在有限醫療資源下，若能提供基層照護及預防保健為優先，在未病或疾病臨床初期，提供保健服務以阻斷其對健康之影響，為最具成本效益及有助於改善健康；雖然在C型肝炎醫療資源分布及臨床藥物均有相關研究，但尚缺乏空間上研究分析；因此本研究先以羅倫茲曲線及吉尼係數瞭解花蓮縣各鄉鎮醫療資源公平性現況；以進階式兩階段流動搜尋法（The flow-based two-step floating catchment area method,以下稱為F2SFCA），利用地理資訊系統運算，衡量花蓮各村里20歲以上C型肝炎醫療資源空間可及性，探討醫療資源配置有那些醫療區域是相對不足，那些相對值得投入。本研究結果為：(一)在2011年至2018年期間醫療資源分布的確集中於特定地區，如花蓮市及玉里鎮，且逐年因人口流向變動使資源分配越不均，也說明花蓮地區醫療資源分布呈現強者越強，弱者越弱之兩極分化。(二)花蓮縣176村里推估20歲以上C型肝炎患者人口數計11,495人，89個村里空間可及性大於平均推估人口數佔26.07%，低於可及性平均有87個村里，推估患病人口數佔73.93%。(三)花蓮縣10家醫療機構空間分布具有群聚現象，納入肝膽腸胃科之IDS及巡迴診醫療服務，各村里空間分布可及性為0之村里由原43個村里降為41個村里，推估648位C型肝炎人口在醫療服務效能上能有提升。綜合上述結果，潛在疾病需求高區域，以移動式增加服務據點，便能改變及增加空間可及性及醫療服務效能，以提供政府相關單位改革之參考依據。

In the context of limited medical resources, the provision of primary care and preventive care as a priority is most cost-effective and conducive to improving health by providing services to prevent the impact of disease on health in the absence or early clinical stages of disease; Although there are related studies on the distribution of medical resources and clinical drugs in hepatitis C, there is still a lack of spatial research and analysis. Therefore, this study first used lorenz curve and gini coefficient to understand the fairness of medical resources in Hualian county.
In this study, The flow-based two-step floating catchment area method (hereinafter referred to as F2SFCA) was used to measure The spatial access of hepatitis C medical resources over The age of 20 in each village in hualian by using geographic information system (GIS), and to explore which medical resource allocation areas were relatively insufficient and which were relatively worthy of investment.
The results of this study are as follows: (i) During the period from 2011 to 2018, the distribution of medical resources was indeed concentrated in specific regions, such as Hualian City and Yuli Town, and the resource distribution became more uneven year by year due to the change of population flow, indicating that the distribution of medical resources in Hualian region was polarized between the strong and the weak. (ii) In 176 villages of Hualian county, the estimated population of hepatitis C patients over 20 years old was 11,495, and in 89 villages, the spatial accessibility was greater than the average estimated population, accounting for 26.07%, while the average accessibility was lower than 87 villages, accounting for 73.93%. (iii) The spatial distribution of 10 medical institutions in Hualian county was clustered, including IDS of the department of hepatobiliary and gastroenterology and the medical services of traveling diagnosis. The villages with 0 spatial distribution accessibility were reduced from 43 villages to 41 villages, and it was estimated that 648 hepatitis C population could improve the medical service efficiency. Combined with the above results, the spatial accessibility and efficiency of medical services can be changed and increased in areas with high potential disease demand by adding service sites on the move, so as to provide a reference for the reform of relevant government agencies.

第壹章 緒論 1
第一節 研究背景 2
第二節 研究動機 6
第三節 研究目的及方法 11
第四節 研究流程 12
第五節 相關名詞解譯 13
第貳章 文獻探討 15
第一節 醫療資源供給面與需求面 15
第二節 醫療資源分配成效 24
第三節 可接近性定義理論架構 28
第四節 地理資訊系統與流動搜尋法 32
第五節 小結 37
第參章 研究方法 39
第一節 研究範圍與對象 39
第二節 研究工具 41
第三節 研究架構 49
第四節 分析方法 55
第肆章 研究結果 69
第一節 花蓮醫療資源分布概況 69
第二節 花蓮縣C型肝炎人口數與空間距離之綜合分析 74
第三節 空間自相關 90
第伍章 研究結論與建議 93
第一節 研究結論 93
第二節 研究限制 96
第三節 研究建議 97
參考文獻 99
附錄一： 107
花蓮縣衛生福利部健保署IDS計畫服務據點、負責醫療機構、服務科別 107
附錄二：西醫醫療資源不足地區改善方案-醫院巡迴(服務地點、醫院、科別) 108
附錄三：西醫醫療資源不足地區改善方案-診所巡迴(服務地點、醫院、科別) 109
附錄四：執業西醫師數相對於人口數的羅倫茲曲線圖 110
附錄五：執業西醫師數相對於地理面積的羅倫茲曲線圖 111
附錄六：醫療機構數相對於人口數的羅倫茲曲線圖 112
附錄八：執業西醫師數分布的歷年排序結果 114

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