台灣急重症跨區就醫之變化情形：2001－2010年

Change in the cross-boundary flow of emergent care in Taiwan, 2001-2010

目標：本研究以急重症就醫流向為基礎，探討過去10年間民眾急重症跨區就醫流向的變化情形。方法：本研究利用全民健康保險資料庫約200萬人的就醫及承保資料做為分析的主要檔案，首先利用保險對象基層醫療利用次數最多地區及投保地區定義其居住地，接著採美國紐約大學急診緊急分類規則將門診之急診案件依其診斷判定急重症，而住院之急診案件則直接視為急重症；接著利用50個醫療次區域做為地區單位，計算各地區在2001及2010年的急重症跨區就醫比例，並以配對t檢定比較此10年間的急重症跨區就醫比例差異，最後將跨區就醫分為低、中、高三組，分別檢定其10年間的急重症跨區就醫比例及急診能量的差異。結果：整體之急重症跨區就醫比例自2001年的43.4％降至2010年的41.2％，但差異未達顯著，而第三個四分位數和第一個四分位數的比值則由2.19降為2.13。急重症跨區就醫比例較高地區10年間的跨區就醫比例有顯著的下降，但平均仍達57.7％。地區的急重症跨區就醫比例愈高，其急診能量有愈小的趨勢。結論：整體而言，我國2001年至2010年急重症跨區就醫比例並沒有顯著的下降，區域間的跨區就醫差異亦未大幅縮小，但急重症跨區就醫比例較高地區的急診能量有顯著的改善，其跨區就醫比例亦有顯著降低，未來應將緊急醫療資源優先分配至跨區就醫比例較高的地區。

Objectives: This study explored the changes in the proportions of cross-boundary emergent care (CBEC) visits from 2001 to 2010 based on the emergent care flow among 50 subregions in Taiwan. Methods: Approximately 2 million randomly sampled representative beneficiaries from the National Health Insurance database were used as the data source for analysis. A modified New York University algorithm was applied to classify emergency department (ED) visits to emergent care, as well as ED visits resulting in hospitalization. Subsequently, 50 medical subregions were used as the analytical units to calculate the proportion of CBEC visits between 2001 and 2010 in Taiwan. Paired t tests were applied to examine the differences in CBEC flow over one decade, and the ratio of the third quartile (Q3) to the first quartile (Q1) was presented to reflect the regional variation in CBEC flow. Finally, the 50 subregions were divided into low, medium, and high groups according to their CBEC flows in 2001, and the differences in the CBEC and emergent care capacities between 2001 and 2010 were compared. Results: The average proportion of CBEC visits nonsignificantly declined from 43.4% in 2001 to 41.2% in 2010. The Q3 to Q1 ratio slightly decreased from 2.19 to 2.13 in that decade. However, the CBEC flow in the subregions in high CBEC groups significantly decreased, accompanied by a significant increase in emergent care capacity, even when the CBEC rate remained as high as 57.7% in 2010. Conclusions: The proportion of CBEC visits did not significantly decrease from 2001 to 2010 in spite of health policies dedicating to allocate emergent care resources more equitably across subregions. Nevertheless, the subregions with higher CBEC flows improved significantly as emergent care capacity was enhanced, in spite of continuously maintaining higher CBEC flow, indicating that allocating more emergent care resources into these subregions is necessary.