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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 郭年真(Nein-Chen Kuo) | |
| dc.contributor.author | Ya-Hui Chung | en |
| dc.contributor.author | 張雅惠 | zh_TW |
| dc.date.accessioned | 2022-11-24T03:09:47Z | - |
| dc.date.available | 2021-11-03 | |
| dc.date.available | 2022-11-24T03:09:47Z | - |
| dc.date.copyright | 2021-11-03 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2021-10-26 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80577 | - |
| dc.description.abstract | 研究背景:我國在全民健康保險實施後，醫療機構家數逐年上升，讓民眾就醫更具便利性、快速性。在全民健康保險實施後歷經多次傳染病大流行(如SARS、H1N1等)，並依傳染病疫情嚴重程度也會直接影響民眾就醫意願，進而間接影響醫療機構服務量，像是2002-2004年SARS(嚴重急性呼吸道症候群)流行期間，因SARS病毒傳播途徑主要透過飛沫、空氣等傳播且病毒感染力、致病力強，導致民眾影響民眾外出至醫療機構就醫意願，加上SARS確診個案大多數送至醫學中心、區域醫院接受治療，因此受到各種因素的影響下，事後分析全民健康保險資料庫發現，SARS疫情流行期間醫院的申報件數呈現明顯下降。在本次新型冠狀病毒肺炎(COVID-19)傳染病疫情流行期間，我國的防疫政策已達到超前部署，然仍有出現COVID-19確診個案，因此各醫療機構服務量能仍有受到本次疫情影響。 研究目的:本研究目的為探討本次新型冠狀病毒肺炎(COVID-19)傳染病疫情流行期間，不同層級別之醫療機構服務量疫情受到影響程度，並與SARS(嚴重急性呼吸道症候群)疫情期間進行比較，藉此瞭解兩種不同疫情對我國醫療機構服務量所造成的衝擊。 研究方法:本研究為橫斷性研究，透過分析全民健康保險資料庫，瞭解在 2018-2020年(COVID-19)及2002-2004年(SARS)傳染病疫情流行期間，不同層級別醫院及西醫基層診所醫療服務利用情形之變化。統計軟體是以SAS9.4版及SAS EG進行統計分析，描述性分析包含分析各科別申報平均值、百分比；推論性統計包含兩組變項T檢定、迴歸分析。 研究結果:在2020年COVID-19疫情流行期間，與2019年同期相比後發現2020年3-5月對我國醫療機構衝擊最明顯。SARS疫情期間與疫情前一年(2002年)同期相比，2003年4-8月對我國醫療機構衝擊最明顯，醫院整體門診、住診申報件數均呈現下降，其中醫院門診、住診申報件數均以6月份醫學中心下降最多，分別下降44.38%、42.81%；醫院急診申報件數在醫學中心呈現下降，但區域醫院及地區醫院則呈現上升；西醫基層整體門診申報件數以2003年6月份下降最多(下降20.22%)。 在2020年COVID-19疫情流行期間，小兒科、內科、耳鼻喉科、家醫科是影響最多的科別，且在基層診所申報件數及醫療費用均受疫情影響有呈現明顯下降但醫院部分科別未有明顯減少，但SARS時期醫院的影響居較顯著，與這次COVID-19研究得知的結果相反。 結論:2020年醫院門診、急診、住診與西醫基層診所門診醫療利用情形，與2019年相比，總體來說呈現顯著下降，可以推論COVID-19疫情確實帶來醫療機構服務量能不小的衝擊。雖然疫情流行嚴重程度會影響民眾到醫療機構就醫意願，但以2020整年度觀之，醫院與西醫基層診所整體門診、急診、住診申報件數在3月到5月期間有明顯下降之外，在5月過後其申報件數有回升趨勢，可能是我國防疫政策奏效。 以整體門診申報件數來看，COVID-19疫情期間西醫基層呈現顯著下降，但醫院未有明顯下降；SARS時期則是醫院下降有達統計顯著，西醫基層診所則未受到明顯衝擊，因此COVID-19與SARS兩個疫情流行期間，醫療機構受到衝擊的程度正好相反，推測可能是我國西醫基層診所及執業醫師人數等醫療機構量能逐年增加、2018年起推動分級醫療期望達到壯大基層目的有關。 以就醫科別來看，基層診所整體門診受到衝擊影響最多的科別分別為小兒科、家醫科、內科、耳鼻喉科等，與醫院不同的是，四大科別基層診所門診申報件數及醫療費用在2020年均呈現負成長，且與2019年相比均呈現受到疫情影響有明顯減少，推估可能是截至2020年12月COVID-19疫情尚在流行及COVID-19病毒傳播特性、致病力等，降低民眾就醫意願，間接導致基層四大科別的醫療服務利用情形仍無法恢復。