The Associated Factors of Internist’s Geographic Distribution in Taiwan.

• Main Authors: HUANG, PIN-FANG, 黃品芳
• Other Authors: HUANG,WEI-YAO
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/c67fza

碩士 === 長榮大學 === 醫務管理學系碩士班 === 107 === Background In recent years, with the growth of the elderly population and chronic diseases, the demand for medical services in the future will increase. Medical care needs to be provided by physicians, that is, the geographical distribution of physicians is closely related to the medical accessibility of residents, showing the importance of the geographic distribution of internists. Purpose Explore the geographic distribution of internists and the associated factors of their geographic distribution. Method This study is cross-sectional research design, the unit of analysis is the township level. The participants in this study were the internists in the 2010ambulatory care expenditures by visits from the National Health Insurance Research Database. The research data include the number of internists and regional characteristics. The data of the number of internists are taken from theNational Health Insurance Insurer Information Integration Application Service Center of the National Health Insurance Administration, the files used include the data of ambulatory care expenditures by visits, the registry for medical personnel, and registry for board-certified specialists. The regional characteristic data are taken from two public platforms: (1) "2010 population and housing census" is obtained from national Statistics and (2) "The number of medical institutions and the number of hospital beds and the number of ambulances by location" and "The number of practitioners in medical institutions by location of counties, cities"are obtained from the Ministry of Health and Welfare in 2010. Dependent variables include the number of internists, the number of internists with an internal medicine specialty certificate, the number of internists with other specialty certificates, and the number of internists without specialty certificate. Independent variables include three dimensions: demographic characteristics, socio-economic development, and medical resources. Among them, the demographic characteristics include the population, the sex ratio, and the percentage of the population over 65 years old. The socio-economic development includes the percentage of the education level above junior college, the percentage of service employment, and the percentage of agriculture employment. Medical resources include the number of clinic per 10,000 people, the number of hospitals per 10,000 people, the number of clinics beds per 10,000 people, the number of hospital beds per 10,000 people, and the number of Western medicine physicians per 10,000 people. This study uses descriptive analysis to presents the form of the variables. Pearson correlation presents the correlation between the number of four types of internists and independent variables, whereas the multiple regression analyzes the association between four types of internists’ geographic distribution and regional characteristics. Results In 2010, there are 13,874 internists providing internal medicine services, including 7,528 internists with internal medicine specialty certificate (54.26%), 5,739 internists with other specialty certificates (41.37%), and 607 internists without specialty certificate (4.38%), and they provide 81.07%, 13.8%, and 5,12% internal medical services respectively. The three townships with the most number of four types of internists are: the internists - Beitou District of Taipei City, Zhongzheng District of Taipei City, and Xitun District of Taichung City; the internists of internal medicine specialty certificate - Zhongzheng District of Taipei City, Beitou District of Taipei City, and Guishan Township of Taoyuan County; the internists of other specialty certificates - Beitou District of Taipei City, Zhongzheng District of Taipei City, and North District of Tainan City; the internists without specialty certificate - Banqiao District of New Taipei City, Sanmin District of Kaohsiung City, and Zhongli of Taoyuan County. Among the 368 townships, there are 31 townships have no internist, 93 townships have no internist of internal medicine specialty certificate, 70 townships have no internist of other specialty certificates, and 158 townships have no internist without specialty certificate. In the Pearson correlation analysis, independent variables that significant and positive correlated with the number of four types of internists are population, the percentage of the education level above junior college, the percentage of service employment, the number of clinic per 10,000 people, the number of hospital per 10,000 people, the number of clinic beds per 10,000 people, the number of hospital beds per 10,000 people, and the number of Western medicine physicians per 10,000 people (p<0.05). The independent variables that significant and negative correlated with the number of four types of internists are the percentage of the population over 65 years old, and the percentage of agriculture employment (p<0.05). Sex ratio is not significant and negative correlated with the number of four types of internists(p>0.05). The results of multiple regression analysis indicated that: (1) the population had all significant and positive associated with the number of four types of internists (p<0.05);(2) for the sex ratio, it had non-significant and negative associated with the number of internists, the number of internists with internal medicine specialty certificate, and the number of internists with other specialty certificates (p>0.05), but it had non-significant and positive associated with the number of the internist without specialty certificate (p>0.05);(3) for the percentage of population over 65 years old, it had significant and positive associated with the number of internists, the number of internists with internal medicine specialty certificate, and the number of internists with other specialty certificates (p<0.05), but it had non-significant and positive associated with the number of internists without specialty certificate (p>0.05);(4)for the percentage of education level above junior college, it had significant and positive associated with the number of internists, the number of internists with internal medicine specialty certificate, and the number of internists with other specialty certificates(p<0.05), but it had significant and negative associated with the number of internists without specialty certificate (p<0.05);(5) for the number of clinic per 10,000 people, it had significant and positive associated with the number of internists with other specialty certificates, and the number of internists without specialty certificate (p<0.05), but it had non-significant and positive associated with the number of internists, and the number of internists with internal medicine specialty certificate (p>0.05);(6) for the number of hospital beds per 10,000 people, it had significant and positive associated with the number of internists, the number of internists with internal medicine specialty certificate, and the number of internists with other specialty certificates (p<0.05), but it had non-significant and positive associated with the number of internist without specialty certificate (p>0.05). Conclusion In geographic distribution, the more urbanized townships have more the number of internists, more the number of internists with an internal medicine specialty certificate, more the number of internists with other specialty certificates, and more the number of internists without specialty certificate. In the associated factors of geographical distribution, population and the percentage of education level above junior college are associated with four types of internists. Among the internists, the internists have an internal medicine specialist certificate and the internists have other specialist certificates are similar, their associated factors of geographic distribution include population, the percentage of the population over 65 years old, the percentage of education level above junior college, and the number of hospital beds per 10,000 people. The physicians without specialty certificate are different - associated factors of geographic distribution include population, the percentage of education level above junior college, and the number of clinic per 10,000 people; the percentage of the population over 65 years old and the number of hospital beds per 10,000 per people is not associated with the physicians without specialty certificate. Indicates the specialist certificate is associated with internist's geographic distribution.