臺北市醫療設施分佈之地理研究

Abstract

評量一地區醫療資源規劃是否適當；供需是否平衡等問題時，以醫療資源的空間規劃、醫療 設施的分佈與運作等方向來做評估，是為醫療行政單位重要的考量之一，而此更可以反映一區域 的特色及發展情形。本研究以醫學地理的大、小尺度區域空間研究觀點，分析台北市醫療設施之 分佈現況及其分佈機制。透過台北市人口統計、交通狀況、政府政策、醫院性質及經營者理念等 區域條件，來探討台北市醫院空間分佈之擴散、供給面空間分佈程度及開業醫的選址原因機制、 滿意度和理想等。此結果期能為有關單位及經營者之參考。本文之研究目的為：1）瞭解台北市各級醫療設施空間擴散的階段與其分佈的區域；2)探討台 北市基層診所單位面積的服務密度；3) 分析台北市開業醫的選址主要原因及影響因子；4) 瞭解 台北市開業醫對設置點的決策、滿意度及其理想的設置區位。本研究有關醫療設施選址資料以台 北市參加健保的開業醫為主，全面郵寄 1190 份的問卷調查（不含牙醫），共回收358 份的有效樣 本問卷。以地理資訊系統（GIS）及主成分分析、線性迴歸分析等統計程式處理資料。結果顯示 台北市醫療院所之設置的擴散和其人口密集區的擴散是相當一致。由於不同行政區，其人口結構 及發展不盡相同，因此開業醫的專業科目及數量也不一樣。基層開業醫選址會和配偶商量，且以 居民之年齡及社經情形、交通方便、環境好為主要考慮因素，並且有極大的地緣關係，包括和大 學及實習醫院所在地、家人及好友住附近、熟悉此區等顯著相關。至於理想的位置以交通便利、 人口密度高佔大部分，部分則認為醫術、醫德及服務品質才是最重要，位置其次。Health care facility is fundamental in designing medical resources in a health care system. Distribution of medical facilities affects quality and efficiency of medical resource usage tremendously. As most of the medical facilities are owned privately in Taipei, it is crucial to understand local medical practitioners’ attitudes and patterns in choosing their practice locations so as to analyze the city’s demand and supply model and possibly, mechanism of medical resource spatial distribution. The aims of this study are: 1) to explore medical facility distribution diffusion and its relationship with other relative elements in Taipei city. 2) to study the primary medical care density and distribution in Taipei city. 3) to analyze key factors affecting medical practitioners’ decisions in practice location. 4) to understand medical practitioners’ ideal locations of practice. In this study, we mailed questionnaires to 1190 general practitioners who were medicare providers in Taipei city. Of these, 358 questionnaires were returned and analyzed. We then used medical geography spatial location theory as a framework, Geographical Information System (GIS) as a tool to obtain facility distribution maps. We analyzed spatial elements such as population, traffic densities and also practitioners’ behavior in choosing their practice locations. We used Principal Component Analysis (PCA) for statistics. The results showed that the distribution of health care facility diffusion is highly related to the population density in Taipei city. Different population structure and community development level in individual sub-district of Taipei city have obvious impacts on local practitioners’ sub-specialty and practice density. Important factors such as partners’ preferences, local residents’ age and socioeconomic status, traffic condition and the so called “good environment” are crucial in determining practice locations. Locations in close convenience to main teaching hospitals, families and