台灣婦幼衛生於公共衛生護理發展之反思

Reflections on the Development of Maternal and Child Health in Public Health Nursing in Taiwan

由於近年全球經濟環境持續惡化，醫療體系依據健保給付的分配造成過度醫療化及市場化、健保給付無法依需求適時調整以致醫療照護成本緊縮、進而形成醫院護理人力短缺等現象，衛生所以及健康服務中心護理人員人力也因上述因素受到排擠及邊緣化，亟待政府及專業團體共同研議符合民眾健康需求之社區照護模式，除強化既有公共衛生護理角色與功能，也需進行相關研究及服務模式試辦；本文嘗試透過國內婦幼衛生照護需求及現況分析問題，並借鏡世界各國公共衛生護理在婦幼衛生的成功經驗，針對我國公共衛生護理未來發展提出建議。

Continued global economic difficulties and Taiwan's health insurance scheme have focused the domestic healthcare system excessively on medical treatments and made this system overly market-oriented. The NHI (national health insurance) Reimbursement Policy lacks adequate flexibility to adjust to current health needs. This situation constrains the medical service budget and causes nursing shortages in hospitals, which in turn marginalizes the public health nurses working at health centers. It is important for the government and professional associations to establish a public healthcare model that adequately meets the needs of the community. In addition to strengthening the role and function of public health nurses, a service model must be developed and piloted. This paper analyzes the situation and problem of maternal and child healthcare in Taiwan, studies the successful experiences of maternal and child healthcare from other counties, and then provides recommendations for the future development of public health nursing in Taiwan.