| Summary: | 碩士 === 國立臺灣大學 === 衛生政策與管理研究所 === 87 === Abstract
This research provides observations of the supply of and patients’ demand for health care services in order to understand the impact brought by the establishment of a new hospital in the Wenshan area of Taipei City. In terms of medical supply, the study describes changes in services volume generated by surrounding medical institutes, based on longitudinal data collected before and after the new hospital was founded. The Neihu area of Taipei City served as a comparison area. Interview surveys were conducted among residents of Wenshan, with 966 subjects in the pretest and 579 subjects in a posttest to examine the demand changes. The major findings are as follows.
I. Medical supply
1. The new hospital was established in 1997. The service volume of medical service-providers in Wenshan increased 30 percent in that year, and 20 percent growth in 1998. The number of patients in Neihu (where there was almost no increase in medical resources) also increased but slower. The growth of service volume in Neihu was 15 percent in 1997 and 10 percent in the following year.
2. After the opening of the new hospital, no significant change was found in the service volume of pre-existing primary-care medical clinics in Wenshan. The growth rate was in fact about the same as that of the Neihu area.
3. However, the amount of patients in each clinic in Wenshan experienced a sheer drop after the opening of the new hospital. This was particularly obvious for eye clinics, rehabilitation clinics, and internal-medicine clinics.
4. The main source of patients at the new hospital came from Wenshan, but an increase in the number of patients from nearby areas was also observed.
II. Patients’ demand
1. In the 1997 pretest, about 45% of patients received medical services from hospitals. This figure increased to 56.5 percent in the 1999 posttest with a statistical significance.
2. In the 1997 pretest, only 42 percent of the Wenshan-area residents went to local providers for medical services. This figure rose to 69 percent by the time of the 1999 posttest. A significant drop in the number of people who sought medical care outside Wenshan for treatment was observed.
3. In the posttest, those who received treatment from medical institutes outside the Wenshan area spent an average of three times the amount of travel time and twice as much money on their medical co-payment. Besides, those who sought treatment outside the area of their residence had a higher rate of chronic disease and felt less healthy in general. Half of the subjects who chose to return to local providers for medical treatment went to the case hospital.
4. Three indicators were used to evaluate supplier-induced demand: the amount of out-of-pocket fees for medication and tests, the follow-up rate, and the amount of basic co-payment for doctor visits. These indicators tended to decline after the opening of the new hospital. Therefore, no evidence was formed for the supplier-induce demand hypothesis.
In general, the health care utilization of Wenshan-area residents increased after the founding of the new hospital. However, the increase was not due to a shift of patients from existing medical institutes in that area. Aside from the Wenshan residents who returned to seek treatment at the new hospital, there was no significant evidence of supplier-induced demand in the area. A question remains as to why people have increased their utilization of medical services. The health authorities are therefore urged to examine whether there is any supplier-induce demand from hospitals, or whether there is still unmet medical need existing.
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