目標：巡迴醫療服務一直是衛生單位與中央健康保險局作爲解決山地與偏遠地區原住民基本醫療服務之策略之一。其策略通常是增加醫療服務提供者之經濟誘因，促使較具規模之醫院運用巡迴方式提供原住民醫療與保健服務，提供山地及偏遠地區更完整之醫療服務藉經改善居民之健康。本研究希望藉著探討原住民對巡迴醫療及保健服務利用之影響因素，作爲提供原住民巡迴醫療及保健服務之決策參考。方法：以結構式問卷以訪員親自拜訪方式，取得原住民對健康狀態及對巡迴醫療之認知與滿意度等三方面進行調查。並進一步以逐步迴歸分析影響其醫療利用次數與滿意之因素，並以Two-part model分析求得各相關因素對巡迴醫療利用次數之邊際效果。結果：知道巡迴醫療時間、知道有夜間急診醫療、身體疼痛程度較高者，巡迴醫療利用的次數也愈多。對於巡迴醫療時間、地點之認知情形對於巡迴醫療的使用有顯著性影響的結果，顯示相關資訊宣導傳播對於提升巡迴醫療之使用狀況有其重要性。而分析利用巡迴醫療保健服務次數與其滿意度之相關性，民眾對醫療滿意度愈高，則巡迴醫療服務之利用次數也顯著愈高。利用Two-Part Model公式計算出自變項對巡迴醫療利用次數之邊際效果顯示：對於巡迴醫療時間及服務內容的認知影響原住民之醫療利用呈顯著水準，瞭解巡迴醫療者較不知道者多利用1.5420次。結論：原住民對於巡迴醫療服務之認知也會影響其對巡迴醫療保健服務之利用。因此在提供巡迴醫療保健服務時也應提高民眾對於巡迴醫療保健服務之認知，將有助於提高住民對於巡迴醫療服務之利用。
Objectives: The implementation of National Health Insurance (NHI) has given relief for most people of the economic risk of medical care. However, for residents in mountain areas, distance barriers and lack of medical resources result in lower accessibility to medical care utilization and lower satisfaction. To help these medically deprived populations, the Bureau of National Health Insurance contracted a mobile medicine program with a Christian hospital to deliver primary health care for a rural area in the middle of Taiwan. The purpose of this study is to explore the factors of mobile medicine program on access and medial utilization by residents in mountain areas. Methods: Primary data sets were collected by the household interviewed survey to obtain information from residents concerning their health status, satisfaction, and understanding of mobile medicine programs. Stepwise regression was further adopted to explore the significant factors in explaining the utilization and satisfaction. Also, a two-part model was used to understand the marginal effects of possessed medicine program on utilization. Results: (1) utilization increased significantly if residents have more information about the mobile medicine program; (2) people with a higher satisfaction with the mobile medicine program tended to have a higher utilization of mobile medicine program; (3) people with a higher opinion of the mobile medicine program used its services 1.5 times more than those with a lower opinion. Conclusions: All the results imply that the mobile care program has improved the equity of access to health care.
關聯:
台灣公共衛生雜誌 / Taiwan Journal of Public Health 23(4)324 ~333
