Using Taiwan National Health Insurance Database to Explore the Change of Medical Manpower in Taiwan

全民健保實施已逾 20 年,我國國民納保率超過 99%,不論貧富皆享有相同 的就醫機會,提升國人健康及延長平均壽命,我國也因全民健保制度及醫療品質 而聞名於世。然而,全民健保也有亟需解決的問題,又以醫療資源的分配不均最 為人詬病,擁有較豐沛資源的醫學中心、教學醫院等醫療院所大多位於院轄市, 偏遠鄉鎮地區民眾就醫相對不便利,難以享有同等公平的健保服務。有鑑於此, 近年衛生署開放醫療資源較匱乏的地區設立醫院、增加床位,以縮短城鄉間的差 距,而二代健保的原意也在於提高醫療品質及降低財務危機,但醫療供給及需求 間的均衡是否可因此獲得解決,仍是未知數。 本文以臺灣醫療人力的特性及其變化為研究對象,探討近十年全民健保的醫 療人力總數、年齡結構、及其在臺灣各地分布變化,評估醫療人力的變遷,並作 為測量醫療資源不均度的依據,計算依據為全民健康保險資料庫門診處方及治療 明細檔、醫事人員基本資料檔、醫事機構基本資料檔。其中,另外也針對各地醫 療需求及醫療人力的執業地變化,分析醫師數與看診量在各地的供給量,探討醫 療供給及醫師流動趨勢,包括醫療資源分配不均與偏鄉居民健保就醫狀況的關聯, 討論醫療資源的公平性問題。Taiwan’s National Health Insurance (NHI) has been implemented for more than 20 years and more than 99% of people are covered, no matter if they are rich or poor. Equal right of medical accessibility, as well as good quality of health cares, are two key features of NHI, which play an important role in extending Taiwan’s human longevity. However, despite these fine attributes, there are potential problems in the NHI, especially about the uneven spatial distribution of medical resources. In general, rural and remote areas have less abundant medical resources, and most of the larger hospitals (e.g., medical centers and teaching hospitals) are located in populous counties, e.g., six major cities. In order to narrow the gap between urban and rural areas, the Ministry of Health and Welfare re-allocates medical resources, such as arranging more outpatient tours and short-term stays annually for physicians from six major cities to rural areas, particularly to remote islands. In this study, the goal is to explore the spatial characteristics of Taiwan’s physicians and their changes over time. We can treat these as a measure of inequality of health care accessibility, and use them as a reference to allocate medical resources. The study is based on the data from the NHI database, including CD (out-patient visit), PER (Registry for medical personnel), and HOSB (Registry for contracted medical facilities). We found that the population aging also appears at physicians and more of them continue to work beyond the retirement age. The unevenness of physicians’ distribution widens, for example, no pediatricians in 130 Taiwan’s townships in 2012 and people in rural areas pay more travel costs for hospital attention