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-24T03:09:47Z (GMT). No. of bitstreams: 1 U0001-2510202100065000.pdf: 2218735 bytes, checksum: 6fae8b9879a678c0848ca246c008d94b (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | 致謝 I 摘 要 II ABSTRACT V 目 錄 IX 表目錄 XI 圖目錄 XII 第壹章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 4 第三節 實習單位簡介 4 第貳章 文獻回顧 6 第一節 新型冠狀病毒肺炎(COVID-19) 對我國醫療體系影響 6 第二節 新型冠狀病毒肺炎(COVID-19) 對各國之醫療體系影響 7 第三節 嚴重急性呼吸道症候群(SARS)對我國醫療體系影響 10 第四節 嚴重急性呼吸道症候群(SARS)對各國醫療體系影響 13 第五節 流行疫情影響程度影響民眾就醫行為的改變 14 第參章 研究設計與方法 16 第一節 研究設計與架構 16 第二節 研究假說 18 第三節 研究對象 18 第四節 資料來源與處理流程 18 第五節 研究變項與操作型定義 21 第六節 統計分析方法 24 第肆章 研究結果 25 第一節 基本資料描述 25 第二節 不同層級別醫療機構醫療費用申報之多變項分析 61 第三節 研究結果小節 80 第伍章 討論 81 第一節 研究方法之討論 81 第二節 研究結果之討論 81 第三節 研究假說驗證 87 第四節 研究限制 88 第陸章 結論與建議 89 第一節 結論 89 第二節 建議 91 參考文獻 93 | |
| dc.language.iso | zh-TW | |
| dc.subject | 科別 | zh_TW |
| dc.subject | 新型冠狀病毒肺炎 | zh_TW |
| dc.subject | 醫療機構服務量 | zh_TW |
| dc.subject | 醫療機構層級別 | zh_TW |
| dc.subject | 疫情大流行 | zh_TW |
| dc.subject | healthcare service volume | en |
| dc.subject | different level of healthcare service provider | en |
| dc.subject | pandemic | en |
| dc.subject | COVID-19 | en |
| dc.subject | division | en |
| dc.title | 探討新型冠狀病毒肺炎(COVID-19)對不同層級醫療機構服務量的影響 | zh_TW |
| dc.title | Explore the impact of the Coronavirus Disease 2019 (COVID-19) on the healthcare service volume among different level of provider | en |
| dc.date.schoolyear | 109-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 楊銘欽(Hsin-Tsai Liu),許忠逸(Chih-Yang Tseng) | |
| dc.subject.keyword | 新型冠狀病毒肺炎,醫療機構服務量,醫療機構層級別,疫情大流行,科別, | zh_TW |
| dc.subject.keyword | COVID-19,healthcare service volume,different level of healthcare service provider,pandemic,division, | en |
| dc.relation.page | 97 | |
| dc.identifier.doi | 10.6342/NTU202104103 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2021-10-26 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
| 顯示於系所單位： | 公共衛生碩士學位學程 | |
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