结果：（1）台湾地区医疗资源分配不均问题严重。 (2)医疗资源利用效率 关键词：共同边界规律、医疗资源、医疗利用、效率。
Introduction
Research Background and Motivation
The distribution of medical resources caused the death rate of 10.61% in Taitung, 4.85% higher than that in Taipei (Ministry of the Interior, 2017). To explore the efficiency of the use of medical resources in different regions, this study aims to use the DEA method, which was applied to determine the efficiency of the allocation of medical resources and the medical utilization across 20 provinces and improving cities in Taiwan.
Problem Statement
Research Purposes
Literature Review
Medical Services in Taiwan
2011) investigate health service utilization under the NHI among different stages of urbanization in Taiwan. Most studies in the evaluation of health services have mainly focused on equity and as a.
The Utilization of Medical Services
As the increase in medical expenses is an inevitable trend, assessing the effectiveness of medical services will become more important. Research on the effectiveness of medical services provides guidance for societal decision-making regarding the combination of health products and services to be produced with society's limited resources.
Date Envelopment Analysis
The attractive feature of the meta-frontier model is that it takes into account any heterogeneity between firms in the comparison of. Islas and Rubén (2017) indicate that the meta-frontier analysis technological gaps for hospitals under.
Methodology
Data Envelopment Analysis of the basic model
When the input distance function D(x,y)1, the input vector x falls within the production frontier; when D(x,y)1, the input vector x just falls on the production frontier. As we can see from Figure 2, this output distance function is the maximum ratio of output vector y that can be withdrawn at a given input vector x. The CCR model is most commonly used to measure performance, which can be treated as an index to evaluate the relative efficiency of decision-making units (DMUs) on the basis of multiple inputs and outputs (Adler et al., 2002).
1984) expanded the assumption and scope of application of the CCR model ratio; efficiency should be measured in CRS, but inefficiency may lack allocative efficiency, appropriate scale and technical efficiency. In Figure 3, for Point P the technical efficiency, assuming a constant scale level, is AC/AP; the pure technical efficiency under the assumption of variable returns to scale is AB/AC, and the scale efficiency. The stochastic meta-frontier production models compare the gap in technical efficiency between different groups to calculate the technology gap ratio (TGR), which represents the gap between the production technology used by the producer and the overall industrial production technology.
If the input strings, Lk (y) k=1,2,…,K, satisfy the standard regularity properties, then the distance functions, Dk (x,y), k=1,2,…,K, also satisfy the standard regularity. From property 4, the distance function of group k, Dk(x,y), will have a value not less than the value of the meta-distance function, D(x,y).
Data description
The data of this study comes from the Ministry of Health and Welfare in 2016. It means that the cumulative number of patients who registered for outpatient treatment is the number. It means that the cumulative number of patients who have registered emergency treatment is equal to the number of admitted patients.
In the first stage, the input-oriented CCR model is used to measure technical efficiency to construct the unbundled frontier. In the second phase, this study classifies all DMUs into two groups (urban area and rural areas) according to the Local Self-Government Act. The input-oriented CCR model measures the technical efficiency of the two groups to construct group boundaries.
In the third stage, this study calculates the meta-technology ratio (MTR) of counties and cities based on the technical efficiency and group technical efficiency of 20 counties and cities in Taiwan. Finally, after completing the above three stages and discussing the results, this study uses Tobit regression to evaluate the factors affecting efficiency.
Results
Descriptive statistics
Relative amounts are calculated by dividing the number of variables in each area by the total number of people in each area. Population and density distribution of input and output variables for each county and city in Taiwan in 2016. As we can see, Taipei City and Chiayi City are the richest areas in the distribution of health resources.
In addition to the distribution of doctors, the distribution of other input variables is more than sufficient. As the figures show, there are many outpatient visits, emergency visits and inpatient visits in Taipei City and Chiayi City. In short, we can see that the distribution of medical resources in urban and rural areas in Taiwan is very different.
Analysis of the efficiency of medical utilization
The relatively efficient counties and cities are Taipei City, Hsinchu City, Miaoli County, Nantou County, Yilan County and Penghu County. The technical efficiency after grouping equal to 1 is also called relatively efficient counties and cities. These areas include Taipei City, Keelung City, Hsinchu City, Chiayi City, Miaoli County, Changhua County, Nantou County, Pingtung County, Yilan County, Taitung County and Penghu County.
