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研究生:牛淑萍
研究生(外文):Shu-Ping Niou
論文名稱:改善偏鄉地區緊急醫療資源之空間可及性研究
論文名稱(外文):Improve the Rural Areas Spatial Accessibility of Emergency Medical Resources
指導教授:褚志鵬褚志鵬引用關係
指導教授(外文):Chih-Peng Chu
口試委員:陳正杰林俊銘
口試委員(外文):Cheng-Chieh ChenChun-Min Lin
口試日期:2020-06-12
學位類別:碩士
校院名稱:國立東華大學
系所名稱:企業管理學系
學門:商業及管理學門
學類:企業管理學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:英文
論文頁數:61
中文關鍵詞:緊急醫療偏鄉地區可及性救護車
外文關鍵詞:Emergency medicalRural areasAccessibilityAmbulance
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隨著臺灣人口結構快速老化、醫護人力不足、醫療資源分布不均,形成醫療照護沉重的負擔,進而影響到醫療品質,偏鄉地區的民眾就醫可及性也降低。依需求特質將醫療服務分為醫療、緊急醫療兩類,緊急醫療服務包含現場急救、包紮、運輸患者等,本研究主要以運輸患者的救護車為研究重點,瞭解典型的偏鄉地區臺東縣緊急醫療資源分布是否平均、瞭解臺東縣緊急救護案件發生地點、運用地理資訊系統之空間分析,探討臺東縣緊急醫療資源的空間可及性。
本研究使用地理資訊系統工具運算最短旅行時間,利用兩階段流動搜尋法與三階段流動搜尋法計算空間可及性,並使用吉尼係數和羅倫茲曲線表示空間不公平指數與緊急醫療資源分配是否公平。臺東縣空間不公平指數為0.4440(兩階段流動搜尋法)、0.4405(三階段流動搜尋法),數值越接近零代表救護車資源分布越平均,羅倫茲曲線越接近對角線表示救護車資源分布越平均。
研究結果顯示臺東縣緊急醫療資源空間可及性最佳的前三名為關山鎮、臺東市、東河鄉,緊急醫療資源空間可及性最差的後三名為海端鄉、長濱鄉、卑南鄉。根據本研究重新配置白天及晚上的救護車位置後,臺東縣救護車空間不公平指數由0.24降為0.19,代表調整後比調整前的救護車資源分布的更平均,符合當地民眾的緊急醫療需求。
With the rapid aging of Taiwan's population structure, inadequate medical care manpower and uneven distribution of medical resources, the Taiwan’s medical care burden has increased, which has affected the quality of medical care and the accessibility of people to medical treatment in rural areas. According to the characteristics of demand, medical service can be divided into two categories: medical service and emergency medical service. Emergency medical service includes on-site first aid, bandaging, and transportation of patients. This study focuses on ambulances to transport patients, to understand whether the distribution of emergency medical resources in typical rural areas of Taitung County is average, to understand the location of emergency rescue cases in Taitung County, and to use the space of geographic information system to explore the spatial accessibility of emergency medical resources in Taitung County.
In this study, GIS tools were used to calculate the shortest travel time, two-step floating catchment area(2SFCA) and three-step floating catchment area(3SFCA) were used to calculate the spatial accessibility, and Gini coefficient and Lorenz curve were used to express the spatial inequality index and the fairness of emergency medical resource allocation. Taitung County spatial inequality index is 0.4440 (2SFCA) and 0.4405 (3SFCA). The closer the value is to zero, the more average the distribution of ambulance resources is. The closer the Lorenz curve is to the diagonal, the more average the distribution of ambulance resources is.
The results show that the first three places with the best spatial accessibility of emergency medical resources are Guanshan Town, Taitung city and Donghe Township, and the last three places with the worst spatial accessibility are Haiduan Township, Changbin Township and Beinan Township. According to this study, the spatial inequality index of ambulances in Taitung County decreased from 0.24 to 0.19 after relocation of ambulances in the daytime and at night, which means that after adjustment, the distribution of ambulances resources is more average than before, which meets the emergency medical needs of local people.
