臺灣基層醫療缺乏區域界定之初探：整合空間與非空間因素的分析

Exploring the Definition of Primary Healthcare Shortage Areas in Taiwan: Integrating Spatial and Nonspatial Factors

10.29865/PAP.201406_(58).0004

廖興中(Hsin-Chung Liao)

醫療資源可近性 ； 地理資訊系統 ； 進階式兩階段流動搜尋法 ； 因素分析 ； Geographic information systems ； Healthcare access ； Spatial Accessibility ； Primary healthcare shortage areas

行政暨政策學報

58期（2014 / 06 / 01）

121 - 152

繁體中文

本研究透過空間因素與非空間因素的整合思考，評估有關臺灣基層醫療的可近性。空間可近性著重患者與醫生在地理空間上的阻隔因素，而非空間性因素則包含了非地理空間上的阻隔或促進因素，例如年齡、性別、種族、貧窮、教育。本研究有關人口與社會經濟資料從臺灣2013年內政部之社會經濟資料庫取得，2012年基層醫療醫師資料則是由中華民國醫師公會全國聯合會提供。首先，本研究透過地理資訊系統以進階式兩階段流動搜尋法，計算出15公里開車範圍內的空間可近性指標。其次，因素分析則用來幫助本研究將各項的社經變數重新組合成兩個主要的因素：（1）社會經濟弱勢（2）高度健康需求。最後，本研究將整合這些空間與非空間因素，界定出臺灣基層醫療可能缺乏的區域，並與目前中央健康保險署2014年「西醫醫療資源不足地區改善方案」，以及2013年「全民健康保險山地離島地區醫療給付效益提昇計畫」進行對照。

This study considers both spatial and nonspatial factors in examining access to primary healthcare in Taiwan. Spatial access emphasizes the importance of geographic barrier between patient and physician, and nonspatial factors include nongeographic barriers or facilitators such as age, gender, race, poverty, and education. The population and socioeconomic data are from the 2013 Ministry of Interior's Socioeconomic Database, and the 2012 primary care physician data are provided by the Taiwan Medical Association. First, an enhanced two-step floating catchment area method which is implemented in Geographic Information System (GIS) is used to measure spatial accessibility based on 15 km road distance. Secondly, the factor analysis method is used to group various sociodemographic variables into two factors: (1) socioeconomic disadvantages, and (2) high healthcare needs. Finally, spatial and nonspatial factors are integrated to identify areas with poor access to primary healthcare, and the findings are used to compare with the ＂2014 Improving under Served Healthcare Resources＂ program and ＂2013 Integrated Delivery System＂ program of National Health Insurance Administration.

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