探討醫療機構層級與醫療服務利用之關係－以糖尿病患者為例

Abstract

我國自從實施健保制度後，對於醫院的經營管理，造成許多直接與間接的衝擊，而為落實分級醫療制度的理念，中央主管機關亦將醫療機構分為醫學中心、區域醫院、地區醫院及基層診所等層級。但當面臨醫療成本控制與醫療品質管制的難題時，醫療機構是否真能提供該層級應有的服務水準，並落實分級醫療制度？ 本研究透過2004年全民健康保險資料庫中糖尿病患者之各項醫療服務利用，以多項羅吉斯迴歸模型分析，檢視現行醫療機構之層級是否具有差異，並以醫療機構為出發點，探討不同層級之醫療機構應如何提供其最適之醫療服務。 研究結果顯示，現行醫療機構之層級彼此間確實有差異，但並未能與分級醫療制度相符合。建議層級高的醫療機構應致力提供更專精的醫療服務，而層級低的醫療機構應提供周全性、連續性高的醫療服務（如家庭醫師照護制度），讓整體社會能善加分配所有可利用的醫療資源，並提供最有效益的醫療保健服務。

Since the implementation of the healthcare system in Taiwan, it causes many direct and indirect impacts to the hospital management. To carry out the hierarchical health care system, the authority concerned classifies medical institutions into medical centers, regional hospitals, district hospitals and clinics. But when it goes to medical costs and quality control, do medical institutions really provide what it should provide, and successfully implement the hierarchical health care system? The study analyses the use of health services by diabetic patients based on National Health Insurance database in 2004, and examine the existence of difference between current levels of medical institutions by multinomial logistic regression analysis. Beginning with medical institutions, we explore what different levels of medical institutions should do to provide the most suitable health services. The results show that the current levels of medical institutions do have differences between each other which are obviously inconsistent with current classification of the health care system. We suggest high-level medical institutions should seek to provide more specialized health services, whereas low-level ones should provide comprehensive and continuous health services (such as family physician care system). That can make good distribution of all available medical resources and help hospitals provide the most cost-effective health care services.