緊急救護需求影響因素：新北市之實證研究

Abstract

緊急救護服務(emergency medical service, EMS)為社會重要的福利措施，亦為整體醫療體系中的重要環節。對於緊急救護需求影響因素的掌握與分析，可進一步作為緊急救護資源配置的參考，並可從中探討救護資源濫用的可能影響因素，作為防範救護資源濫用的依據。然而，過去研究所探討的影響因素多以人口與社會經濟因素為主，忽略城鄉差異與醫療資源的可能影響，實務上則缺乏相關研究基礎以作為政策研擬之參考。 本研究根據文獻回顧與實務經驗推論影響緊急救護需求與救護資源濫用的因素及其假說關係，並以新北市為實證對象，使用新北市政府消防局67個消防分隊(救護車配置據點)服務空間範圍為樣本，蒐集內政部國土資訊系統社會經濟資料庫、新北市政府消防局出勤紀錄與衛生局2012年統計資料，運用地理資訊系統整理樣本資料，採取截斷迴歸(truncated regression)模式分析樣本資料。 研究發現人口特徵、社會經濟、城鄉差異與醫療資源等四個層面對於整體、創傷、非創傷之緊急救護需求與救護資源濫用具有明顯的影響關係。研究結果釐清臺灣的影響因素與關係，及其與世界其他地區的異同；並且也討論將其應用於我國緊急救護需求推估、救護資源配置以及減緩救護資源濫用策略擬訂等實務的參考；同時，人口與城鄉差異變數的影響關係，也呼應緊湊城市理論中關於密集發展有助於提高公共服務與設施的營運效率論點。

Emergency medical service (EMS) is an important welfare measure in society as well as a vital part in a general medical system. Identifying and analyzing the factors which matter demands of emergency medical services may provide references to allocate emergency medical resources and clarify reasons why emergency medical resources are abused and prevent abuses therefrom. However, the previous researches mainly focused on demographic and socioeconomic factors and ignored the possible influences of rural-urban differences and unequal medical resources. In practice, it lacks broader researches to be used as references of policy developments. Based on literature review and practice experiences, this research identified the factors influencing emergency medical demands and emergency medical resource abuses and draws hypothetical relationships. To verify the proposed hypotheses, this research used the 67 fire station service districts in New Taipei City as study sample. The sample data were from the socioeconomic data base of land information system of Ministry of the Interior, attendance records of the Fire Department and the statistical data in 2012 of the Health Department.Geographic information systems and truncated regression models were employed to analyze the sample data. The empirical evidence show that attributes of demography, socioeconomy, rural-urban differences and medical resources were all significant factors affecting local emergency medical service demands and medical resource abuses of either trauma or non-trauma. The results of this research reach the following three contributions. First, the results clarify the influencing factors in Taiwan and their differences from other countries. Second, the results are able to be applied to estimate emergency medical service demands, allocate medical resources and mitigate medical resource abuses. Finally, the results support compact city theory regarding that compact developments facilitate operational efficiencies of public services and facilities.