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    題名: 以空間計量分析探討臺灣長照需求推估與資源配置的區域差異
    Regional Disparities in Long-Term Care Demand Estimation and Resource Allocation in Taiwan: A Spatial Econometric Approach
    作者: 郭沛禎
    Kuo, Pei-Jhen
    貢獻者: 傅健豪
    Fu, Chien-Hao
    郭沛禎
    Kuo, Pei-Jhen
    關鍵詞: 長期照護
    區域差異
    空間分析
    空間計量模型
    Long-Term Care
    Regional Disparities
    Spatial Analysis
    Spatial Econometric Models
    日期: 2025
    上傳時間: 2025-07-01 14:18:53 (UTC+8)
    摘要: 伴隨著人口快速高齡化、家庭照顧功能式微等趨勢,臺灣社會正面臨著日益嚴峻的長期照護挑戰。長照政策的規劃與推動均仰賴對需求的精準掌握,然而,目前臺灣在長照需求人口的推估上仍面臨標準不一的問題,各項研究與調查結果難以比較與整合。另一方面,長照資源配置在以「在地老化」為目標的政策架構下亦顯得更加重要。過往研究多著重於資源分布現況的描述,對於造成區域間可近性差異的潛在因素則較少著墨,以空間視角切入的實證分析亦相對缺乏。
    本研究以臺灣本島349個鄉鎮市區為研究對象,結合公開資料與財政資訊中心資料推估近五年長照需求人口,探討以報稅資料作為推估基礎的合理性,並進一步運用冷熱點分析、空間計量模型等空間分析方法探討長照資源擁有率冷區之分布特性。
    實證結果顯示,報稅資料雖具穩定性高、能夠如實反映短期變化的優勢,但其完整性仍有待提升,尤其在經濟條件相對弱勢的地區,低估現象更為明顯。此外,長照資源擁有率的冷區存在顯著的空間自相關,且主要分布在人口總數多、醫療資源相對分散之區域。因此,本文建議未來政府在進行長照據點規劃與資源投入時,除公平性的考量外,亦應兼顧人口規模與區域差異,並推動跨區共享機制,提升整體長照資源可近性及配置效率。
    With a rapidly aging population and weakening family caregiving capacity, Taiwan faces growing long-term care (LTC) challenges. Effective policy planning relies on accurate demand estimation, yet inconsistent standards hinder cross-study comparison. Meanwhile, resource allocation has become even more critical under policies that promote aging in place. While previous research has mainly focused on distribution patterns, fewer studies have examined the factors behind regional disparities in accessibility. Spatial perspective-based analyses remain limited.
    This study focuses on the 349 townships on Taiwan main island. It combines publicly available data and data from the Fiscal Information Service Agency to estimate the long-term care demand population over the past five years. The study examines the validity of using tax data as the basis for estimation and further applies hotspot analysis and spatial econometric models to explore the distribution characteristics of LTC resource cold spots.
    The results demonstrate that while tax data has the advantage of high stability and accurately reflecting short-term changes, its completeness still needs improvement, especially in economically disadvantaged areas, where underestimation is more pronounced. Additionally, the cold spots of LTC resources exhibit significant spatial autocorrelation and are mainly distributed in regions with larger populations and more dispersed medical resources. Therefore, this study suggests that future government planning in LTC facilities should consider not only equity but also population size and spatial disparities. Inter-district resource sharing is also recommended to improve accessibility and allocation efficiency of LTC services.
    參考文獻: 一、中文部分
    王雲東、薛承泰、鄧志松、陳信木、楊培珊、詹慶恩(2012)。我國失能與失智人口及其所需照顧服務員人力之推估。臺大社會工作學刊,(25),51-102。
    李宗儒、陳昭榮、李妙純(2021)。台灣大腸癌死亡率之空間分析。台灣公共衛生雜誌,40(2),225-240。
    洪乙禎、林錦鴻(2010)。探討醫療資源和民眾健康差異的相關性-以台灣二十三縣市粗死亡率和事故傷害死亡率為例。台灣公共衛生雜誌,29(4),347-359。
    胡立諄、賴進貴(2006)。臺灣女性癌症的空間分析。臺灣地理資訊學刊,(4),39-55。
    陳柏琪、張靜貞、陳肇男(2015)。臺灣老年長期照護需求之推計─GEMTEE模型之應用。人口學刊,(51),43-93。
    陳柏琪、許聖民、林幸君、陳肇男、張靜貞(2020)。臺灣縣市別長照需求之中長期推計及趨勢分析。人文及社會科學集刊,32(4),523-558。
    曾明性、吳慧卿(2020)。臺灣社區照顧關懷據點與需求人口之資源供需差異分析:應用地理可近性方法評估社區照顧資源配置妥適性。調查研究-方法與應用,(44),41-95。
    黃龍冠、楊培珊(2021)。以長照2.0為基礎回顧臺灣長照政策發展與評析未來挑戰。福祉科技與服務管理學刊,9(2),212-236。
    楊家瑞(2016)。財稅資料低所得報稅戶背景分析。政府機關資訊通報,(343),15-20。
    廖興中(2013)。臺灣小兒科醫療資源空間可接近性分析。公共行政學報,(44),1-39。
    廖興中(2014)。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。行政暨政策學報,(58),121-152。
    劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義(2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊,4(1),1-22。
    鐘子婷、吳世權、黃瑋絜、杜裕康、陳雅美(2022)。台灣中老年族群失能率趨勢:以中老年身心社會生活狀況長期追蹤調查重新驗證。台灣公共衛生雜誌,41(3),347-357。

