應用空間可接近性分析於臺灣婦產科醫療資源的評估   全文下載

Assessing the Resources of Obstetricians and Gynecologists in Taiwan by Using Spatial Accessibility Analysis

本研究利用地理資訊系統製圖與計算的功能，透過進階式兩階段流動搜尋法，針對臺灣婦產科醫療資源的空間可接近性進行評估。薛費法與空間分析結果顯示，位於偏遠鄉鎮、農業市鎮或高齡化市鎮的村里，相較於在都會區的村里，其婦產科醫療資源是較差的。而中央健康保險署在2012 年的醫療資源不足地區改善方案與巡迴服務所涵蓋的範圍，大致有回應到實際的情況，並未出現過多資源錯置現象。然而，仍有將近25% 的成年女性與16% 的生育年齡女性，位處在婦產科醫療資源不足的區域，並可能無法取得巡迴醫療服務。總言之，臺灣確實存在婦產科專科醫師分配不均的現象，如果資源持續過度集中於都會區，這樣的現象將會更加惡化。因此，針對缺乏醫療資源的地區女性之健康照護需求，未來需要創新的政策，使婦產科醫療資源的地理分配更均衡。

According to the data from the Department of Health, it shows that more than 200 townships without any obstetricians and gynecologists in Taiwan. An appropriate evaluation of the supply of and demand for obstetricians and gynecologists is important for the allocation of obstetrics and gynecology resources. The current evaluation practice, the township level physician-to-population ratio, cannot capture the characteristics of cross-district movements of the population. This study uses a geographic information system to calculate a geographically modified obstetrician and gynecologist to population ratio by using a two-step floating catchment area method which incorporated two different distance-decay functions to evaluate obstetrics and gynecology resources in Taiwan. The result of Scheffe and spatial analysis shows that there is a gap between urban and rural areas in spatial accessibility. Although the Bureau of National Health Insurance’s policy does cover some shortage areas, there are still nearly 25% of adult women and 16% of reproductive-aged women within obstetrics and gynecology shortage areas. An uneven distribution of obstetricians and gynecologists exists throughout Taiwan and may worsen if resources continue to cluster in metropolitan areas. Meeting the needs of women in underserved areas requires creative innovations in enhancing a more uniform geographic distribution of providers.