區域透析資源對基層腎臟科醫師產出表現之影響

The Impact of Regional Dialysis Resources on Primary Nephrologists' Productivity on Terms of Patient Care

10.6288/TJPH2013-32-04-03

陳怡潔(Yi-Chieh Chen)；吳肖琪(Shiao-Chi Wu)

區域透析資源 ； 基層腎臟科醫師人力 ； 產出表現 ； regional dialysis resources ； primary nephrologist labor ； output performance

台灣公共衛生雜誌

32卷4期（2013 / 08 / 15）

320 - 330

繁體中文

目標：應用標準位置理論及環境選擇模式分析台灣各鄉鎮市區血液透析床資源與基層腎臟科醫師產出表現的關係。方法：利用國家衛生研究院全民健康保險資料庫，以回溯性世代研究探討2007年鄉鎮市區透析資源對已執業及新執業基層腎臟科醫師於2009年產出表現之影響，採piecewise迴歸及逐步複迴歸分析。結果：血液透析床資源飽和程度對已執業醫師與新執業醫師產出未達統計上顯著差異，基層腎臟科醫師之總申報金額隨血液透析床資源飽和程度僅有小幅下降。醫師產出隨都市化程度往鄉鎮市區降低而增加，2007年每萬人口醫院血液透析床越多，已執業醫師2009年總申報金額會減少0.5%，而新執業醫師總申報金額降低0.38%。結論：血液透析床資源飽和程度可能影響醫師間的競爭情形，使基層腎臟科醫師之產出增加趨勢有減緩現象，且每萬人口醫院血液透析床越多則基層腎臟科醫師之產出下降。

Objectives: This study applied standard location theory and the environmental selection mode to examine the relationship between a township's dialysis resources and primary nephrologists' productivity in Taiwan. Methods: This was a retrospective cohort study using the National Health Insurance database. The study subjects were licensed nephrologists who had practiced dialysis services from 2007 to 2009. Piecewise regression and stepwise linear regression were applied to explore whether a township's dialysis resources in 2007 were associated with primary nephrologists' production in terms of patient care in 2009. Results: The number of hemodialysis beds per ten thousand population had no significant impact on the nephrologists' total outpatient income. The nephrologists' production in terms of patient care increased over time, but at a descending pace. Primary nephrologists who practiced in suburban townships tended to raise their production of patient care. In townships with more hemodialysis hospital beds per ten thousand population in 2007, established primary nephrologists' output decreased by 0.5% in 2009, while new primary nephrologists' output decreased by 0.38%. Conclusions: Fewer than 10 hemodialysis beds/10,000 population may have an impact on competition among primary nephrologists and lead to the descending pace of increase in productivity. In townships with more hemodialysis hospital beds per ten thousand population, practicing primary nephrologists' output decreased.

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