全民健康保險醫療資源潛在空間可近性分析——以台灣北部四縣市為例

Potential spatial accessibility of health care resources: an example of four counties and cities in northern Taiwan

目標：本研究旨在探討台灣北部四縣市醫療資源在地理空間上的可近性，並納入醫療資源不足提升服務據點，評量其對醫療資源空間可近性改善的程度。方法：使用內政部人口資料、交通部道路距離、中央健康保險署西醫巡迴地點、山地離島地區醫療給付效益提昇計畫（Integrated Delivery System, IDS）提供醫療服務地點、醫師及院所資料，以台灣北部四縣市各村里民眾為研究對象。本研究以道路交通距離15公里內每萬人口西醫師數為空間可近性的測量指標，利用「進階式兩階段流動搜尋法」針對各村里西醫醫療資源空間可近性進行評估。結果：共有11個村里在15公里的範圍內，沒有任何的西醫師資源（佔0.14%），144個村里在可近性較低的區域（佔2.84%），1,723個村里在可近性較適當的區域（佔97.02%）。巡迴醫療及IDS資源投入後，可近性不足的村里減少為99個（佔2.33%）。結論：巡迴醫療及IDS所涵蓋的村里，大部分位於可近性不足之地區，已回應到實際的情況，整體資源配置尚無明顯錯置現象。然而，仍然有2.33%的人口（174,575人）處在醫療資源不足的區域。 Objectives: The purposes of this study were to evaluate potential spatial accessibility of health care resources in four counties and cities in northern Taiwan and examine the provision of medical services in areas with shortages of health care resource to identify the degree to which the potential spatial accessibility of health care resources has been be improved. Methods: We conducted our studying using data concerning population, physicians and medical institutions, travel distance, health insurance mobile health care, and integrated delivery system (IDS) service locations. The study subjects were the populations living in the villages of four counties and cities in northern Taiwan. This study calculated physician to population ratio within a 15-kilometer travel distance and applied this ratio as an indicator of the spatial accessibility of health care resources in the use of the enhanced two-step floating catchment area method. Results: Eleven villages (0.14%) had no physician resources within 15 kilometers, 144 villages (2.84%) were in less accessible areas, and 1,723 villages (97.02%) had sufficient resources within 15 kilometers. After mobile health care and IDS service resources were implemented, the number of villages with insufficient accessibility was reduced to 99 (2.33%). Conclusions: Most of the villages covered by mobile health care and IDS are located in areas with insufficient accessibility. The policies promoting these two services have responded to the actual situation, and there is no obvious misallocation of overall resources. However, 2.33% of the population (174,575) still resides in areas with insufficient medical resources.