| 摘要: | 本研究旨在初探假日西醫資源分配公平性。以羅爾斯正義論為公平性觀點，探討台南市診所醫療資源時間特性分配情況。研究以兩階段實施，首先觀察現行健保法規與台南市醫療資源現況，確認法規是否能滿足地區需求。另分別就(一)台南市平、假日診所醫療資源(二)假日診所未營業之區域，探討該區民眾假日醫療資源可近性，以確證假日醫療資源分配是否符合社會公平。其中醫療資源可近性，係採用Aday and Andersen的醫療可近性架構為理論基礎，並依據Penchansky and Thomas所提出之可取得性、可接近性觀點探討，利用醫療資源與人口、里之比及田野調查實際量測醫療資源可近性來探討台南市假日醫療資源分配情況。資料來源為衛生福利部中央健康保險署及台南市政府民政局網站次級資料。所得結果如下：一、現行醫療法規及其醫療資源缺乏規定與台南市醫療資源現況：（一）台南市診所醫療資源分別以現行醫療政策、主要疾病區分後之醫療資源仍與每日主要疾病醫療資源情況有差異，且此差異無固定在某個區產生。（二）台南市有四個資源缺乏地區（安定、將軍、大內、南化區）高於法定規範每人醫療資源值，但因《全民健康保險醫療資源缺乏地區應具備之條件》規定設限，將可享有9個月額外福利。二、台南市西醫資源經時間特性劃分後資源分配情況：（ㄧ）台南市各區域內主要疾病醫療資源之時間特性情況：１、除原台南市「醫療服務與人口數比」及「醫療服務與里數比」、原縣轄市「醫療服務與人口數比」醫療資源無時間性之差異外，其餘各區「醫療服務與人口數比」及「醫療服務與里數比」醫療資源均有時間特性之懸殊差異。２、山上區、將軍區、七股、北門區、大內區、南化區及龍崎區等七個地區於假日與週日發生無診所營業情況。（二）無論是以台南市全部診所醫療資源、「主要疾病」醫療資源觀察或平日、假日、週日研究結果均發現非公告區比公告醫療資源缺乏區低情況。（三）台南市主要疾病假日無基本醫療資源地區，其平日區域內醫療資源與假日臨近醫療資源兩者醫療可近性情況有顯著差異。
This research aims to probe the fair distribute of holiday medicime resource. With J.Rawl’s Theory of Justice to be the fair viewpoint, we try to find out the condition of time property about the medicine resource of the clinics in Tainan City. The research is divided into two steps. First, we observe the situation of current health insurance legislation and medicine resource in Tainan City to make sure if the legislation can satisify the request from local. In addition, we also want to investigate the access of holiday medicine resoure to local people and probe if the holiday medicine resource can match society justice by the following terms, (1) weekday and holiday medicine resource in the clinics in Tainan City, (2) the local clinics with no business on holidays. Among them, the access of medicine resource is adopting the structure of medicine access of Aday and Andersen as theory foundation, also probing according to the viewpoint of disirability and accessibility of Penchansky and Thomas, using medicine resource, the proportion of population, the proportion of villages and field investigation to get the access of medicine resource and find out the real situation of the distribute of holiday medicine resource.Date source: National Health Insurance Administration. Minstry of Health and Welfare & secondary data from the website of Tainan City Civil Affairs Bureau. Research Results：First, The situation of current health insurance legislation, lack of medical resources provision and medicine resource in Tainan City.1.We could distinguish be different that the medicine resource in Tainan City into health insurance legislation, the major diseases of medicine resource and the major diseases of everyday medicine resource, they were produced without fixed area.2. Four resource-scarce areas was higher than the statutory standard medical resources in Tainan City (Anding District, Jiangjyun District, Danei District, Nanhua District)，but the provision limits - The lack of universal health insurance medical resources areas should have the condition, They enjoy additional benefits have about 9 months.Second,It’s distribution of the situation when medicine resources were divided by the time characteristics in Tainan City.1.The situation is the major diseases of medicine resource with time characteristic in Tainan.(1) In addition to the former Tainan ＂ medicine resource and population ratio＂ and ＂ medicine resource and villages ratio＂, the former county cities ＂ medicine resource and population ＂no differences of time characteristics. The rest of area about＂ medicine resource and population ratio ＂and＂ medicine resource and villages ratio ＂ are differences of time characteristics.(2) The clinic of seven area is no-business on holidays and Sundays. It is Shanshang District, Jiangjyun District, Chiku District, Beimen District, Danei District, Nanhua District and Longci District.2.The Non- Announcement areas was lower than the announcement areas that clinic of medicine resource in Tainan, Observed the major diseases of medicine resource, medicine resource at weekday, holiday or Sunday.3.The areas had not the major diseases of medicine resource at holiday in Tainan, the medicine resource access is difference at weekday and holiday. |
