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    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/99756


    Title: 以全民健康保險資料庫探討臺灣醫療人力的特性及變化
    Using Taiwan National Health Insurance Database to Explore the Change of Medical Manpower in Taiwan
    Authors: 楊崇甫
    Yang, Chung Fu
    Contributors: 余清祥
    Yue, Jack C.
    楊崇甫
    Yang, Chung Fu
    Keywords: 全民健康保險
    醫療可近性
    大數據
    不均度
    醫療供給
    National Health Insurance
    Accessibility
    Big Data
    Inequality
    Supply and Demand
    Date: 2016
    Issue Date: 2016-08-09 10:15:20 (UTC+8)
    Abstract: 全民健保實施已逾 20 年,我國國民納保率超過 99%,不論貧富皆享有相同 的就醫機會,提升國人健康及延長平均壽命,我國也因全民健保制度及醫療品質 而聞名於世。然而,全民健保也有亟需解決的問題,又以醫療資源的分配不均最 為人詬病,擁有較豐沛資源的醫學中心、教學醫院等醫療院所大多位於院轄市, 偏遠鄉鎮地區民眾就醫相對不便利,難以享有同等公平的健保服務。有鑑於此, 近年衛生署開放醫療資源較匱乏的地區設立醫院、增加床位,以縮短城鄉間的差 距,而二代健保的原意也在於提高醫療品質及降低財務危機,但醫療供給及需求 間的均衡是否可因此獲得解決,仍是未知數。
    本文以臺灣醫療人力的特性及其變化為研究對象,探討近十年全民健保的醫 療人力總數、年齡結構、及其在臺灣各地分布變化,評估醫療人力的變遷,並作 為測量醫療資源不均度的依據,計算依據為全民健康保險資料庫門診處方及治療 明細檔、醫事人員基本資料檔、醫事機構基本資料檔。其中,另外也針對各地醫 療需求及醫療人力的執業地變化,分析醫師數與看診量在各地的供給量,探討醫 療供給及醫師流動趨勢,包括醫療資源分配不均與偏鄉居民健保就醫狀況的關聯, 討論醫療資源的公平性問題。
    Taiwan’s National Health Insurance (NHI) has been implemented for more than 20 years and more than 99% of people are covered, no matter if they are rich or poor. Equal right of medical accessibility, as well as good quality of health cares, are two key features of NHI, which play an important role in extending Taiwan’s human longevity. However, despite these fine attributes, there are potential problems in the NHI, especially about the uneven spatial distribution of medical resources. In general, rural and remote areas have less abundant medical resources, and most of the larger hospitals (e.g., medical centers and teaching hospitals) are located in populous counties, e.g., six major cities. In order to narrow the gap between urban and rural areas, the Ministry of Health and Welfare re-allocates medical resources, such as arranging more outpatient tours and short-term stays annually for physicians from six major cities to rural areas, particularly to remote islands.
    In this study, the goal is to explore the spatial characteristics of Taiwan’s physicians and their changes over time. We can treat these as a measure of inequality of health care accessibility, and use them as a reference to allocate medical resources. The study is based on the data from the NHI database, including CD (out-patient visit), PER (Registry for medical personnel), and HOSB (Registry for contracted medical facilities). We found that the population aging also appears at physicians and more of them continue to work beyond the retirement age. The unevenness of physicians’ distribution widens, for example, no pediatricians in 130 Taiwan’s townships in 2012 and people in rural areas pay more travel costs for hospital attention.
    Reference: 一、中文部分
    1. 林渤越(2014),以全民健康保險資料庫探討國人慢性疾病的現況,國立政治
    大學商學院統計學系碩士論文。
    2. 蘇維屏(2014),全民健保資料庫分析:重大傷病及癌症之研究,國立政治大
    學商學院統計學系碩士論文。
    3. 鄭志新(2015),以全民健康保險資料庫探討長期照顧需求,國立政治大學商學
    院。
    4. 李昇龍(2015),由健保資料庫探討常駐人口及醫療利用,國立政治大學商學院
    統計學系碩士論文
    5. 章殷超、溫在弘、賴美淑(2009),利用地理資訊系統探討肝癌病患就醫地理可
    近性與醫院選擇間之相關性,台灣衛誌 2009, Vol.28, No.6。
    6. 紀雪雲、林怜利、林麗美、阮祺文、蔡明忠、闕瑞紋、梁繼權(2007),基層醫
    療的新思維,醫療爭議審議報導 系列 27。
    7. 吳依凡(2004),醫療資源可近性對個人醫療利用的影響 ---台灣地區的實證研
    究,國立中央大學產業經濟研究所碩士論文。
    8. 林淑敏(2004),醫療資源與國人健康的關聯,國立中央大學產業經濟研究所碩
    士論文。
    9. 張雅雯(2002),醫療利用可近性—台灣老人之實證研究,國立中央大學產業經
    濟研究所碩士論文。
    10. 鄭守夏(2012),醫療服務與管理之問題與分析,101 年度研究計畫期末報告。
    11. 薛立敏、曾喜鵬、謝玉偉(2007),台灣地區近年來遷移行為變化之影響因素分
    析-家戶遷移決策與遷移地點選擇之聯合估計,人口學刊,第 34 期,頁 69- 107。
    12. 曾淑芬、楊銘欽、陳珹箖(2002),台灣地區各級醫院任用醫管人力之現況分析, 台灣公共衛生雜誌,頁 123-132。
    13. 陳珮青、楊銘欽、江東亮、鄭守夏(2003),病人跨區住院與醫療區資源分佈 之探討,台灣公共衛生雜誌,頁 27-32。
    14. 林民浩、郭年真、陳威全、溫在弘(2016),剖析台灣民眾的就醫流動:利用引 力模式評估就醫距離與醫療資源分佈的影響,台灣衛誌,頁 136-151。
    15. 唐珮玲、陳玟伶、張敬俐、林惠賢(2005),護理人員憂鬱程度及其相關因素之 探討,中華心理衛生學刊第十八卷第二期,頁 55-74。
    16. 張金堅、陳炯年、朱樹勳(1998),全民健保後外科醫師人力之調查與分析,醫 學教育第二卷第三期,頁 273。
    17. 蔡政珈(2013),兩母體共有物種數的估計及最佳停止點,國立政治大學統計學 系碩士學位論文。
    18. 蘇喜、黃月桂、李丞華、郝宏恕(1997),健保資料庫在醫療資源耗用及醫療品
    質偵測上之公用,中華公共衛生雜誌,頁 527-537。
    二、英文部分:
    1. Chuang, C.J. (2012). Estimation of similarity indices via two-sample jackknife
    procedure. Journal of Applied Science and Engineering, 15, 3, pp. 301-310.
    2. Lin, J. P., K. L. Liaw, and C. L. Tsay (1999), “Determinants of Fast Repeat Migrations of the Labour Force: Evidence from the Linked National Survey Data
    of Taiwan.” Environment and Planning A, 31, No.5, pp.925-45.
    3. Lin, J. P. and K. L. Liaw (2000), “Labor Migrations in Taiwan: Characterization and Interpretation Based on the Data of the 1990 Census.” , 32, No.9, pp.1689-1709.
    4. Ravenstein, E.G. (1889), “The Laws of Migration,” Journal of the Royal Statistical
    Society, 7, 241-301.
    Description: 碩士
    國立政治大學
    統計學系
    103354020
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0103354020
    Data Type: thesis
    Appears in Collections:[Department of Statistics] Theses

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