臺灣醫療區跨區住院比例之變遷，1985-1995

Changes in the Proportion of cross-region Admissions in Taiwan, 1985-1995

10.6288/CJPH1998-17-05-04

洪維河(Wei-Her Hong)；鄭守夏(Shou-Hsia Gheng)；張睿詒(Ray-E Chang)；江東亮(Tung-Liang Chiang)

醫療網 ； 跨區住院 ； 計畫評估 ； medical care network ； cross-region admission ； program evaluation

中華公共衛生雜誌

17卷5期（1998 / 10 / 01）

388 - 394

繁體中文

自1985年衛生署推動醫療網計畫以來，不但資源缺乏醫療區的醫院設施已明顯增加，而且醫院病床地理分布不均的現象亦不再惡化。本研究旨在以跨區住院比例為指標，檢視過去十年來住診可近性的改變情形。本研究假設跨區住院比例會隨著醫院病床供給及地理分布情形之改善而降低；研究資料則取自衛生署傷病調查資料庫、內政部臺閔地區人口統計，以及其他官方出版品。研究結果顯示，(l)1985到1995年間，雖然全國跨區比例已從19.9%降低至17.9%，但醫療區跨區住院比例的變異係數則從50.0%增加為57.9%；(2)對任一研究年度而言，跨區住院比例均與人口密度存在弱相關，與醫院病床供給存在強相關；(3)控制醫療區的區域醫院和醫學中心家數後，跨區住院比例與人口密度和醫院病床供給的相關變為不顯著；以及(4)跨區住院比例的改變與人。密度和醫院病床供給的增加，呈現弱負相關。根據以上結果，本研究建議衛生政策必須考慮區域醫院與醫學中心的角色，以改善臺灣住診服務的可近性。

Since the implementation of the Medical Care Network program in 1985, the supply of hospital facilities in disadvantaged medical regions has substantially increased and the geographic distribution of hospital beds in Taiwan has been improved. This study aims to examine changes in access to inpatient care as measured by the proportion of cross-region admissions for the last decade. It was hypothesized that the proportion of cross-region admissions has decreased following the improvement in the supply and geographic distribution of hospital beds. The data for the analysis came from Hospital Discharge Surveys, Demographic Fact Books, and other governmental publications. The results of this study showed that: (1) Between 1985 and 1995 regional differentials in the proportion of cross-region admissions in terms of coefficient of variation have increased from 50.0% to 57.9% though the national proportion of cross-region admissions has slightly decreased from 19.9% to 17.9%; (2) For each study year the proportion of cross-region admissions was weakly associated with population density but strongly associated with the supply of hospital beds; (3) After controlling the number of regional hospitals and medical centers in a region, the proportion of cross-region admissions had little to do with population density and supply of hospital beds; and (4) Change in the proportion of cross-region admissions was negatively and weakly associated with increasing population density and increasing supply of hospital beds. This study thus concludes that the important role of regional hospitals and medical centers should be well taken into account in order to improve geographic access to hospital care in the future.