高齡者醫療旅次運具選擇之研究

Abstract

高齡者生理與心理的退化，使其就醫頻率較高，就醫過程與運具選擇所面臨的問題亦較為複雜。過去高齡者運輸之文獻多考慮整體旅運特性，甚少針對醫療旅次作探討，且著重於高齡者生理、社經以及旅次特性，忽略高齡者心理層面與外在環境之影響。為滿足高齡者對於醫療之需求，除了瞭解高齡者就醫行為外，亦必須提供高齡者合適的醫療旅次運具。因此，本研究將心理與環境特性納入研究分析面向中，以完整探討高齡者醫療旅次運具選擇行為，釐清影響醫療旅次運具選擇的因素，探討高齡者面對運具選擇的問題。 本研究針對高齡者的醫療旅次，利用問卷調查方式瞭解臺灣高齡者就醫的運具選擇行為，運具選擇項目包含汽車、機車、公車、捷運、計程車、自行車、步行、復康巴士以及愛心敬老計程車，又依據高齡者自主性將私人運具分為駕駛或搭乘行為，變項設計上分為五大面向，包含生理特性、心理特性、社經特性、旅次特性以及建成環境，以完整探討高齡者醫療旅次運具選擇行為。本研究選擇臺北市大安區與臺北市立聯合醫院中興院區作為調查地點，於民國99年3月進行問卷調查，共收集307份有效樣本，並且利用巢式羅吉特模式校估高齡者醫療旅次運具選擇模式，探討各面向對於運具選擇之影響。 由模式校估結果得知，生理特性方面，行動能力對於運具選擇具有顯著影響關係，高齡者行動能力較為衰弱，較不能適應行車穩定性較差之運具，如駕駛機車、公車以及自行車。心理特性方面，則以安全性對於運具選擇具有顯著影響關係，高齡者對於駕駛機車、自行車以及計程車的安全性認知較低。高齡者受限於體力與行動能力，故醫療旅次普遍集中於短程；而高齡者醫療旅次時間價值估算為0.054(元/分鐘)，表示高齡者較不願意以多付旅行成本來換取較少的旅行時間。高齡者注重車道與人行道環境的安全性，及業密度越高的地區，其車輛與行人越多，對於駕駛機車與自行車之效用會下降，改而選擇安全性較高之運具。根據實證結果，本研究研擬其政策構想，以運具選擇為分項，分別提供改善政策，作為交通運輸政策改善方向之依據，以提升高齡者醫療旅次的交通運輸服務，使得高齡者能夠更便利地就醫。

For the elderly, physical and psychological declines raise the frequency and complexity of medical trips. The previous researches on elderly travel mostly focused on general trips with the considerations of elders’ physical, socioeconomic and travel attributes, while ignored medical trips and elders’ psychological and environmental attributes. To satisfy the elderly needs of medical care, not only the medical care behaviors but also the modal choices of medical trips should be explored. Therefore, this research empirically studied the elderly modal choices of medical trips with comprehensive considerations on explanatory factors in Taipei. This research aimed at exploring the factors affecting the elderly mode choice of medical trips in Taipei by questionnaire surveys. The studied mode choice alternatives include: car, motorcycle, bus, MRT (mass rapid transit), taxi, DRT (demand responsive transportation), bicycling and walking. The explanatory variables were comprehensively identified in five perspectives including physical factors, psychological factors, socioeconomic factors, travel factors and built environments. The sample data including 307 effective observations were collected from the surveys in Daan District and Taipei City Hospital Zhongxing Branch in March 2010 and were analyzed by nested logit models. The empirical results reveal that individual mobility significantly affects mode choices of medical trips. Decreasing mobility declines the usage of lower-stable modes such as driving motorcycle, riding bus and bicycling. Security is proven to be a significant factor affecting mode choices in psychological perspective; an elder’s security perception is negatively associated with the uses of driving motorcycle, bicycling, and riding taxi. An elder’s medical trip is commonly short in distance because of the limitations of physical strength and mobility. The time value of 0.054 (NT$/min) estimated in this study represents a tiny trade-off between travel cost and travel time for elders. Increasing employment density decreases driving motorcycle and bicycling because that dense environment induces vehicles and pedestrians and thus causes security concerns for elders moving on roads and sidewalks. Based on the empirical findings, this study proposed development strategies to elevate transportation services for elders’ medical travels.