台灣醫療院所各類病床發展回顧：1985－2017年

A review of hospital and clinics beds in Taiwan from 1985 to 2017

第一期醫療網計畫訂定2000年一般醫療設施每萬人口40床（含精神病床）之目標。本文系統性回顧我國醫療院所病床的分類與沿革發展。研究結果發現病床分類上越趨精細，且總病床數持續增加，2000年後醫院急性一般病床數增加趨緩，然特殊病床明顯增加，且以安寧病床、慢性呼吸照護病床、血液透析床、及亞急性呼吸照護病床增加最多；2017年每萬人口病床數為69.83床，已超過醫療網40床之目標。2064年預估我國總人口數將減少至1,758萬人，每萬人口病床數將因人口數減少而增加，減少病床與增加使用效率同等重要。本研究建議（1）將加護病床、燒傷病床、燒傷加護病床、嬰兒病床、急診觀察床等急性特殊病床納入管理；（2）因應多重慢性住院病人的增加，一般內科病房宜轉型為醫院整合醫學病房；（3）慢性一般病床應加速退場，（4）透析病床、安寧療護、呼吸照護治療、急性後期照護不應計入急性病床；透析病床屬治療床，其它後三者宜朝使用長期照顧機構提供服務。

The Medical Care Network Plan, established in 1986, set the goal of having 40 physical and mental health beds per 10,000 people in general medical facilities by 2000. This study systematically reviewed the classification and development history of hospital and clinic beds in Taiwan. The classification of beds has become more complex, and the number of bed types has continued to increase. After 2000, the number of acute care beds increased slowly, but the number of special beds increased significantly. The most-increased special beds included hospice palliative care beds, chronic respiratory care beds, hemodialysis beds, and subacute respiratory care beds. In 2017, the number of beds per 10,000 people was 69.83, exceeding the original goal of 40 beds. In 2064, the total population will decrease to 17.58 million; thus, the number of beds per 10,000 people will automatically increase. Reducing the number of beds is as important as increasing efficiency. We suggest: (1) incorporating acute special care beds such as intensive care beds, burn beds, burn unit intensive care beds, infant care beds, and emergency observation beds into management; (2) transforming general medical beds into hospitalist beds to better respond to the increasing number of multiple chronic patients; (3) accelerating the withdrawal of chronic beds; and (4) excluding hemodialysis beds, hospice palliative care beds, respiratory care beds, and postacute care beds from the acute beds category. Regarding this last suggestion, the hemodialysis bed is a treatment bed, and the others should be served by long-term care institutions.