The counties and cities that have achieved efficiency include Taipei City, Hsinchu City, Hsinchu County, Miaoli. In addition, there are two counties that initially without technical efficiency become counties with technical efficiency, they are Hsinchu County and Hualien County. Hsinchu County and Hualien County were ranked 19th and 20th, respectively, which had never been grouped.
As mentioned above, the MTR of a total of 8 provinces and cities is equal to 1, that is, Taipei City, Hsinchu City, Hsinchu County, Miaoli County, Nantou County, Yilan County, Hualien County and Penghu County. On the contrary, counties with MTR less than 1 have New Taipei City, Taoyuan City, Taichung City, Tainan City, Kaohsiung City, Keelung City, Chiayi City, Changhua County, Yunlin County, Chiayi County, Pingtung County and Taitung County, indicating that the use of medical resources in these provinces and cities is inefficient and the medical resources in these provinces and cities are not good.
Discussion and Conclusions
Discussion
The purpose of this study was to investigate the distribution and use of medical devices and find ways to improve medical use in twenty provinces and cities in Taiwan. Chen (2017) points out that the relatively inefficient medical sector is due to the excessive amount of medical resources invested, but there is no corresponding output of medical services, so the utilization efficiency of medical resources is low. However, since the unequal distribution of medical resources is already a fact in Taiwan, the most important point is that the utilization of medical resources should be improved and the allocation of medical resources should be optimized.
To reduce the urban-rural disparities caused by uneven. distribution of medical resources, this study aims to improve medical utilization. If medical utilization can be improved, medical resources will not be wasted and will be used properly, allowing inefficient counties and cities to increase efficiency. of the utilization of medical resources. 2012) indicate that it may be useful to reduce the differences in medical use. improve communication to accommodate health care, establish transportation of inefficient regions, and to increase funding to help physicians who typically have lower profits. Therefore, we use Tobit regression to observe the effects of spatial. variables and the average number of people served by medical facilities on.
Furthermore, the coefficient of the average number of people served by each medical institution is negative. This means that as the average number of people served by a medical institution increases, the metatechnology ratio will decrease, and this has statistical significance.
Conclusions
This result is similar to the views of Chu et al. 2005), because they show that some eastern areas are less developed than other areas in Taiwan, the Bureau of NHI has tried to increase the accessibility of medical care there. Then the most real efficiency is the metatechnology ratio; the overall average in Taiwan is 0.9729, and the counties and cities that have achieved efficiency include Taipei City, Hsinchu City, Hsinchu County, Miaoli County, Nantou County, Yilan County, Hualien County and Penghu County. This means that these eight provinces and cities have achieved the best production technology and have no technological gap.
This result is not consistent with the views of Lin et al. 2010), they reckon that the areas with severe insufficient medical resources are Hualien County, Tainan City, Nantou County, and Hsinchu City and Hsinchu County. In addition, especially the results of this study also mentioned that Penghu County and Yilan County are with medical efficiency. Finally, the results of the Tobit regression analysis show that the higher the average number of people served by each medical institution in each country and city, the lower the efficiency of the medical use.
Therefore, it is necessary to avoid wasting health resources in areas where the average number of people served by each health facility is high. Based on the above conclusions, we conclude that policymakers should recognize that characteristics of inefficient regions may result in differential impacts of health reform on medical utilization between urban and rural areas.
Limitations of the Study
Therefore, a better understanding of the differences in access to health care between urban and rural areas is important. It is suggested that future studies can be carried out discussing the two regions to find out the correct reasons for this situation. In addition, the utilization of medical resources from cross-regional is also one of the important factors affecting medical utilization.
The effects of Taiwan's National Health Insurance on access and health status of the elderly. Evaluating efficiency and productivity research: A review and analysis of the first 30 years of scientific literature in DEA. Is there a difference in hospital care received under a universal health insurance program in Taiwan?
Trends in rural-urban differences in incidence rates of ruptured appendicitis under the National Health Insurance in Taiwan. Equality of Resource Allocation in Healthcare Under the National Health Insurance System in Taiwan. Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly?
The relationship between accessibility of health care facilities and medical care utilization among the middle-aged and elderly population in Taiwan.