Chapter 1 Introduction 1
1.1 Background and motivation 1
1.1.1 The Medical Status of Taiwan 1
1.1.2 The Scope of Emergency Medical Care 3
1.1.3 Emergency Time 4
1.1.4 Summary 6
1.2 Research Purpose 7
1.2.1 Understand Whether The Distribution of Emergency Medical Resources in Taitung County is Even 7
1.2.2 Understand The Location of The Emergency Rescue Case in Taitung County 8
1.2.3 The Use of GIS Space to Analyze The Spatial Accessibility of Emergency Medical Resources in Taitung County 10
1.3 Research Range 11
Chapter 2 Literature Review 15
2.1 Section I Medical Services Resources 15
2.1.1 According to The Characteristics of Demand: It Can be Divided into Two Categories Which is Medical Treatment and Emergency Medical Treatment 15
2.1.2 According to The Characteristics of The Institution: Hospitals, Clinics, Other Medical Institutions 15
2.1.3 According to The Level of Medical Resources: Medical Centers, Regional Hospitals, Regional Hospitals, Primary Clinics Four Levels 16
2.1.4 According to The Ambulance Management Unit: Fire Department 119 Ambulances, Civilian Ambulances 17
2.1.5 According to the type of injury: non-trauma category, trauma category 18
2.2 The Allocation of Ambulance Resources 20
2.3 Rural Area 23
2.4 Accessibility Theory 25
2.5 Accessibility Assessment 26
Chapter 3 Research Methods 31
3.1 Research architecture 31
3.2 Research Subjects 33
3.2.1 Research Data Collection 33
3.2.2 The Application of Research Materials 34
3.3 Data analysis methods 35
3.3.1 Two-Step Floating Catchment Area (2SFCA) 35
3.3.2 Three-step floating catchment area (3SFCA) 36
Chapter 4 Research and Strategy Analysis 39
4.1 Ambulance accessibility of emergency medical resources 39
4.2 Section of Emergency Rescue Case Data Analysis 45
4.3 Reconfiguration of ambulance resources 49
Chapter 5 Conclusion and Suggestion 54
5.1 Research Conclusions 54
5.1.1 Understand Whether The Distribution of Emergency Medical Resources in Taitung County is Even 55
5.1.2 Understand The Location of The Emergency Rescue Case in Taitung County 55
5.1.3 Use of GIS Space to Analyze The Spatial Accessibility of Emergency Medical Resources in Taitung County 56
5.2 Research recommendations 57
References 58
Appendix I Fire fighting rescue table 61
Chinese Part
1.章殷超、溫在弘、賴美淑(2011)。「比較不同地理可及性分析方法於評估 臺灣各鄉鎮每萬人口西醫師數之差異」。臺灣公共衛生雜誌,30(6),頁558-572。
2.廖興中(2014)。「臺灣基層醫療缺乏區域界定之初探:整合空間與非空間因素的分析」。行政暨政策學報,58,頁121-152。
3.陳建中 (2014). "救護資源濫用與救護車收費政策問題認定: 以嘉義市政府為例." 中正大學政治學系學位論文 : 1-185.
4.黃詩敏(2014)。 "在成長經濟中, 都會與偏鄉醫療保健支出不均對健康壽命之影響." : 1-43.
5.王麗芬、吳姿瑩、吳文祥(2018)。「運用地理資訊系統探討新設醫院對緊急醫療資源可及性之研究-以新竹區為例」。健康管理學刊,16(2),頁69-84。
6.蔡承翰(2018)。消防機關救護車遭不當使用之影響及改善方案-以桃園市為例。PhD diss., National Central University, 2018.

English Part
1.Richard L.M., Robert J.E., & Philip R. (1970). Factors Influencing Distance Travelled to Hospital. Economic Geography, 46, 161-171.
2.Penchansky, R., & Thomas, J. W. (1981). The Concept of Access. Medical Care, 19, 127-140.
3.Kleinman, J. C., Makuc, D. (1983). Travel for Ambulatory Medical Care. Medical Care, 21(5), 543-555.
4.Wei, L., Fahui, W. (2003). Measures of Spatial Accessibility to Health Care in A GIS Environment: Synthesis and A Case Study in The Chicago Region. Environment and Planning B, 30, 865-884.
5.Matthew, R. M., John, S.H. (2009). Measuring Spatial Accessibility to Primary Care in Rural Areas: Improving the Effectiveness of the Two-step Floating Catchment Area Method. Applied Geography, 29, 533-541.
6.Kanuganti, S., Sarkarb, A.K and Singh, A.P (2016). Quantifying Accessibility to Health Care Using Two-step Floating Catchment Area Method (2SFCA): A Case Study in Rajasthan. Transportation Research Procedia, 17, 391-399.
7.Rekha, R.S., Wajid, S., Radhakrishnan, N., Mathew, S. (2017). Accessibility Analysis of Health care facility using Geospatial Techniques. Transportation Research Procedia, 27, 1163-117.

Internet Part
1.The News Lens關鍵評論(2016)。取自https://www.thenewslens.com/article/38122
2.內政部消防署(2020)。取自https://www.nfa.gov.tw/pro/index.php
3.內政部(2020)。取自https://www.moi.gov.tw/
4.行政院(2020)。取自https://www.ey.gov.tw/Page/5A8A0CB5B41DA11E/341cd1dc-b6bf-4364-bb17-80f501d3ab90
5.山地、平地原住民及離島等偏鄉地區一覽表 (2020)。取自https://www.cdc.gov.tw/File/Get/oqXE2BJJJpJ4L_MmBKWtRw
6.衛生福利部(2019)。https://www.mohw.gov.tw/mp-1.html
7.全國法規資料庫─醫療法(2020)。取自https://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0020021
8.全國法規資料庫─緊急醫療救護法(2020)。取自https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020045
9.全國法規資料庫─醫療機構設置標準(2020)。取自https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020025
10.全國法規資料庫─民間救護車機構管理辦法(2020)。取自https://law.moj.gov.tw/LawClass/LawOldVer.aspx?pcode=L0020060&lnndate=20060104&lser=001
11.內政部─直轄市縣市消防機關救護車輛裝備人力配置標準(2020)。取自https://glrs.moi.gov.tw/LawContent.aspx?id=FL005078
12.衛生福利部中央健康保險署(2020)。取自https://www.mohw.gov.tw/mp-1.html
13.偏遠地區學校分級及認定標準(2020)。取自https://edu.law.moe.gov.tw/LawContent.aspx?id=GL001771
14.偏遠地區學校教育發展條例(2020)。取自https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=H0070073
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