目標：分析台灣醫療次區域之醫院產業擴張與診所醫師人力成長的關係。方法：本研究以醫療網之醫療次區域為分析單位，研究期間分為1995-1997年和1997-1999年前後兩期。資料來源為「臺灣地區公私立醫療院所現況暨服務能量調查」以及「臺閩地區人口統計」。醫院產業擴張指標為病床成長率、醫院醫師人力成長率，及醫院門診量成長率。本研究採用複迴歸分析，比較前後兩期醫院產業擴張對診所醫師人力成長影響的相對重要性。結果：1995-1999年之間，台灣醫院病床供給、醫院醫師人力，以及醫院門診服務量分別增加5.9%，16.8%，和21.8%。複迴歸分析結果顯示：醫療次區域的醫院產業擴張越快，診所醫師人力的成長就越慢，且前期醫院產業擴張的影響較後期大；惟控制醫師人口比後，僅前期醫院醫師人力成長及前期醫院門診服務量成長兩指標與診所醫師人力成長之相關達統計顯著水準 (P<0.05)。結論：前期醫院產業擴張是醫療次區域診所醫師人力消長的重要影響因素。

Objective: To examine the relationship between the expansion of the hospital industry and the growth of office-based physician manpower in sub-medical regions in Taiwan. Methods: We used the sub-medical region as the unit of analysis. There were tow study periods: 1995-1995 (early stage) and 1997-1999 (late stage). Data for the analysis came from “The National hospital and Services Survey” and “Taiwan-Fukien Demographic Fact Book”. The expansion of the hospital industry was measured using three indexes: the growth in hospital bed supply, the growth in hospital physician manpower, and the growth in hospital outpatient services. Multiple regression analysis was applied to explore the relative importance of early versus late expansion of the hospital industry to the growth of office-based physician manpower in the sub-medical region. Results: Between 1995 and 1999, the supply of hospital beds, the number of hospital physicians, and the volume of outpatient services provided by the hospital increased by 5.9%, 16.8%, and 21.8%, respectively. Through using multiple regression analysis, we found that the expansion of the hospital industry was negatively associated with the growth of office-based physician manpower in the sub-medical region, and that the early-stage expansion was more important than the late-stage expansion. However, after controlling for the physician-population ratio, we found that only the growth of hospital physician manpower in the early stage and the growth of outpatient services in the early stage were significantly related to the growth of office-based physician manpower (p＜0.05). Conclusions: The expansion of the hospital industry in the early stage is important in determining the growth of office-based physician manpower in sub-medical regions in Taiwan.

醫院產業擴張；診所醫師人力；臺灣

expansion of hospital industry; office-based physician manpower; Taiwan