921地震對國內醫療資源與醫療服務造成的衝擊，影響重大，災民的醫療照護是災後復健工作重點之一，本研究的目的在於探討921震災對於中央健康保險局中區分局與中區醫療機構所產生的衝擊，以及災民在地震前後半年醫療利用率的改變。 本研究採定量研究與定性研究之方法，從文獻回顧開始，針對健保局中區分局之申報資料與中區現有醫療資源進行描述性統計分析，找出921地震發生前後半年醫療服務與醫療需求之變化，進行健保醫療資源整合之分析。選擇一指標性疾病洗腎來分析地震前後半年醫療服務利用之差異性，針對災區六家醫院為例進行危機管理之個案分析，以期對健保醫療提出適當之建議及將來對重大危機事件處理與因應之參考。 研究結果顯示在地震發生後，災民在西醫門診醫療利用率上升，地震前後西醫門診總醫療服務次數成長36.66%，總醫療費用成長26.63%。災民於基層院所、區域醫院與醫學中心之地震前後六個月門診總醫療服務利用次數分別為增加40.47%、減少1.97%、與增加17.62%；醫療服務費用分別為增加33.87%、減少8.50%、與增加19.21%。在就診次數上，基層院所大於區域醫院大於醫學中心。 在年齡層的分析上，十二歲以下的災民的西醫門診醫療次數增加最高，地震後增加47.26%。災民洗腎患者在震災醫療利用率分析結果，地震後洗腎醫療總次數增加4.91%，於災區醫療機構洗腎次數增加13.49%，於非災區醫療機構洗腎次數增加2.47%。 醫院危機管理個案訪視結果，本研究個案醫院專訪對象為災區六家醫院在921震災的重大災害發生時，醫院的危機處理與緊急應變措施，經訪談研討分析結果發現，災區醫院在醫療設施遭受損害、電力、電話通訊中斷的情形下，進行災難搶救，但是政府的緊急救難系統未如預期的發揮效用。建議衛生醫療網路的衛星資訊系統設備與直昇機救護運送設施，使醫院能迅速將災情傳遞並迅速將患者後送就醫。 本研究結果證實政府震災健保措施，有效提升災民的醫療利用，滿足災民的醫療需求。醫院之間應該訂定緊急應變計劃與傷患輸送計劃，發揮醫療緊急救護功能，確保全體國民健康。; The September 21 earthquake has made an enormous impact on the system of medical resources and services in Taiwan. One major task of the government after the 1999 Chi-Chi earthquake was to fulfill the medical needs of the afflicted population. This study utilize claim data files from Bureau of National Health Insurance to investigate the changes and impact of 921 earthquake on healthcare organizations in central Taiwan by hospital accreditation level, hospital location, and patient age groups. This study evaluated and analyzed the medical services utilization patterns of the residents in the afflicted regions before and after the earthquake. This study analyzes and compares the use of health insurance resources in central Taiwan before and after the September 21 earthquake. By a perusal of relevant records, it was found that the emergency medical care measures adopted by the Bureau of National Health Insurance after the September 21 earthquake had enabled victims of the quake to obtain immediate and efficient medical treatment. This study also analyzes refugees with uremia as well as case study of risk management of these hospitals'' located in disaster area. The results indicated that both outpatient and services utilizations among the afflicted population had increased dramatically. The utilizations of western medicine after the earthquake had been raised. The overall ambulatory visits increased by 36.66%, the growth rate of total medical expenditure was 26.63%. For clinics and local hospital the number of ambulatory visit increased by 40.47%, for regional hospitals the number of visits decreased by 1.97%, and for the medical centers the visits increased by 17.62%. For patient age group analysis, the group with age below 12 has the highest grow rate of 47.26% in terms of ambulatory visits. The growth rate of medical expenditure increased by 33.87%, decreased by 8.50%, and increased by 19.21%, respectively. The overall ambulatory visits increased, for clinics and local hospitals the number of visits is greater than regional hospitals and regional hospitals visits is greater medical centers. For patient age group analysis, the group with below 12 has the highest grow rate 0f 47.26% in terms of ambulatory visits. The Analysis of refugees with uremia the overall ambulatory visits increased by 4.91%. For disaster areas the number of ambulatory visit increased by 13.49%, for non-disaster areas the number of ambulatory visits increased by 2.47%. Risk Management of six hospitals. After paying visits to hospitals located in the disaster areas, it was also found that these hospitals had all taken proper and efficient measures in the situation of emergency caused by the tremor. Although the earthquake damaged the medical equipment of the hospitals and cut off all electric powers and telephone communication, the staff members of the hospitals still managed to move inpatients to safer places and make emergency rescue. Those in charge of these hospitals also made suggestions to relevant a
