桃園縣復興鄉居民醫療保健資源使用調查滿意度暨因素分析

Health care services to residents at remote mountain areas have been constrained by geographical dispersion of the population, limited economic activities and shortage of appropriate health care personnel. Therefore, health care status of residents in these remote areas, especially those of the aboriginal, has not been ideal in comparison with those living in the plain. Equity concerns for the population become a serious challenge under the National Health Insurance Program. The aims of the study are three folds: 1)to evaluate the impacts of medical service teams on the health care utilization patterns of residents at Fu-Hsing Hsiang, Tao-Yuan County; 2)to compare residents？？ level of satisfaction to services provided by the medical team with their regular sources of care; 3)to analyze the factors affecting the residents？？ use of health care services. Using data collected from benefit claims of the Northern Branch of National Health Insurance Bureau and community surveys conducted by the investigator, the researcher employs inferential statistics, such as logistic regression, multiple linear regression, as well as descriptive statistics in fulfilling the goals of the study. Medical service team did enhance access to primary health care for residents at Fu-Shiang: out-patient visits have increased by 12% and travelling time for receiving care has been greatly reduced from 70 minutes to 12 minutes on average. However, the average cost of 587 NT dollars per out-patient visit also ranks higher among those of primary care services in other regions. On the other hand, hospital utilization did not exhibit significant change over the year, the average length of stay even dropped by 0.53 day. Nevertheless, the cost for hospitalization increased sharply: average cost per admission raised from 25806 NT dollars to 30772 NT dollars, and average cost per hospitalization day raised from 4130 NT dollars to 4511 NT dollars. Whether the elevation of health status of the residents is commensurate with the investment remains to be observed in the long run. However, the residents are disappointed at the services provided by the medical service team. In the unique market of health care services in remote areas, oligopoly is formed easily. The benefits of and rights to health care services could be much compromised without appropriate monitoring systems either instituted by the market or the governing organization. Generally speaking, residents who are advancing in age, aboriginal, smokers, and insured are more likely to use out-patient care services. Yet, economic capacity and drinking behavior did not show statistically significant impacts on the utilization. Residents living in different villages of Fu-Hsing Hsian also exhibit different patterns of health care utilization, which demands recognition of health care planners. Whether medical service team model or integrated delivery services model is adopted in organizing the health care services needed, appropriate monitoring and evaluation mechanisms must be instituted to prevent inadvertent outcomes. Health care issues of the aboriginal could not be solved by the health care institutions alone, and require integration of efforts from other groups, such as the social welfare administration, the Aboriginal Committee, other social organizations, and the aboriginal themselves.

Project ID:PG9409-0143
External Project ID:DOH87-NH-052