台灣醫療網計畫評估：理性指標及資源分布指標之分析

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题名:	台灣醫療網計畫評估：理性指標及資源分布指標之分析
作者:	劉子仲;Zi-Chung Liu
贡献者:	中國醫藥大學：環境醫學研究所碩士班
关键词:	醫療網;理性計畫;GINI係數;Le Grand係數;醫療資源;medical health network plan;rational plan;GINI coefficient;Le Grand coefficient;health care resources
日期:	2007-07-02
上传时间:	2009-08-11 16:56:27 (UTC+8)
摘要:	中文摘要目的本研究希望能將錯綜複雜的醫療網計畫作系統性的回顧，並將其與近年所推展之區域輔導與資源整合計畫應用理性計畫的十個標準進行評估，最後，試著使用醫師人力分布指標，評估醫療網計畫對醫療資源分布的影響。研究方法本研究用來探討計畫是否符合理性的標準有以下十個：(1)計畫是否具有價值性目標(goal)，(2)價值目標是否符合公共性或公共利益(public interest)，(3)計畫是否具有可量性目標(objective)，(4)可量目標的訂定是否適當反映價值目標，(5)計畫是否進行現況分析，(6)分析造成現況之因素的因果推論是否適當，(7)計畫有無可能達成相同目標的替選方案，(8)替選方案之間是否進行效率、公平和可行性的比較，(9)計畫所提的方案與目標的達成是否有關聯性，(10)計畫機構的組織型態是否限制計劃過程中理性的運用。所使用的醫師人力分布指標為GINI係數與Le Grand係數。結果醫療網計畫在研擬方面逐漸具有理性計畫的特點，以目前來說，比較欠缺的僅是現況分析的因果推論以及方案的效率性、公平性、可行性評估，而區域輔導與資源整合計畫則尚有目標價值公共性不足及方案與目標的關聯性不足等問題。醫師與病床的分布最平均與最不平均的情形皆分別出現在2004年前後與1996年前後，代表醫師與病床的分布有某種程度的正向關係。歷年來醫師和病床GINI係數的變化，病床的分布看來似有越來越平均的趨勢，複迴歸的分析結果，醫療資源的分布對0歲平均餘命的增加達到顯著相關。結論針對醫療網計畫，仍可對尚未執行之方案的效率性、公平性、可行性評估作補救，而區域輔導計畫方面，則建議能將計畫的組織型態由行政型改為獨立型的組織型態，將計畫的研修單位與執行單位分開。持續的對醫療資源和醫師的分布作監控，是政府相關部門該做的事，另一方面也可與他國的資料做比較，可以幫助我們建立基準值。 Abstract Purpose：This research hoped to retrospect systemically to the intricate medical health network plan, and use 10 rational plan standards to assess that medical network plans and area coach with resource integration plans in recent years. Finally, we try to use the allocation of doctor''s manpower to be the indicators to assess the influence on the allocation of medical resources by the medical health network plan. Method：The 10 rational plan standards used in this research would be introduced in the following：(1)Whether the plan have value goals, (2)Whether the value goal accord with public or public interests, (3) Whether the plan have quantity objectives, (4) Whether the quantity objectives can reflect the value goals, (5)Whether the plans have present situation analysis, (6)Whether the cause－effect inference causing the factors of the present situation be proper, (7)Are there alternative scheme may reach same goals, (8)Whether the alternative scheme compare with efficiency, fairness and feasibility, (9) Whether the goals have the relation to the scheme proposed, (10)Whether the organization type limit to the rational application in the process of planning. The allocation indicators of doctor manpower are GINI coefficient and Le Grand coefficient. Result：The medical health network planning gradually has the characteristic of rational plan. At present, only the cause－effect inference of present situation and efficiency, fairness, feasible assessment that is relatively deficient. The area coach with resource integration plans has more problems, such like the inadequate for the public of value goals and the relationship between the scheme and goals. Our results indicate a positive association between the current physician distribution and hospital-beds’ distribution. There is a trend toward increased equality with respect to physician distribution. Conclusion：First, for medical network plans, it still can do the efficiency, fairness and feasible assessment of the schemes not carrying out yet. Second, for the area coach with resource integration plans, this study proposes that it can change the organization type from the administrative type to the independent type, and separate the planning unit from the carry out unit. To continue monitoring of the inequality in health care resources, and particularly of physician distributions, should be ongoing. Comparative data from other countries, would help establish benchmarks.
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