醫療可近性與可預防住院的關聯-檢測偏鄉巡迴醫療計畫的成效

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陳育穎(Yu-Ying Chen) 查詢紙本館藏

畢業系所

產業經濟研究所

論文名稱

醫療可近性與可預防住院的關聯-檢測偏鄉巡迴醫療計畫的成效
(Medical Care Accessibility and Preventable Hospitalization: evaluate the IDS effects)

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摘要(中)

雖然台灣從1995 年開始實施全民健保制度，減輕了民眾在使用醫療資源上的財務負擔，但是位於偏遠山區或是離島的居民卻仍然空有保險，而無處看病，導致醫療可近性存在城鄉差距。因此，健保署也逐步實施偏鄉醫療計畫以改善偏遠地區醫療資源不足的問題，其中於民國88 年起實施的「全民健康保險山地離島地區醫療給付效益提昇計畫」（Integrated Delivery System, IDS），藉由導入偏鄉外的醫療資源與整合當地醫療院所與山地離島鄉衛生所，改善偏鄉地區整體健保醫療服務品質。本研究使用1996 至2006 年健保資料庫中，偏鄉地區病患資料，利用差異中差異分析法，估計參與計畫之鄉鎮在IDS 計畫實施前後兩年可預防住院的變化。實證結果發現位於台灣西半部地區的IDS 計畫之鄉鎮，在IDS 計畫實施之後有顯著的降低可預防住院的發生，而對於住院醫療費用也有節制的效果存在。然而，位於台灣東半部地區的IDS 計畫之鄉鎮，在IDS 計畫實施之後反而有增加可預防住院發生的趨勢，而可預防住院醫療費用也有提高的現象，隱含當地可能存在未獲滿足的醫療需求（unmet medical need），而在經過醫療介入之後，當地醫療資源的增加正好滿足了當地病患的醫療照護需求量。

摘要(英)

Despite the fact that Taiwan has implemented National Health Insurance (NHI) at 1995, there′s still some people who live in rural areas have obstacles to access medical
care. In order to improve the accessibility of medical care, the Department of the Health and Welfare successively implemented the integrated delivery system (IDS for short) programs which appoint local hospitals to regularly offer ambulatory care to the residents living in different remote areas since 1999.
This research selects patients reside in rural areas and its neighbor townships from 1996-2006 National Health Insurance Database and uses difference-in-difference
technique to evaluate the IDS policy effect on preventable hospitalization. We found that rural townships in the west of Taiwan have lower rate of preventable hospitalization as well as the hospitalization expenditures after the implementation of the IDS plan. By contrast, the rural townships in the east of Taiwan have the opposed effects, that is the
IDS program will increase the rate of preventable hospitalization and its expenditures. This may imply that the IDS may substitute inpatient care for ambulatory care for the residents in remote township in the east.

關鍵字(中)

★ 醫療可近性
★ 可預防住院
★ DID
★ 山地離島地區醫療給付效益提昇計畫

關鍵字(英)

★ Accessibility of medical care
★ Preventable Hospitalization
★ Difference in Difference
★ Integrated Delivery System

論文目次

中文摘要 ··························································································· I
ABSTRACT ······················································································ II
誌謝 ······························································································· III
目錄 ······························································································· IV
圖目錄 ····························································································· V
表目錄 ···························································································· VI
第一章緒論 ······················································································ 1
第一節研究背景與動機 ···································································· 1
第二節研究目的 ············································································· 5
第二章文獻回顧 ················································································ 7
第一節可預防住院 ·········································································· 7
第二節醫療資源分佈 ······································································· 8
第三節偏鄉醫療政策 ······································································· 9
第四節醫療體系變化 ····································································· 11
第三章研究方法 ·············································································· 14
第一節差異中差異分析法（DIFFERENCE-IN-DIFFERENCE METHOD） ············ 14
第四章資料來源與變數說明 ······························································· 18
第一節資料來源與建構 ··································································· 18
第二節變數說明與敘述統計 ····························································· 22
第五章實證結果分析 ········································································ 32
第一節可預防住院機率 ··································································· 32
第二節住院醫療費用 ······································································ 48
第六章結論 ···················································································· 52
第一節結論與建議 ········································································· 52
第二節研究限制 ············································································ 54
參考文獻 ························································································· 56
附錄一 ···························································································· 59

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指導教授

蔡偉德(Wei-Der Tsai)

審核日期

2017-6-27

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