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| 題名: | 台灣地區醫師人力分佈指標之建置研究
Establishment of Physician Manpower Distribution Indicators in Taiwan |
| 作者: | 蔡文正;龔佩珍;吳守寶;楊志良 |
| 貢獻者: | 中國醫藥大學醫務管理學系 |
| 關鍵詞: | 蔡文正;吳守寶;龔佩珍;楊志良 Tsai, Wen-Chen;Wu, Shou-Bao;Kung, Pei-Tseng;Yaung, Chih-Liang;醫師人力;分佈指標;吉尼係數;羅賓漢指標 |
| 日期: | 2006-12 |
| 上傳時間: | 2010-08-03 16:14:18 (UTC+8) |
| 摘要: | 目的：近年來醫療資源的分佈均衡與公平性是大家所關注的問題，為了均衡醫師人力資源分配，健全民眾醫療照護之可近性，相關評估指標的建立為現階段醫師人力規劃之重點。因此本研究欲建立多種醫師人力分佈之評估指標，藉以評估台灣地區醫師人力分佈情形。 方法：透過1997-2003年健保資料庫分析歷年醫師人力供給變化情形，再以吉尼係數探討全國醫師、偏遠地區醫師、醫院醫師、診所醫師之醫師人力地理分佈情形，並召開2場專家座談，經彙整擬定醫師人力分佈評估指標後，運用修正式德菲法，針對醫師人力分佈指標進行評分，並以平均值、中位數、眾數、標準差、四分位差來描述各個指標的調查結果，以找出多種台灣地區醫師人力分佈指標。 結果：研究結果顯示1997年至2003年全國西醫、中醫、牙醫醫師人力地理分佈呈現逐年改善的趨勢，六年間以中醫改善幅度最大，西醫改善最少。在偏遠地區醫師人力地理分佈部分，以西醫年平均改變率最多但趨惡化，以牙醫師分佈改善最多。醫院醫師人力分佈皆高度不均勻，而診所醫師人力分佈情形明顯優於醫院醫師人力分佈情形。在醫師人力分佈指標部份，針對兩回合問卷結果進行分析，發現吉尼係數、羅賓漢指標、以及貧窮指標(Sen-sherrocks- Thon)在適切性、重要性、可行性上的平均得分皆高於3.5分，因此選擇採用。 結論與建議：台灣地區醫師人力地理分佈逐年改善中，但仍存在醫師人力分佈不均的問題，除了吉尼係數外，應可考慮其他評估指標。本研究篩選出吉尼係數、羅賓漢指標、貧窮指標三種醫師人力分佈指標，作為未來台灣醫師人力分佈之多重評估方法。因此，本研究針對衛生主管機關提出以下建議：(1)應用本研究確立之醫師人力分佈指標；(2)各別明定西醫、中醫、牙醫之醫療資源缺乏標準；(3)準確地建立並公開全國醫師人力資料庫；(4)持續推動醫療資源缺乏地區執業或或巡迴醫療獎勵方案。
Objective: The balance distribution and equality for healthcare resources was one of the most concerned issues in recent years. In order to balance the resources of physician manpower and increase the healthcare accessibility, the priority is to establish the indicators for physician manpower distribution. The research would like to establish several kinds of indicator for physician manpower distribution to evaluate the distribution of physician manpower in Taiwan. Methods: This research used national health insurance physician manpower dataset between 1997 and 2003 to analyze the changes in supply of physician manpower. Gini coefficient was applied to investigate the manpower distribution for nationwide physicians, physician in rural areas, hospital physicians, and clinical physicians. In addition, two expert meetings were held to work up the indicators of physician manpower distribution. Then the Delphi method was conducted to evaluate the different indicators for physician manpower distribution. This research calculated the mean, median, mode, standard deviation, and quartile for these indicators and found several indicators for physician manpower distribution in Taiwan. Results: The distributions of physician, Chinese medicine physician, and dentist manpower have been improved in Taiwan during 1997-2003, in which Chinese physician manpower had largest improvement whereas physician manpower had least improvement. Regarding the rural areas, the dentist manpower distribution had best improvement, whereas the physician manpower distribution had the largest changes but became worse. Hospital physician manpower had high unbalance distribution in Taiwan. Clinic physician manpower had better distribution comparing with that of hospital physician manpower. With respect to indicators of physician manpower distribution, after going through two times of Delphi method approach, this study concludes three indicators- Gini coefficient, Robin Hood index (RHI), and Sen-Sherrock-Thon index (SST) to be the indicators for physician manpower distribution in terms of appropriateness, importance, and feasibility with score greater than 3.5. Conclusion and suggestions: The geographic distribution for physician manpower was improved in Taiwan year by year. However, the unbalance distribution of physician manpower still existed. Besides Gini coefficient, other indicators should be considered for assessing manpower distribution. This research concluded Gini coefficient, RHI, and SST index to be the indicators for physician manpower distribution. This research had some recommendations for health decision makers as follows: (1) Using the indicators for physician manpower distribution based on the results of this research. (2) Establishing the standard level of lack of healthcare resources in western medicine, Chinese medicine, and dental care. (3) Establishing the nationwide physician manpower database precisely. (4) Encouraging physician to practice or provide mobile medical services in the areas with insufficient healthcare resources. |
| 顯示於類別: | [醫務管理學系暨碩士班] 研究計畫
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