| 摘要: | 摘 要 全國各醫療院所目前所面臨最大的經濟衝擊，除了全民健保多元化給付制度之外，次之，即是環保法令對醫療事業廢棄物處理的規定。醫院為了提升醫療品質及保障個人衛生，大量使用拋棄式醫療用品及耗材，進而造成醫療事業廢棄物數量增加，相對的處理費用也隨之增加了。醫院總額支付制度預定於民國91年7月開始實施，屆時醫院將更致力於開源節流及有效的控制管理成本面，而醫療廢棄物有效管理將顯得更加重要。不同層級與經營規模的醫療院所事業廢棄物產生的數量及處理費用影響因素有哪些，是本研究主要探討的重點。 本文研究主要目的調查醫療院所廢棄物處理情況，以及探討醫院感染性廢棄物處理方式、醫院層級別、權屬別、地區別、醫院規模、服務項目、平均門診人次、平均住院人次、平均開刀人次及醫療廢棄物管理及教育等因素，透過Classification and regression tree，簡稱CART分類方式，將不同層級與經營規模醫療院所的感染性廢棄物每公斤處理費用分組，進而探討各組間的影響差異。 以衛生署評鑑合格醫院共540家為研究範圍，進行全面問卷普查，回收率為32.4%，研究結果如下： 一、 本研究經由CART分類分析後發現，平均住院人次、門診人次、總病床數、服務科別數之歐基里德距離、醫院所在區域及院內舉辦醫療事業性廢棄物分類教育課程等感染性廢棄物處理費用有顯著影響。 二、 醫療院所每月平均住院人次>9、門診人次>3555人次、總病床數>542床及有定期舉辦醫療事業性廢棄物分類教育課程時，醫療院所支付的每公斤感染性廢棄物處理費用為最低（44.37元/㎏），當住院人次<＝9人次，每公斤感染性廢棄物處理費用為最高（256.9元/㎏）。 三、 醫療院所定期舉辦院內全體醫療廢棄物分類教育課程，對減少感染性廢棄物數量有絕對的幫助效益。; ABSTRACT Now in Taiwan, all hospitals face two major economic issues, one is the payment policy from the Bureau of National Health Insurance, the other is the environmental protection laws for the proper treatment of medical waste. In order to improve health care quality, lots of disposal medical material has been used at hospitals. It causes the rapidly increase of the medical waste and also the disposal fees. Since hospital income will be limited by the Global Budget Payment System in 2002, the cost constrain will become an important topic in hospital management, including the cost control of medical waste treatment. This study attempted to analyze the medical waste treatment data based on different hospital categories and scales, and to discover the influence factors on the disposal fees of medical waste. This research has surveyed 540 hospitals to compile medical waste treatment data. The disposal fees per kilometer is used as dependent variable and hospital categories, ownership, location, scales, service items, average OPD visits, average inpatient numbers, average operation numbers and education programs etc. as independent variables. By Classification and Regression Tree (CART) method, we classify the disposal fees of infectious medical waste into different groups, then analysis the differences between these groups. The response rate of the questionnaire is 32.4%, and the conclusion of this study is as follow: 1. According to the CART analysis, the factors of average inpatient numbers, average OPD visits, total number of beds, Euclidean distance of department numbers, location of hospital, and the education programs about medical waste classification have significant influence on the disposal fees of infectious medical waste. 2. Hospitals have the least disposal fee（NT$ 44.37/kg）when average inpatient numbers per month >9, average OPD visits per month >3555, total number of beds >542, and the education programs about medical waste classification are held periodically. On the opposite, the disposal fee is the highest （NT$ 256.9/ kg）when the average inpatient numbers per month <=9. 3. The education programs about medical waste classification are held periodically at hospitals have great effects on reducing the amount of infectious medical waste. |