    二、英文部分
    Anselin, L. (1988) Spatial Econometrics: Methods and Models. Netherlands:Springer.
    Anselin, L. (1995). Local Indicators of Spatial Association—LISA. Geographical Analysis, 27(2), 93-115.
    Kane, R. A., & Kane, R. L. (1987). Long-term care: Principles, programs, and policies.New York: Springer Pub.
    LeSage, J., & Pace, R.K. (2009). Introduction to Spatial Econometrics (1st ed.). Chapman and Hall/CRC.
    Ord, J. K., & Getis, A. (1995). Local spatial autocorrelation statistics: distributional issues and an application. Geographical analysis, 27(4), 286-306.
    Penchansky, R., & Thomas, J. W. (1981). The concept of access: definition and relationship to consumer satisfaction. Medical care, 19(2), 127-140.
    Spinelli, D. (2022). Fitting spatial autoregressive logit and probit models using Stata: The spatbinary command. The Stata Journal, 22(2), 293-318.
    Tobler, W. R. (1970). A computer movie simulating urban growth in the Detroit region. Economic geography, 46(sup1), 234-240.
    Tsai, P. J., Lin, M. L., Chu, C. M., & Perng, C. H. (2009). Spatial autocorrelation analysis of health care hotspots in Taiwan in 2006. BMC Public Health, 9, 1-13.
    Villalobos Dintrans, P. (2018). Do long-term care services match population needs? A spatial analysis of nursing homes in Chile.PLoS One,13(6), e0199522.
    Weissert, W. (1991). Community-based long-term care: A prospective budgeting strategy for achieving cost-effectiveness. In J. C. Romeis & R. M. Coe (Eds.), Quality and Cost Containment in Care of the Elderly (pp. 175-189). New York, NY: Springer.
    Xiong, X., Li, V. J., Huang, B., & Huo, Z. (2022). Equality and social determinants of spatial accessibility, availability, and affordability to primary health care in Hong Kong, a descriptive study from the perspective of spatial analysis. BMC health services research, 22(1), 1364.
    Yin, C., He, Q., Liu, Y., Chen, W., & Gao, Y. (2018). Inequality of public health and its role in spatial accessibility to medical facilities in China. Applied Geography, 92, 50-62.
    Yue, J. C., Wang, H. C., & Liou, Y. (2024). Using the Taiwan National Health Insurance Database to explore the need for long-term care . Geneva Papers on Risk and Insurance-Issues and Practice, 49(2), 400-416.
    Zainol, R., & Pettit, C. J. (2016). Elderly and community health care facilities: A spatial analysis. Planning Malaysia, (5).

    三、政府資料與網路資源
    衛生福利部(2016),長期照顧十年計畫2.0(106~115年)(核定本),取自:https://1966.gov.tw/LTC/cp-6572-69919-207.html
    衛生福利部國民健康署(2025),民國112年中老年身心社會生活狀況長期追蹤調查結果報告,取自:https://www.hpa.gov.tw/Pages/List.aspx?nodeid=108
    衛生福利部統計處(2024),民國111年老人狀況調查報告,取自:https://dep.mohw.gov.tw/DOS/lp-5095-113.html
    衛生福利部統計處(2023),民國110年身心障礙者生活狀況及需求調查報告,取自:https://dep.mohw.gov.tw/DOS/lp-5096-113-xCat-y110.html
    中華民國老人福利推動聯盟(2021),取自:
    https://www.oldpeople.org.tw/pop/pages/12662f9d00c54c29a05aaa8e0013d507
    衛生福利部,長期照顧特別扣除額-問答集,取自:https://www.mohw.gov.tw/dl-78143-1afb9d41-0057-492f-a70e-09db96f6d9d9.html
    行政院主計總處,人口及住宅普查,取自:https://www.stat.gov.tw/cl.aspx?n=2748
    描述: 碩士
    國立政治大學
    財政學系
    111255006
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0111255006
    資料類型: thesis
    顯示於類別:[財政學系] 學位論文

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