群體醫療執業中心開辦對民眾健康影響評估──台東縣的實證分析

Impact of the Operations of Group Practice Centers on Residents’ Health --An Empirical Study of Taitung County

目的：比較台東縣在74至79年間分別於太麻里鄉、大武鄉、長濱鄉與鹿野鄉四個鄉開辦群體醫療執業中心後，民眾健康狀況是否改善。方法：以可避免死亡疾病死亡率做為健康之負面測量指標，利用60至89年衛生署死因檔計算各年度標準化死亡佔率，並採用時間數列介入分析方法進行評估分析。結果：除長濱鄉外，其他三個鄉在設置群醫中心後可避免死亡疾病死亡佔率均呈現顯著下降的改善情況，其下降值分別為鹿野鄉1.71、大武鄉3.02、太麻里鄉3.45。然而在對照組部分，亦有部分鄉鎮分別在不同指標呈現顯著下降，但其下降值均比實施群醫中心的鄉來得小。結論：群醫中心開辦對於偏遠地區醫療服務可近性有所提昇，並有改善民眾健康的效果，尤其是對於健康弱勢的兒童部分，因此推行群醫中心或委請醫療院所支遠山地離島、偏遠地區的醫療支援計劃可以再進一步的評估後，考慮推廣擴大。

Objective:The purpose of this study was to evaluate the effect of operation of group practice centers on residents’ health among Taimali, Dawu, Changbin, and Luye township in Taitung county between 1985 and 1990. Methods: The avoidable death mortality was employed as adverse measurement of health. Age standardizes mortality between 1971 and 2000 were calculated from cause of death data provided by Department of Health. The interrupted time series intervention analysis was used to determine whether operation of group practice centers resulted in any significant change in avoidable mortality. Results: There were significant decreases of avoidable mortality in Luye (-1.71), Dawu (-3.02), and Taimali (-3.45) but in Changbin township. Eventhough there were also significant decreases in some control townships, but the effects were slightly then these townships with operation of group practice center. Conclusions: The operations of group practice centers may result in improve accessibility and residents’ health among remote districts, especially in children. To provide medical services via group practice center or HOM should be add after further details research support.