原住民及離島地區醫事人員養成計畫效益評估與未來醫事人力需求推估

CMUR > College of Public Health > Department and Graduate of Health Services Administration > Research reports > Item 310903500/11461

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Title:	原住民及離島地區醫事人員養成計畫效益評估與未來醫事人力需求推估
Authors:	蔡文正(Tsai, Wen-Chen);龔佩珍;戴志展(Chih-Jaan Tai);黃光華(Kuang-Hua Huang)
Contributors:	公共衛生學院醫務管理學系
Keywords:	地方醫事人力;醫事養成制度;醫師人力;偏遠地區;山地離島;medical professionals’ manpower;Medical Professionals Development Program;physician manpower;remote communities;mountains and islets districts
Date:	2009-02-28
Issue Date:	2009-09-01 15:12:49 (UTC+8)
Abstract:	台灣地區於2004年達每萬人口 14.7位西醫師，已達醫療網計畫每萬人口醫師數13.3人之目標，醫師人力可謂相當充足。然而台灣地區醫師問題不在於人力供給量的不足，而在於資源地理上的分配不均。就地理分佈而言，醫師多分佈在都市化程度較高的縣市，以2004年每萬人口醫師數而言，西醫部份台北市為27.69人，而台灣地區48個山地離島為7.01人，相較之下有相當顯著的差距。前台灣省政府及行政院衛生署自1969至2000年執行之「地方醫謢人員養成計畫」具有相當之效益，目前服務期滿100人中仍有62人選擇繼續留在山地離島地區服務，占山地離島現有執業醫師人力（249人）四分之一。而中央健康保險局1999年起實施「全民健康保險山地離島地區醫療給付效益提昇計畫」，鼓勵承作計畫之醫療院所整合既有的醫療資源，以醫療支援方式提供醫療保健服務，以彌補山地離島醫師人力地理分佈不均之情形，但醫師人力不足仍為各執行中心醫院遭遇最主要的問題。因此本計畫首先透過衛生署相關單位蒐集地方醫事人員養成計畫之歷年醫事人數相關資料，分析參與養成計畫之醫事人員留在原住民及離島地區服務之歷年人數，並以問卷調查在服務期屆滿後選擇離開或續留於偏遠地區持續服務的考慮之因素。其次，依據專家集體決策技術，歸納出偏遠地區醫師人力分佈指標，評估目前醫師人力分佈情形，呈現偏遠地區醫療利用可近性。另外，以問卷調查原住民及離島地區居民對養成計畫之醫事人員之喜好及醫療可近性情形。為了瞭解養成計畫之醫事人員未來需求，以問卷調查透過各地相關衛生局所瞭解未來醫事人員之主觀需求量，再針對過去台灣原住民與離島投入之醫事人力予以分析，以客觀人力指標分析未來醫事人員需求，藉由未來偏遠地區醫事人力主、客觀需求量，並運用趨勢分析法或灰色預測模式推估出未來原住民與離島地區醫事人力養成需求，提供繼續地方醫事人員養成相關政策之參考，並作為未來地方醫事人員養成計畫之醫事人力規劃與調整依據。 In 2004, the number of physicians every ten thousand population was 14.7 in Taiwan. The number already attained the objective of the plan of medical net system in which the number of physicians every ten thousand population should be 13.3. But the problem of physician manpower in Taiwan is not insufficient supply, the problem is the unequal distribution geographically. Physicians often worked in cities which had high degree of urbanization. In 2004, the physician manpower in Taipei was 27.69 per ten thousand population, compared with 7.01 per ten thousand populations in 48 remote townships. The effects of “Medical Professional Development Program” which held by ex- Taiwan Provencal and Department of Health during year 1969 to 2000 were showed significant improvement for physician manpower in remote communities. 62 per 100 physicians chosen to stay in remote communities after the program run out, the number was quarter of physicians working in remote communities on hand (N=249). The “National Health Insurance Project of Integrated Delivery System in Mountainous and Islet Districts” has been carried out in mountainous, islet and outlying districts nation-wide since 1999. The program encouraged health care supplies to cooperate with health care facilities to integrate existing medical resources and support medical care to remote communities. The objective of this program was to resolve the problem of unequal distribution of physician manpower in mountainous and islet districts. The study will collect healthcare professionals’ manpower from “Medical Professional Development Program” from the Department of Health. The study will calculate numbers of healthcare professionals who still stay and work in mountainous and islet districts. Questionnaires will be used to investigate the factors which affect medical professionals’ choices to stay in remote communities or leave after the services period run out which regulated by the “National Health Insurance Project of Integrated Delivery System in Mountainous and Islet Districts”. Otherwise, according to the expert meetings, the study will conclude the indicators for physician manpower distribution in Taiwan, and will evaluate the distribution of physician manpower, and will show the accessibilities of medical utilization in remote communities. Furthermore, questionnaires will be conducted to understand the affinity and accessibility of medical care for the residents in mountains and islet districts. In order to understand the medical professionals’ manpower needs for Medical Professionals Development Program, the study will use questionnaire to understand the subjective demands for medical professionals. Moreover, the study will analyze the numbers of medical professionals in mountains and islet districts to calculate the objective manpower demands for medical professionals. According to the subjective and objective manpower demands for medical professionals in remote communities, trend analysis and grey prediction model will be conducted to predict the medical professionals’ manpower demands in mountains and islets districts. The results of this study can be the useful references for the policies of Medical Professionals Development Program.
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