2003~2013年台灣主治醫師人力與服務量分佈之長期資料研究
－以產科、兒科、外科住院服務為主

張乃云

doi:10.6342/NTU201602605

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2003~2013年台湾主治医师人力与服务量分布之长期资料研究－以产科、儿科、外科住院服务为主

A longitudinal study on the distribution and service volume of obstetricians, pediatricians, and general surgeons between 2003 and 2013 in Taiwan

张乃云 , 硕士　　导师：郭年真　　

繁体中文 DOI： 10.6342/NTU201602605

医师人力；产科；小儿科；外科； obstetricians ； atricians ； general surgeons ； distribution

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摘要 │ 参考文献 (96) │ 国际计量

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Background： Currently, the 4 major medical disciplines in Taiwan (internal medicine, general surgery, pediatrics, and obstetrics and gynecology) suffer from a shortage of specialized physicians, which could lead to a crisis in health care system. This shortage can be attributed to an insufficient number of specialized physicians opting to work in hospitals and a declining number of medical students that are willing to enter a specialized discipline. Previous research that investigated physician manpower focused on overall decline, rather than the distribution of physicians by specialty. The current study aims to elucidate the geographic distribution of physicians and the relationship between patient volume and the number of attending physicians in different regions of Taiwan between 2003 and 2013. In so doing, we focused on general surgery, obstetrics, and pediatric inpatient services.

Methods：This study analyzed data from the National Health Insurance Research Database (NHIRD) that had been recorded between 2003 and 2013. Specifically, we developed multilevel growth curve models; performed one-way analysis of variance (one way ANOVA) for bivariate analysis; and used the growth curve function for multivariate analysis. The primary goal of this analysis was to elucidate relationships between level of urbanization, number of doctors per million people, average patient volume per physician, average number of payment dots, and average age of physician.

Results： There were a number of key findings in this study. (1) The number of obstetricians providing obstetric inpatient surgical services decreased between 2003 and 2013. (2) The number of pediatricians working in hospitals increased; however, the proportion of young pediatricians decreased. (3) There was an inverse relationship between the number of surgeons who work in a given area and patient volume, which increased the average patient burden of some surgeons. (4) There was disparity in the geographic distribution of attending physicians who provided general surgery, obstetric, and pediatric inpatient services. (5) The average age of obstetricians, pediatricians, and general surgeons increased. (6)Surgeon who worked in hospital tended to be young in low urbanized areas.
Conclusion：Between 2003 and 2013, the number of obstetricians, pediatricians, and general surgeons who provided inpatient service decreased. Furthermore, there was disparity in the geographic distribution of these specialized physicians. Specifically, our findings indicate that most doctors were clustered in highly urbanized areas. Currently, most physicians are middle-aged. Indeed, the number of younger physicians decreased throughout the study period, leading to an increase in average physician age. Given these findings, we suggest that policy interventions are necessary to resolve physician manpower issues in surgery, obstetrics, and pediatrics.

参考文献 ( 96 ) 〈TOP〉

Chang, R.-K. R., & Halfon, N. (1997). Geographic distribution of pediatricians in the United States： an analysis of the fifty states and Washington, DC. Pediatrics, 100(2), 172-179.
连结：
McConnel, C. E., & Tobias, L. A. (1986). Distributional change in physician manpower, United States, 1963-80. American Journal of Public Health, 76(6), 638-642.
连结：
Nomura, K., Inoue, S., & Yano, E. (2009). The shortage of pediatrician workforce in rural areas of Japan. The Tohoku journal of experimental medicine, 217(4), 299-305.
连结：
Rosenthal, M. B., Zaslavsky, A., & Newhouse, J. P. (2005). The geographic distribution of physicians revisited. Health Services Research, 40(6p1), 1931-1952.
连结：
Shipman, S. A., Lan, J., Chang, C.-h., & Goodman, D. C. (2010). Geographic maldistribution of primary care for children. Pediatrics, peds. 2010-0150.
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引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。