仁愛鄉巡迴醫療保健計畫成果評估

CMUR > College of Public Health > Department of Public Health > Research reports > Item 310903500/25789

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Title:	仁愛鄉巡迴醫療保健計畫成果評估
Authors:	李卓倫
Contributors:	中國醫藥學院公共衛生學系
Keywords:	評估;效果;效率;evaluation;effectiveness;efficiency
Date:	1998-06
Issue Date:	2010-09-06 23:26:48 (UTC+8)
Abstract:	中央健康保險局為改善部分地區醫療資源不足的問題，在1997年9月於南投縣仁愛鄉辦理巡迴醫療保健服務，由埔里基督教醫院負責辦理，計畫至1998年2月執行六個月時由本研究進行初期評估。研究主要以就醫公平性的五個標準的十八種指標加以評估，其中初級資料的來源為家訪問卷資料，次級資料的來源為埔里基督教醫院的執行成果報告及成本分析、仁愛鄉衛生所的業務及成本報表、以及中央健康保險局中區分局所提供的醫療院所申報檔案和個人歸戶醫療利用記錄。研究結果發現巡迴醫療計畫增加了醫療人力、設施與醫療服務時間，降低民眾就醫交通時間及等候時間，增加民眾就醫的潛在可近性。此外，巡迴醫療服務原則上按居民的健康需要而加以分配，符合健康需要的公平原則。研究對象對巡迴醫療六個月的利用率44.3﹪，利用次數每人平均2.38次，保健服務利用率為41.4﹪，利用次數每人平均0.96次。當地民眾對巡迴醫療的滿意度高於其他一般醫療服務。成本效果的分析顯示巡迴醫療的平均總社會成本並未較現行的其他醫療服務為高，因此建議巡迴醫療保健服務應該繼續辦理。但在此同時健保局也可考慮嘗試其他替選方案，例如委託當地開業基層診所或衛生所辦理巡迴醫療，再作比較評估，以提升效率並落實基層醫療保健。本研究並建議埔里基督教醫院再加強對巡迴醫療各項服務內容的宣導，建立當地家戶的健康需要檔案，並考慮將中正村巡迴醫療資源移往其他較偏遠的村落提供服務，以及落實預防保健業務的推展。 Taiwan implemented its compulsory national health insurance scheme in March 1995. There remains ,however ,very limited physician manpower in some rural area. To improve equity, the Bureau of National Health Insurance contracted a mobile medicine program with the Christian hospital to deliver primary health care for a rural area in the middle Taiwan. There is 4167 population in the rural area, which are served by two clinics and one government primary health center. In the mobile medicine program, the Christian hospital delivered medical, dental and some preventive care in this area every two or three days since September 1997. This study is carried out six months after the initiation of the mobile medicine program. The effectiveness of the mobile health care program is evaluated in this study by 18 indicters that can be categorized into 5 concepts of the equity of access to health care. The primary data in the study were collected by household interviewed questionnaires. The secondary data came from the implementation and cost reports of the Christian hospital and the local primary health center, and the claim data from the Bureau of National Health Insurance. The results represent that the health manpower, facilities and the service time available have been increased in the township, and patients' traffics and waiting time reduced after the initiation of the mobile care program. Although the time series regression of the monthly total physician visits for curative and preventive care in this area from September 1996 to February 1998 indicates that there is no significant of the mobile care program for the total physician visits, other indicators show satisfactory results. The utilization rate and average visits per person in six months of the mobile care are 44.3% and 2.38 visits for curative care, and 41.4% and 0.96 visits for preventive care. People feel more satisfied to mobile services than other ones. On the other hand, the mobile services are located corresponding to peoples' health needs because people with lower SF-36 scores use more mobile services when controlling for other important variables in a two-part regression model. All the results imply that the mobile care program has improved the equity of access to health care. The cost-effectiveness analysis shows that the average opportunity cost of the mobile services is lower than the others in the current situation. The mobile care program is therefore an efficient service, which should be continued in the near future. Meanwhile, the Bureau of National Health Insurance should consider the alternatives, contracting local clinics and primary health care center to implement the similar programs for example, then evaluate the cost-effectiveness among alternatives. This suggestion is led both for the objectives of efficiency and providing primary health care that following the principles suggested by World Health Organization. The study also suggests some details for the Christian hospital to improve the quality and efficiency of the mobile health care program.
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