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研究生:李奇燁
研究生(外文):Chi-Yeh Li
論文名稱:跨區就醫及其影響因素分析-以雲林縣西醫基層診所為例
論文名稱(外文):The research of cross-region health care utilization and it’s influencing factors– Case of primary physician clinics in Yunlin country
指導教授:王精文王精文引用關係
口試委員:楊志良戴志展
口試日期:2011-05-28
學位類別:碩士
校院名稱:國立中興大學
系所名稱:高階經理人碩士在職專班
學門:商業及管理學門
學類:其他商業及管理學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:88
中文關鍵詞:跨區就醫西醫基層診所雲林縣
外文關鍵詞:Cross-Region DoctoringPrimary Physician clinicsYunlin
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本研究旨在探討雲林縣民眾西醫基層門診之跨區就醫影響因素及趨勢變化,以健保資料庫2005年「承保抽樣歸人檔(LHID 2005)」作為研究主檔,串連「醫事機構機本資料檔(HOSB)」、「門診費用申請總表主檔(CT)」、「門診處方及治療明細檔(CD)」、「承保資料檔(ID)」等檔案進行研究;第一階段分析2008年民眾跨區就醫之影響因素;第二階段分析2004年及2008年兩年間民眾跨鄉鎮就醫之趨勢變化,以及2008年雲林縣民眾跨鄉鎮、跨醫療區、跨次醫療區就醫之趨勢變化,研究結果如下:
第一階段:跨區就醫之影響因素及就醫流向
一、跨區就醫影響因素:
(一)人口特質:「性別」、「年齡」、「投保薪資」、「投保鄉鎮」等對跨區就醫皆有顯著的影響。
(二)就醫科別:「內科」、「外科」、「婦產科」、「小兒科」、「眼科」各科對跨區就醫均有顯著的差異;其中「婦產科」、「小兒科」等科別有較高的跨區就醫比例。
(三)醫療費用:本研究之各項醫療費用對跨區就醫均有顯著的影響,在控制各項醫療費用後顯示:
1.西醫一般案件費用:「65歲以上」、「45,000元以上」、所有「就醫科別」,以及投保鄉鎮除「莿桐鄉」、「東勢鄉」以外之鄉鎮,在西醫一般門診之使用上較易跨區就醫。
2.預防保健費用:「65歲以上」、「內、外、婦、兒」科、以及投保鄉鎮在「虎尾鎮」、「土庫鎮」、「北港鄉」、「元長鄉」、「口湖鄉」等鄉鎮之民眾,在使用預防保健時較易跨區就醫。
3.慢性病醫療費用:以「女性」、「65歲以上」、「眼科」,以及投保鄉鎮除「土庫鎮」、「大埤鄉」、「二崙鄉」、「台西鄉」、「四湖鄉」以外之鄉鎮之民眾,在「慢性病」醫療利用上較易跨區就醫。
三、跨區就醫流向與趨勢:
(一)2004年及2008年鄉鎮跨區就醫趨勢變化:
兩年度跨區就醫比例降低幅度最多者為「麥寮鄉」、「四湖鄉」,增加幅度最多者為「褒忠鄉」及「西螺鎮」;兩年度平均跨區就醫率皆將近40%,兩年度間趨勢變化沒有明顯差異。
(二)2008年跨鄉鎮與跨醫療區、次醫療區之就醫趨勢變化:
1.跨鄉鎮與跨次醫療區:以「林內鄉」下降比例最高,「崙背鄉」與「麥寮鄉」下降之比例最少。
2.跨鄉鎮與跨醫療區:「斗六市」下降比例最高,下降最少為「林內鄉」。
本研究結果顯示:雲林縣普遍存在跨區就醫問題,主因為資源集中於某些鄉鎮且分佈不均;盼當地衛生主管機關能整合縣內資源,均衡分配與管控各鄉鎮醫療院所之設立,結合鼓勵醫師至醫缺地區開業之政策,以提升雲林縣境內醫療資源之可近性。

