| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 94 === Abstract
Background： Since the launch of National Health Insurance in 1995, the barrier to access to medical services has reduced significantly for people. However, the number of hospitals has decreased gradually according to data released from the Department of Health. In Tainan County, there were three district hospitals closed between 1998 and 2002. According to the Medical Care Network plan, district hospitals provide primary care for local residents. The closure of district hospitals may have a negative impact on access to medical services of local residents.
Objectives: To investigate the impact of hospitals closure in Tainan County on access to medical services of local residents and their satisfactions with medical services.
Methods: A Quasi-experimental design with cross-sectional telephone survey is used. Study subjects are residents with 20 years old and above, randomly selected from areas with hospital closure (experimental group) and areas without hospital closure (control group). The phone books of Tainan City and County are used for the systematically random selection with 200 subjects drawn from each group. The telephone interviews with a structured questionnaire were conducted during November and December of 2003, and a total of 400 residents were surveyed.
Results:
1. Residents in areas with hospital closure use more outpatient, inpatient, and emergency services than residents in areas without hospital closure, but only the use of outpatient services is significantly different statistically.
2. After controlling external environments, predisposing, enabling and need factors, the uses of medical services are less in areas with hospital closure, but the difference is not significant statistically.
3. To medical services provided by clinics or hospitals, the overall satisfactions are higher among subjects with than without the use of outpatient services in the past three months, however the different is not significant.
4. Residents in areas with hospital closure have a significantly higher overall satisfaction with services provided by clinics than residents in areas without hospital closure. But their overall satisfactions with services provided by hospitals are not different.
Conclusion: This study does not found any significant impact of district hospital closure on local residents. The overall satisfactions with medical services provided by clinics are higher among residents in area with than without hospital closure. To sum up, hospitals closure did not affect local residents’ access to medical services directly.
Key word: hospital closure, Health Service utilization, and satisfaction.
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