期間為民國 107 年 11 月至民國 108 年 3 月，並利用目前取得最新醫療資源分布之現況來了解醫療資源對於病患跨區與否之影響。 研究結果： 本研究主要結果為臺灣整體跨區住院比例下降；區域醫療資源（每萬人口醫師數、每萬人口急性一般病床數、有無醫學中心/重度急救責任醫院、（準）區域級以上醫院數）與民眾跨區住院與否顯著相關。 結論： 在 20 年後的臺灣依然存在醫療資源分布不均之現象，建議衛生主管機關對於各醫療區內的醫療資源重新評估，以期醫療資源均勻分布。

Background: The implementation of the Medical Care Network Program has been more than 35 years. The implementation of National Health Insurance has been more than 25 years. However, the number of medical services has increased year by year. The number of hospitals nationwide has been decreasing year by year. Is the distribution of medical resources in various medical areas currently available and balanced? Has the problem of cross boundary medical utilization improved compared with 20 years ago? Does it affect the inpatient's cross boundary behavior factors? All of the above are the scope of this study. Objective: The main purpose of this study was to compare the distribution of medical resources and the cross boundary inpatients hospitalization across the 20 years, and to explore whether there are differences in factors affecting the cross boundary hospitalization of patients. The study is going to understand the current status of resources in Taiwan's current medical boundary and compare the differences in the proportion of hospitalizations across the 20 years. Further explore the factors affecting the cross boundary medical utilization of inpatients and compare whether there is a difference after 20 years.

Methods: This study used the National Health Insurance Patient Hospitalization Experience Survey conducted by the National Health Insurance Administration of the Ministry of Health and Welfare. The survey period was from November 2018 to March 2019 in Taiwan, and the current status of the latest medical resources distribution was used to understand the medical resources distribution and its impact on inpatients across the medical boundary. Results: The main result of this study is that the proportion of Taiwan's overall cross-boundary inpatient has declined; regional medical resources （number of physicians per 10,000 population, number of acute general beds per 10,000 population, presence or absence of medical centers/severe first aid hospitals, number of Regional Hospitals ） are significantly associated with cross-boundary medical utilization. Conclusions: In the two decades, there is still a phenomenon of uneven distribution of medical resources in Taiwan. It is recommended that the health authorities reassess the medical resources in each medical boundary so that medical resources are evenly distributed.