在醫療資源缺乏的安南區創立新醫院的需求調查

A Need Assessment Study on Hospital Services in An-Nan District, an Underserved Community without a Hospital

行政院衛生署於1991年設置醫療發展基金，鼓勵民間於醫療資源缺乏地區設立醫療機構。台南市安南區是台灣最古老的社區，至今未設醫院，實為醫療資源缺乏地區。1997年衛生署正式核准設立140床的綜合醫院，1998年安南地區舉行了社區醫院需求調查。區長、民意代表及鄰長都熱烈擁護「安南醫院」的成立，當地45家診所亦大都認為應該建設新醫院，但亦有33%並不贊成醫院的設立。「全民健保」的給付，以「醫院評鑑」為依據，為達到地區教學醫院的標準，安南醫院擬籌設內、外、婦產、兒科、放射科與麻醉科；檢驗科、藥局、急診科亦屬必須；麻醉科、病理科、眼科、耳鼻喉科、泌尿科與皮膚科則可依病患數之成長而設立。家庭醫學科的成立為迎接「健康維護組織」、「總額預算」及「論人計酬」等支付制度變遷的準備。新醫院病患主由社區診所的轉診而來，醫院因此必須與所有社區醫師連成一體。由於長期沒有醫院，地方民眾對醫院服務的使用習慣，就必須由醫院社區化的服務來培養。預防保健服務的提供，已成「無牆醫院」的基石，社區醫學的教學與研究活動，將成為該醫院核心競爭能力的著力點。

In 1991 the Department of Health (DOH) Executive Yuan, ROC, provided grants-in-aid to encourage the underserved community to build the hospital in providing comprehensive care for the underserved residents. A general hospital with 140 beds was formally approved to build in An-nan District, a community without a hospital for a population of 154,738 by the DOH in 1997. A community survey assessing the needs of the hospital services was conducted in October 1998. Community leaders and the citizen representatives are enthusiastic in supporting the hospital project. All 45 physicians practicing in the community were interviewed, most of them welcomed the construction of the new hospital and showed their interest in affiliation with the new hospital. Daily medical demands in the An-nan community were around 2,500 patients, 1.5% of the total population. Although the new hospital is adequate to accommodate admission needs of the An-nan people, it is crucial to receive support from the local clinicians. In addition to establish clinical departments of internal medicine, obstetrics and gynecology, surgery, pediatrics, radiology and anesthesiology to serve as the back-up hospital for local clinicians, who largely provide primary care services, it is suggested to open the departments of family medicine and community medicine in order to provide community-oriented primary care in meeting health needs of the underserved An-nan population. Clinical clerkship programs for medical students and specialty residency training programs are to be offered to train future physicians to serve the underserved areas.