運用地理資訊系統探討新設醫院對緊急醫療資源可近性之研究──以新竹區為例

A Geographic Information System Study on the Accessibility to Emergency Medical Resources for New Hospitals -- A Case of Hsinchu District

本文主要目的是以內政部2017年本島7,689村里為研究範圍及衛生福利部公布有設置急診室193家醫院，運用地理資訊系統之空間分布功能，計算最近緊急醫療資源距離，並計算在限定的行車時間內可選擇醫院數量，以呈現各村里緊急就醫資源之分配情況。另以申請新設於新竹縣市之醫院，比較新竹縣市及苗栗縣民眾在可選擇性（醫院數量）及就醫可近性（就醫距離）進行前後差異分析及比較。結果顯示緊急醫療資源可近性集中於北北基、台中市及高雄市，有751個村里（佔總村里數9.8％，總人口數4.1％）10公里內完全無急診室，相較於另1,824個村里（佔總村里數23.4％，總人口數35.7％）有11家以上急診室可選擇。另，發現新竹縣市未因2家新設醫院投入後，民眾平均就醫距離有明顯縮短，代表醫院新設時並未充分考慮地理區位平衡。最後，以若新竹市三區行政區探討再投入新設立醫院對緊急醫療資源的影響，結果發現應投入於香山區較能平衡新竹市及附近區域之緊急醫療資源。結論可知，各縣市都會區的緊急醫療資源可近性較高，山地及偏鄉地區緊急醫療資源的空間可近性相對弱勢，民眾緊急醫療就醫可近性急需改善，但目前醫院設置只考慮萬人口床比，無法反映各區域醫療資源的地理可近性，使緊急醫療資源公平性問題日益擴大。建議未來在規劃地區性之緊急醫療資源時，應考量醫療資源均衡發展及合理分布，就政策制定可配合現有的衛生政策，要求公立醫院新設或擴建計畫應以緊急醫療缺乏之區域為優先考量。 This study is to conduct the spatial distribution analysis in the geographic information systemto calculate the distance from emergency medical resources and the number of available hospitals withinthe limited transportation time, as well as presenting the allocation of emergency medical resources for allvillages. The scope of this study covers the 7,689 villages in Taiwan in 2017 and the 193 hospitals withemergency rooms, announced by the Ministry of Health and Welfare. In addition, we also analyze andcompare the medical accessibility before and after the new hospitals were established in Hsinchu City andCounty for the citizens from Hsinchu City and County and Miaoli County.The results show that the emergency medical resources are densely located in Taipei City, NewTaipei City, Keelung City, Taichung City and Kaohsiung City. There are 751 villages (9.8% of totalvillages, 4.1% of total population) where no emergency room can be found within 10 kilometers,while there are 1,824 villages (23.4% of total villages, 35.7% of total population) where more than11 emergency rooms are available. In addition, it is found that the average distance from medicalresources for citizens is not significantly decreased after two new hospitals were established,meaning that the balance of regional development was not taken into consideration in theestablishment of new hospitals. Finally, we focused on the three administrative districts in HsinchuCity to investigate the effect of new hospitals on emergency medical resources, demonstrating thatthe establishment of emergency medical service in Xiangshan District will balance the allocation ofemergency medical resources around Hsinchu City and neighboring areas.It is concluded from the analysis that the accessibility to emergency medical resources inmountainous and remote districts is relatively restricted, while the accessibility to emergencymedical resources in metropolitan areas is more available. Although the accessibility to emergencymedical resources needs immediate improvement, only the number of hospital beds per 10,000population is taken into consideration in the establishment of new hospitals, which fails toameliorate the allocation issue of emergency medical resources and deteriorate the fairness issueof emergency medical resources. It is suggested that the balance and fair allocation of medicalresources should be taken into consideration in planning the regional emergency medical resources.In coordination with the current policies of public health, public hospitals should be preferablyestablished or expanded in the areas lacking emergency medical resources.