Tan Hsiu-Fen, Tseng Hung-Fu, Chang Chen-Kang, Lin Wender, Hsiao Shih-Huai
Department of Health Care Administration, Chung Jung Christian University, Taiwan, Republic of China.
J Rural Health. 2005 Fall;21(4):372-7. doi: 10.1111/j.1748-0361.2005.tb00110.x.
An experimental Health Care Improvement Program (HCIP) was initiated by the Bureau of National Health Insurance in 1997 to improve the accessibility of health care in several rural, mountainous districts.
This longitudinal study evaluated service availability, utilization patterns, and effectiveness of services under the HCIP in the A-Li Mountain District.
Outpatient claims made by residents in the A-Li Mountain District were extracted from the database of the National Health Insurance program. Changes in utilization pattern and volume were analyzed. Satisfaction levels were assessed by 2-stage face-to-face interviews with local residents.
After the HCIP, the average population served by each doctor decreased 75%, and total outpatient visits increased 15.4%. The total number of in-district outpatient visits increased 83.6%. The proportion of in-district outpatient visits to all visits increased from 22.1% to 35.1%. The total in-district outpatient visit fee claimed increased 100.2%, and the total out-of-district outpatient visit fee claimed increased only 7.2%. About 60.4% of the residents were not satisfied with overall health care services before the HCIP. The proportion decreased to 32.4% after the HCIP.
The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.
1997年，国民健康保险局启动了一项实验性的医疗保健改善计划（HCIP），以改善几个农村山区的医疗服务可及性。
这项纵向研究评估了阿里山区HCIP下的服务可用性、利用模式和服务效果。
从国民健康保险计划数据库中提取阿里山区居民的门诊报销数据。分析利用模式和数量的变化。通过与当地居民进行两阶段面对面访谈来评估满意度。
实施HCIP后，每位医生服务的平均人口减少了75%，门诊总量增加了15.4%。区内门诊总量增加了83.6%。区内门诊量占总门诊量的比例从22.1%增至35.1%。区内门诊报销总费用增加了100.2%，区外门诊报销总费用仅增加了7.2%。HCIP实施前，约60.4%的居民对整体医疗服务不满意。实施HCIP后，这一比例降至32.4%。
HCIP改善了医疗服务可及性，丰富了当地医疗资源，改变了部分居民的利用模式，提高了居民满意度。一个管理良好且资金稳定的项目，如果尊重文化差异并回应社区需求，则更有可能取得成功。
