[[alternative]]A Study on the Allocation Equity and Utilization Efficiency of Medical Resources in Various Counties and Cities of Taiwan

[[abstract]]目的：探討2017年臺灣各縣市醫療資源分配公平與利用效率之情形。方法：以羅倫茲曲線（Lorenz curve）的圖形與吉尼係數（Gini coefficient）的量化數據，評估醫療機構數、執業醫事人員數、病床數此三項醫療資源在臺灣17個縣市的公平程度，並以資料包絡分析法（Data envelopment analysis, DEA）探討臺灣17個縣市醫療資源利用效率，分為兩個階段，第一階段以DEA-CCR模型計算臺灣各縣市的醫療資源利用效率，第二階段以非意欲產出模型（Undesirable Output）將粗死亡率納入考量計算各縣市的醫療資源利用效率。結果：(1)在醫療資源分配公平性的部份，不論由人口數或土地面積觀察各縣市內的醫療資源分配，皆存在著一定程度的分配不公平現象，但各縣市醫療資源相對於人口數分布比起相對於土地面積分布則是呈現更為公平的狀況。(2)在醫療資源利用效率的部分，不論有無考慮非意欲產出（粗死亡率），臺北市、宜蘭縣、新竹縣市、彰化縣、南投縣、嘉義縣市、臺東縣與基隆市均為相對有效率之縣市，新北市、臺南市、高雄市、苗栗縣、雲林縣、屏東縣與花蓮縣則均為相對無效率之縣市，另外，桃園市與臺中市這兩個縣市的效率值在考慮到非意欲產出後提升，從原本相對無效率的縣市變為相對有效率的縣市。最後，都市化程度越高的縣市，其醫療資源利用效率越低。結論：臺灣不公平的醫療資源分配已成為事實，因此，關鍵是要提高醫療資源的利用效率來優化醫療資源的分配、減少無謂的醫療資源浪費。[[abstract]]Objective：The purpose of this thesis is to examine the allocation equity and utilization efficiency of medical resources in various counties and cities of Taiwan in 2017.Methods：Using the graph of Lorenz curve and the quantitative data of Gini coefficient to assess the equity of the allocation of these three medical resources in 17 counties and cities of Taiwan for medical institution, registered medical personnel and hospital beds. Data envelopment analysis is used to evaluate the utilization efficiency of medical resources in 17 counties and cities of Taiwan in 2017. This study is divided into two stages. In the first stage, the DEA-CCR model is used to calculate the medical resource utilization efficiency of 17 counties and cities in Taiwan. In the second stage, the crude mortality rate was taken into account by the undesirable output model to calculate the medical resource utilization efficiency of various counties and cities.Results：(1) In the part of the allocation equity of medical resources, regardless of the population or land area to observe the allocation of medical resources in various counties and cities, there is a certain degree of inequity allocation, but the allocation of medical resources relative to the population is more equitable than the allocation of medical resources relative to the land area. (2) In the part of the utilization efficiency of medical resources, regardless of whether or not to consider undesirable output (crude mortality rate), Taipei City, Yilan County, Hsinchu City and County, Changhua County, Nantou County, Chiayi City and County, Taitung County and Keelung City are relatively efficient counties and cities. And, New Taipei City, Tainan City, Kaohsiung City, Miaoli County, Yunlin County, Pingtung County and Hualien County are relatively inefficient counties and cities. In addition, the efficiency values of Taoyuan City and Taichung City are increased after taking into account undesirable output, and have changed from a relatively inefficient City to a relatively efficient City. Finally, the higher the degree of urbanization, the lower the efficiency of medical resource utilization.Conclusions：Taiwan's inequity medical resources allocation has become a reality. Therefore, the key is to improve the utilization efficiency of medical resources to optimize the distribution of medical resources and reduce the waste of unnecessary medical resources