The purpose of this research is to study the influence factors and trend changes of primary out-patients of cross-region doctoring taken by people of Yunlin County. Use 2005 National Health Insurance database "Underwriting sample classified file (LHID 2005)" as the research master file, and connect "Medical institutions basic data file (HOSB)", "Main file of the application list of total out-patient costs (CT)", "File of outpatient prescription and detailed treatment (CD)", and "Underwriting data file (ID)" as the study samples. The first step is to analyze the influence factors of people’s cross-region doctoring in 2008; the second step is to analyze the trend changes of people’s cross-township doctoring in 2004 & 2008 and also the trend changes of people’s cross-townships, cross-medical district, cross-sub medical district doctoring in Yunlin County in 2008. The results of the research are summarized as follows:
1.Influence factors of cross-region doctoring:
(1) Population characteristics: "gender", "age", "insured salary", " insurance township " have significant impacts to cross-region doctoring.
(2) Medical Department: “Internal Medicine”, “Surgery”, “Obstetrics and Gynecology”, Pediatrics”, and Ophthalmology” have significant differences for cross-region doctoring individually in which “Obstetrics and Gynecology” and “Pediatrics” have higher proportion of cross-region doctoring.
(3) Medical Expenses: The medical expense of each item in this study has significant impact to cross-region doctoring. After controlling the medical expense of each item, it indicates:
a.Expense of general case of western medicine: For those factors such as: “age above 65”, “cost more than NT$45,000”, all “medical departments”, and insurance townships other than “Chitong Township”, “Tongshih Township”, it’s easier to use cross-region doctoring in general western medicine.
b.Prevention & Care Expenses: For those factors such as: “age above 65”, “Internal Medicine/Surgery/Obstetrics and Gynecology/Pediatrics, and insurance townships locate at “Huwei Town”, “Tuku Town”, “Peikang Township”, “Yuanchang Township”, and “Kohu Township”, it’s easier for people there to conduct cross-region doctoring while taking prevention & care treatment.
c.Chronic Medical Expenses: For those factors such as: “female”,“age above 65”,“Ophthalmology”,and insurance townships other than “Tuku Town”,“Dabi Township”,“Erlun Township”,“Taishi Township”,“Four-lake Township”, it’s easier for people to use cross-region doctoring while having chronic medical treatments.
2.Flow and Trends of Cross-region Doctoring:
(1)Trend changes of cross-region doctoring in 2004 & 2008:
The most decreasing proportion of cross-region doctoring in years of 2004 & 2008 is “Mailiao Township” and “Four-lake Township”; “Baochung Township” and “Shiluo Town” are the locations which increase cross-region doctoring most. The average rate of cross-region doctoring in these 2 years is close to 40%, and the trend changes within these 2 years do not have remarkable difference.
(2)Trend changes of cross-townships, cross-medical district, cross-sub medical district doctoring in 2008.
a.“Cross-townships” and “Cross-sub medical district”: “Linnei Township” has a highest rate of decreasing and “Lunbei Township” & “Mailiao Township” have lowest rates of decreasing.
b.“Cross-townships” and “Cross- medical district”: “Daoliu City” has a highest rate of decreasing and the location with lowest rate of decreasing is “Linnei Township”.
The results of this study indicate that Yunlin County has widespread cross-region doctoring problem. It’s mainly because of the uneven resources distribution. We expect that local hygiene/health authorities may integrate the resources within the county, balance and allocate the resources properly also to well control the establishment of clinics in the county. Encourage doctors to those locations where are lack of physicians and to cope with the policy for opening clinics there in order to promote the accessibility of medical resources within Yunlin County.

第一章 研究動機與目的
第一節 研究動機………………………………………………1
第二節 研究目的………………………………………………5
第二章 文獻探討
第一節 跨區就醫………………………………………………6
第二節 國內外跨區就醫相關研究……………………………14
第三節 雲林縣醫療資源概況…………………………………21
第三章 研究方法
第一節 資料來源與研究對象…………………………………39
第二節 研究架構………………………………………………42
第三節 研究變項之操作型定義………………………………43
第四節 資料處理與統計方法…………………………………46
第四章 研究結果
第一節 人口特質與就醫科別描述……………………………48
第二節 人口特質、就醫科別對醫療費用之影響及分佈狀況51
第三節 醫療費用對跨區就醫之影響…………………………58
第四節 人口特質、就醫科別對跨區就醫之影響……………59
第五節 雲林縣民眾之跨區就醫流向與趨勢…………………66
第五章 討 論
第一節 研究限制………………………………………………71
第二節 人口特質、就醫科別與跨區就醫……………………72
第三節 醫療費用與跨區就醫…………………………………74
第四節 跨區就醫流向與趨勢…………………………………76
第六章 結論與建議
第一節 結 論…………………………………………………78
第二節 建 議…………………………………………………79
參考文獻 …………………………………………………………81
附 錄 …………………………………………………………86

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王乃弘(1994),民眾對選擇醫院因素及態度之研究:以中部數家醫院為例,中國醫藥學院醫務管理研究所碩士論文。
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