突破東區醫療困境，預見醫療整合藍圖──擦亮健保東區櫥窗

Break through the medical predicament of the Eastern District and foresee the blueprint for medical integration–Brighten up the east district window of health insurance–

花東民眾平均餘命長年低於全國，且總額預算東區占率從2006年3.03%降到2018年2.8%，相較人口數降幅來得高，對民眾及醫療體系影響甚大。2019年醫院透過總額提撥2億元(占率0.0372%)為風險移撥款，東區17家醫院共同強化區域醫療照護、提升偏鄉弱勢平均餘命、改善疾病照護品質、增進民眾自我照護識能四大目標邁進；為改善花東地區長年醫療資源不均、人口型態改變、多重慢性疾病等窘境，除運用地理資訊系統精準掌握醫療改善區域，策進醫療服務網絡，布建醫事人力支援，聚焦高風險與弱勢群體，拓展糖尿病在地共照網，落地肝炎一條龍在地照護，建立花東癌症連續照護網外，為打破距離藩籬，同步開發偏鄉遠距會診、緊急醫療及傷口遠距諮詢。2019年花蓮及臺東縣雖然比全國平均餘命80.8歲分別少3.8、4.5歲，但較前一年各提升0.47、0.53歲，高於全國的0.17歲。東區醫療整合之革新，不但探究民眾醫療需求，強化醫療體系良好互動及提升醫療品質，落實及平衡各鄉鎮醫療發展，更以三倍速度努力消弭民眾健康不平等，突破東區醫療困境，預見醫療整合藍圖。感恩衛福部、健保署、全民健康保險會、花蓮及台東縣政府、台灣醫院協會、醫院醫療服務審查執行會暨分會、花東醫療院所同仁的支持與努力，才能擦亮台灣健保在偏鄉醫療這一片櫥窗。

"The average life expectancy of the population of Huadong has been lower than the national average for many years. Furthermore, the proportion of the total national budget earmarked for the region dropped from 3.03% in 2006 to 2.81% in 2018. In 2019, 200 million yuan (0.0372%) was allocated for risk transfer funding for hospitals. The 17 hospitals in Huadong used fund matching to strengthen regional medical care. Such actions improved overall health-care quality, increased the average life expectancy of disadvantaged residents in rural areas, and enhanced selfcare awareness. Uneven medical resource distribution, demographic changes, and the presence of multiple chronic diseases have negatively affected Huadong residents for many years. The support and efforts of the Ministry of Health and Welfare, National Health Insurance Agency, National Health Insurance Association, Hualien and Taitung County Governments, Taiwan Hospital Association and its branches, and Huadong medical institutions have helped to improve the Huadong health insurance window.A clear understanding of areas needing improvement, a plan for medical service networks, the deployment of medical personnel, a focus on high-risk and disadvantaged groups, an expanded local diabetes cocare network, the provision of one-stop hepatitis care in the region, and a Huadong continuous cancer care network have brought benefits to Huadong residents. Furthermore, residents can attend remote consultations (e.g., for wound care) and receive emergency medical treatment. These reforms, which were responses to the medical needs of locals, have strengthened the local health-care system and improved the quality of care. Related programs have eliminated health-care disparities, overcome local health-care problems, and established a blueprint for medical integration."