The Impact of Regional Dialysis Resources on Primary Nephrologists' Production of Patient Care

• Main Authors: Yi-Chieh Chen, 陳怡潔
• Other Authors: Shiao-Chi Wu
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/41292485087486301484

碩士 === 國立陽明大學 === 衛生福利研究所 === 100 === Objective: The demand and medical resources of dialysis market had plunged into increasing, the regional dialysis resource maybe associated with the primary nephrologist’s desire to choose the location and tendency to lower competitive areas to enhance the output performance. Methods: This research is a retrospective cohort study. Using “National Institutes of Health National Health Insurance database” for research. To evaluate the influence on levels of regional dialysis resource which is based on geopolitical boundary area in Taiwan and divided into 368 townships. The study subjects are licensed nephrologists who had practiced dialysis services from 2007 to 2009. Piecewise regression , stepwise linear regression and weighted leasted square was applied to explore whether townships dialysis resources on 2007 were associated with primary nephrologist' production of patient care on 2009. Results: In 2007-2009, a higher proportion of dialysis resources and the growth rate to begin with primary care clinics, nephrologists and dialysis beds in the Gini coefficient all decline.Practiced primary nephrologist who located on dialysis per million population the number of beds to more than 10 townships, outpatient total amounts price and dialysis’s total amounts price is decline; more per million people in the hospital dialysis beds, has been practicing primary nephrologist’s total amount price and dialysis’s total amounts price decrease of 0.5% and 4.2%. Physician who work on higher dialysis beds resource areas have output of negative growth for two years, the total amount of declaration and dialysis declare amounts change with every million people in the hospital dialysis beds resources to increase by 74200, 11400. When the output performance of the year a significant impact after two years of income. The new practice primary nephrologist located on less than saturation townships will enhance the total amount price by increasing resources. Resources up to saturation, the total amount prices slow growth; more of the areas in the hospital dialysis beds per 10 thousand population, decrease by 0.38% of the total amount prices and 176200 of dialysis’s total amounts price. Conclusions: Per million population dialysis beds can define the regional dialysis resources degree of saturation. Primary nephrologists expand to the areas of lower dialysis resources and hospital dialysis beds will enhance the output performance. Recommended health care providers and health authorities to encourage primary nephrologists to dialysis beds resources in relatively fewer townships, so that induce competition among physicians and diffuse them to less competitive, typically rural areas.