本文之研究目的為探討專科醫師地理分布與重症病患預後狀況的關聯，我們以台灣地區肝癌病患為例，檢視專科醫師多寡與分布不均程度之變化對於肝癌病患預後情況的影響。本研究資料來源為2001年至2010年全民健保資料庫，擷取居住於台灣本島且初次罹患肝癌的病患做為研究對象，並以肝癌病患確診後六個月內、一年內、一年六個月內與兩年內死亡率，與確診後至死亡日之存活天數，作為病患預後狀況之衡量。其次，由全民健保資料庫之特定資料檔，擷取對於醫治肝癌病患較有影響之專科醫師的資料，計算台灣各個醫療區域每萬人專科醫師數，並且藉由計算各區域特定專科醫師吉尼係數，衡量醫療資源不均度。此外，本研究分別使用線性機率模型、固定效果模型與存活分析之Cox比例危險模型，做實證分析。 實證結果大多顯示專科醫師分布不均度越高，越能降低病患死亡率，亦即雖然醫療資源集中於某地區的居民，但醫療資源的集中卻能有較佳的規模經濟，例如大型醫院的設立，雖然造成醫療資源分布不均度提升，但同時也提升地區醫療水準，因此平均來說，專科醫師分布不均度提升，整體來說能降低病患死亡率；地區每萬人專科醫師數越多，越能降低死亡率，亦即醫療資源越豐富，居民能享受到較佳的醫療資源，因此能提升病患平均存活機率。This paper analyses the effects of specialist regional distribution on the prognosis of liver cancer patients in Taiwan in 2001-2010. The specialists include surgeon and physicians of internal medicine, family medicine, diagnostic radiology, and radiation oncology. The prognosis, in this study, is measured by patients’ 6-month, 1-year, 18-month and 2-year mortality after they are diagnosed as liver cancer patients. Based on the 2001-2010 National Health Insurance Database, we conduct an empirical research analyzing the association of Gini coefficient of specialist regional distribution and patients’ prognosis via linear probability model, linear probability model with fixed effects and survival analysis. Our empirical results show that the inequality in specialist regional distribution has a negative effect on the mortality of liver cancer patients. The higher geographic concentration of medical specialists may deter patients living in rural or remote areas to access medical care, but it also may generate the economies of scale and scope in terms of improving the quality of treatment and the efficiency of care delivery. The advantages coming from specialist concentration override its negative effect on medical care accessibility and benefits patients.
