我國醫療服務提升計畫對醫療資源不足地區的政策效果評估

Policy impact of medical quality improvement project on medically underserved areas

目標：近年我國積極推動各項偏鄉醫療照護計畫，投注預算數逐年提升，為探究政策是否有具體成效，本研究以「全民健康保險醫療資源不足地區之醫療服務提升計畫」（簡稱「醫療服務提升計畫」）為例，評估其政策效益。方法：本研究利用我國2011年與2013年全民健康保險資料庫，採用「綜合特質型居住地估計方法」定義偏鄉長住居民，並將有無參與醫療服務提升計畫醫院之周邊偏鄉分為實驗組與對照組，透過差異中差異法（difference-in-differences,DD）進行實證分析，探討偏鄉醫療照護計畫對醫療資源不足地區之影響。結果：研究結果指出，以門診為基礎的評估指標呈現顯著的政策效果，其門診跨區就醫分率顯著成長5.33%。以急診為基礎的評估指標雖可觀察到政策介入效果，如急診跨區就醫分率成長1.14%，可避免急診率降低0.20%，但皆未達統計上顯著。惟可避免住院率呈現逆勢發展成長0.26%，但同樣未達統計上顯著。結論：以跨區域醫療資源而非行政區來整合醫療資源之政策概念，將有助於改善偏鄉民眾醫療服務需求。

Objectives: Taiwan has implemented numerous healthcare projects in rural areas, and the number of bidding budgets has increased yearly. The aim of this study is to evaluate the policy effect of medical quality improvement projects in medically underserved areas. Methods: This study used 2011–2013 data from Taiwan’s National Health Insurance Database to analyze the effect of the national medical quality improvement policies have on the medically underserved areas. The experimental group comprised of hospitals participating in the projects, while the control group comprised of non-participating hospitals. We examined the effect of projects implemented to improve healthcare services by performing an empirical analysis using the DD method. Results: The outpatient-based evaluation indicators suggested the projects had considerable effect, such as increasing the outpatient cross-boundary medical care rate by 5.33%, increasing the interregional medical treatment rate of emergency departments by 1.14%, and decreasing preventable emergency department visits by 0.20%. Among these results, the outpatient cross-boundary medical care rate reached a statistical significance, while the other two indicators did not. The preventable hospitalization rate showed a contrarian growth of 0.26%, which was also not statistically significant. Conclusions: Policies to provide regional medical services across jurisdictional boundaries will help medical care needs of rural populations.