| 摘要: | 台灣政府長期以來一直致力於解決偏遠地區醫療照護問題，其中巡迴醫療為重要的解決方法之ㄧ。國內對巡迴醫療的成果評估報告，大多集中在滿意度、可近性及利用率的研究，缺乏以經濟評估的方法做深入的研究。故本研究目的在計算投入巡迴醫療的成本，比較醫院與衛生所執行巡迴醫療的社會成本及兩者的效果與效益，及巡迴醫療總體社會成本與總體社會效益的結果為何。 問卷調查以付費卡方式測量民眾的付費意願作為效益面資料，訪問醫院與衛生所投入巡迴醫療相關的成本、人力、藥品等成本資料，及巡迴醫療相關的效果面資料，以進行成本效果與成本效益分析。分析結果分為三部分，第一是成本的分析結果，第二是巡迴醫療的效果結果，第三是巡迴醫療的效益結果。。 結果發現醫院投入巡迴醫療的總成本為224,791.3元，而衛生所巡迴醫療的成本為123,094.1元，醫院巡迴醫療的效益為392,910.59元，衛生所的效益為278,278.6元，醫院的益本比值為1.747而衛生所為2.261，因此衛生所提供巡迴醫療是較醫院有效益。整體而言，巡迴醫療的整體社會效益為671,189.2元大於整體社會成本347,885.4元，相當於社會投入於巡迴醫療的每一元可獲得1.929元的效益，表示巡迴醫療具有成本效益。效果面結果指出巡迴醫療增加民眾醫療可近性，與一般醫療滿意度相較巡迴醫療的滿意度較高，巡迴醫療利用人次較鄉內就醫人次高。 巡迴醫療是解決山地離島地區就醫的重要方法，乃至目前中央健保局實施整合性醫療服務經營模式（IDS），皆傾向於由大型醫療院所提供。長久之計應提升衛生所的醫療功能，畢竟衛生所是鄉內唯一的醫療院所。本研究的結果及成本效果與成本效益分析模式，應可供醫療政策制定者與未來相關研究之參考。; The government is always devoted to solve the problem of medical care in rural area, and especially mobile healthcare is one of the important solutions. In Taiwan, the evaluation report of mobile healthcare focused on satisfaction, accessibility and utilization rate, lacking of economic evaluation methods made in-deep analysis. The aim of this thesis is to count the cost of mobile healthcare, comparing the social cost of the hospital with community health center, including the effectiveness and the benefit of them, the result of mobile healthcare social cost and social benefit. Applying questionnaire survey adopted payment cards techniques to measure the willingness-to-pay as the benefit data. This thesis conducts cost-effectiveness analysis and cost-benefit analysis by gathering the data of the hospital and community health center invested cost, manpower, drug in mobile healthcare and effectiveness data associated with mobile healthcare. The conclusion consists of three parts, one on the result of cost analysis, another on the effectiveness of mobile healthcare, and the other on the benefit of mobile healthcare. The total cost of the hospital putting in mobile healthcare is NTD 224,791.3 , and the community health center is NTD 123,094.1. The benefit of mobile healthcare equals to NTD 392,910.59 of the hospital and equal to NTD 278,278.6 of community health center. The cost-benefit ratio are 1.747 and 2.261 for the hospital and community health center, respectively, therefore, community health center providing mobile healthcare is superior to the hospital. On the whole, the whole social benefit is NTD 671,189.2 higher than the whole social cost that is NTD 347,885.4, equivalent to putting in NTD 1 and gaining benefit of NTD 1.929. It means mobile healthcare is judged as cost-benefit. The result of effectiveness data indicates mobile healthcare increases accessibility. Its’ satisfaction is higher than general medical care, and its’ utilization is higher than seeking medical care in a rural area. Mobile healthcare is an important method to solve problems of seeking medical treatment in rural area, and even the Bureau of National Health Insurance（BNHI）implements Integrated Delivery System（IDS）, tending to hospital providing mobile healthcare. After all, community health center is the only the medical institution, should strengthen the treatment ability of community health center permanently. The result, cost-effectiveness analysis and cost-benefit analysis method in this research can served as reference for policy maker and future research. |
