臺灣小兒科醫療資源空間可接近性分析

Spatial Accessibility to Pediatric Services in Taiwan

10.30409/JPA.201303_(44).0001

廖興中(Hsin-Chung Liao)

小兒科醫師人口比 ； 空間可接近性 ； 地理資訊系統 ； 「兩階段流動搜尋法」 ； 空間自相關分析 ； pediatric physician-to-population ratio ； spatial accessibility ； geographic information system ； enhanced two-step floating catchment area method ； spatial autocorrelation analysis

公共行政學報

44期（2013 / 03 / 01）

1 - 39

繁體中文

本研究利用「進階式兩階段流動搜尋法」（enhanced two-step floating catchment area method）針對臺灣各村里小兒科醫療資源空間可接近性進行評估，並透過敘述統計、單因子變異數分析與Scheffe檢定，檢測不同都市發展類型間在醫療資源可接近性是否有顯著差異。此外，本研究透過Anselin's LISA及Getis-Ord's Gi*(d)進行空間自相關分析，找出臺灣小兒科醫療資源缺乏的集中區域。最後，在空間分析的部分，根據健保局101年巡迴醫療資訊，繪製出服務涵蓋區域的地圖；並與先前所完成評估結果進行對照，評量其對於臺灣小兒科醫療資源空間可近性改善的程度。研究結果顯示小兒科資源缺乏的村里多位於偏遠鄉鎮、農業市鎮或是高齡化市鎮。空間自相關分析則發現，小兒科醫療資源特別缺乏的群聚區域大致分布在中央山脈沿線、雲嘉南沿海與北部竹苗等地區附近之村里。此外，健保局在101年度巡迴服務提供的範圍，大致有回應到實際的情況，並未出現過多資源錯置現象。然而，仍然約有將近27%的小兒人口，位在醫療資源不足的區域，並可能無法取得巡迴醫療服務。因此，未來透過跨區域資源整合的觀點，針對群聚性較高的醫療資源缺乏區域，重新思考小兒科醫療資源缺乏區域的改善政策，有其必要性。

This study uses a geographic information system to calculate a geographically modified pediatrician to population ratio by using a two-step floating catchment area method which incorporated two different distance-decay functions to evaluate pediatrician resources in Taiwan. The result of Scheffe and spatial analysis shows that there is a gap between urban and rural areas in spatial accessibility. The spatial autocorrelation analysis finds that the clusters of pediatric shortage areas are located near Central Mountain Range, southwest coast, Hsinchu and Miaoli. Although the Bureau of National Health Insurance's policy does cover some shortage areas, there are still nearly 27% of the people under eighteen within pediatrician shortage areas. Therefore, it is very important to use cross-boundary policy to improve the shortage of pediatric resources in the future.

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