自全民健保實施以來，民眾對自身健康的重視以及高醫療品質的訴求使得小病逛大醫院的就醫行為持續惡化。原本以病情輕重度分級轉診的醫療制度漸漸地因選擇就醫的自由而被癱瘓。罹患急、重症的病人因此無法有效率的使用醫學中心較完備的技術和設備。更嚴重的是許多原本應該偏重於治療輕症的社區醫院因此而面臨倒閉，從民國84年的508家減少到民國102年的370家，其減少幅度為-35%。醫療可及性雙向受阻，所以如何解決這個困境有其迫切性。本論文的研究目的在探討都會地區醫院急診轉院原因。樣本資料來源是統計2014年的一月到六月間，每個月從該院急診轉院的病人數及其原因與科別，與各專科從急診住院的病人數做比較。所採集的資料共1624個樣本數是採用Excel2007和Minitab 17等軟體做敘述性統計與邏輯斯迴歸分析。實證結果顯示該院急診轉院原因並非單方面的考量，其中需要考慮院方無法提供的服務以及民眾就醫意願等雙方面因素。急診轉院科別與其他文獻所得到的結果雷同，以頭部外傷腦出血、急性腦中風以及性心肌梗塞為主。轉院行為的影響在無該專科醫師時確實增加2.87倍。又預期轉院的機率也會因為轉院原因的加乘而更加倍。若要改變目前民眾對院方的看法，該院必須長時間的投入於如何改善民眾對該院的心智架構。在有限資源的運作下，該院的發展要先考量地民眾的需求以及該院在地區醫療體系中的角色，以病人和同儕的觀點來擬定策略，逐漸發展某些專科處置病情的能力。該院未來經營的重點除了放在如何落實有效率的雙向轉診以做為與不同顧客群的合作誘因以外，還要強化對病人的服務品質與服務公平性以提升病人對該院的滿意度與信任度。 Since the implementation of national health insurance, the situation of people demanding for high-quality medical care by seeking treatment at major medical centers for minor illnesses continues to deteriorate. This behavior of freedom of medical choice gradually paralyzes the originally planned disease-severity referral system from primary to tertiary hospitals. Hence, individuals suffering from acute or severe illness cannot efficiently use the more sophisticated technology and equipment at medical centers. More seriously, many community hospitals that are supposed to take care of mild illnesses therefore face closure and reduce their numbers from 508 in 1995 to 370 in 2014, with a decrease of -35%. Healthcare accessibilities are impaired both ways, thus, there is a pressing need to resolve this predicament. The purpose of this paper is to explore the influence of the relationship between transfer reasons and transferal specialties (independent variables) in a metropolitan community hospital emergency room on inter-hospital transfers to major medical facilities (dependent variable). Data is generated by tabulating each month’s transferred cases of their reasons and specialties for six months. Cases admitted from the emergency room are also calculated for comparison. A total of 1624 samples are collected between January and June of 2014 for the descriptive statistics and logistic regression analysis, using Excel2007 and Minitab17. Empirical results show that transfer reasons need to be considered both the medical services not provided and the local public’s willingness. Transferal specialties such as head trauma, stroke and acute myocardial infarction are similar to that obtained from other literature. To improve the current views of the local public, such hospital must invest long-turn on how to change people’s mental framework. In addition to provide the basic fairness and quality services to built satisfaction and trust, such hospital needs to gradually strengthen abilities to meet the need of the local population as well as its role to work with nearby facilities on how to implement a timely and effective referral.
