系統性文獻回顧ABC：文獻搜尋、評估與整合

International audienc

後SARS台灣重建計畫－SARS事件的社會與經濟衝擊研究─不同醫療體系因應SARS危機動員制度之評估(子計畫五)

本計畫主要在檢討不同醫療體系在面對上次SARS 事件之因應，並探討政府的 角色功能，以檢視現行醫療體系的問題。三個主要研究目為:1) 瞭解SARS 發生對 不同醫療體系醫療服務提供的影響;2)不同醫療體系的應變措施及政府防疫政策配 合的情形。3) 探討不同醫療體系對於未來政府防疫政策之看法。研究方法採健保申 報資料分析、書面資料蒐集及訪談訪談三種方式。 研究結果發現，比較2002 與2003 年的醫療利用率，整體而言2003 年的醫療 利用率比2002 年的下降約2％，在SARS 流行期間則降14％。以層級別分析而言， 醫學中心的降幅最大(34%)；以權屬別分析而言，公立醫院之降幅最大(30%)。隨著 SARS 個案數及相關媒體報導量增加，民眾門診就醫次數逐漸下降。在各醫療體系 中，公立、榮民醫院及署立醫院在SARS 爆發期間為主要的病人收治中心；私人醫 院的態度多為拒收病人。在政府防疫政策上，行政指揮系統在初期出現多頭馬車的 現象；在財務上，雖有補助條款的訂定，但並未切實評估責任醫院因接受SARS 病 患而導致的醫療服務損失。在醫療資源上，包括醫療人力、病床的調度及相關防護 資源，在初期皆呈現無系統狀態，後期則有大幅改善。 針對未來政府實施之防疫政策中，多數受訪者認為公立及軍方醫院在未來類似 SARS 傳染病防疫上扮演重要角色；醫學中心不適合做為權責醫院，但它能提供感 染症醫師協助控制疫情，及收治多重症狀病人。對於在『感染症防治網』中政府指 派專責醫院之專業能力，多數受訪者仍擔心其規模過小，能力恐不足。綜合新加坡、 香港及加拿大處理SARS 的經驗，初步瞭解各國剛開始和台灣一樣，因缺乏充分的 資訊而無法採取正確的防護措施。新加坡政府特有的單一行政體系，緊急應變係由 由國防體系所主導，所以沒有產生行政溝通困難的情形。各國都有指定1-2 間SARS 專責醫院隔離並照護病患，這些醫院全是屬於公立醫院或政府資助的醫院。 建議政府處理類似SARS 疫情時，行政系統上應統一，需重新檢討財務補助機 制、加強公私立醫院之感染品質控制，及不定期演練『感染症防治醫療網』政策。This project aims to understand the responses of various types of hospital to the 2003 SARS outbreak as well as the health authority’s role in this outbreak. Three primary purposes of this study are: 1) to understand the SARS impact on the use of healthcare services; 2) to analyze the hospitals’ response and their strategies, and health authorities’ policies to SARS outbreak; 3) to collect hospital managers’ opinions on the government’s post –SARS policy: Anti-infections Disease Medical Commanding System. Hospitals’ claim data analysis, document analysis, and in-depth interview of key person are conducted in the study. Comparing the volume of outpatient visits during the same periods in 2002 and 2003, we observed a 2 % decrease in volume of outpatient visit year-wide and a 14% decrease during the SARS outbreak period. Among various hospitals of different accreditation level, the number of outpatient visit to medical centers decreased most significantly (34%), while public hospitals decreased the most (30%) according to hospital ownership. As the number of suspected SARS cases and of SARS related news reports increased, the number of outpatient visit decreased accordingly. During the SARS outbreak, public, veteran, and military hospitals played a major role in treating SARS patients. In contrast, most private and non-profit hospitals were reluctant to admit SARS patient. Governments didn’t evaluate hospitals’ financial loss due to the admission of SARS patient, although they were guarantees concerning financial supports. As to governments’ anti-SARS policy, the chain of command was not established at first. They didn’t effectively allocate relevant medical resource, including manpower, quarantine wards, and protective materials (N95 masks, and quarantine clothing). Regarding to the Anti-infections Disease Medical Commanding System, most of interviewees agreed that public and military hospitals will play important roles in anti-communicable disease similar to SARS. The also agreed that medical centers are not appropriate to be designated as infectious disease hospitals. However, they can provide specialties and expertise in fighting the disease. They are also worried about the ability of SARS hospitals designated by the government, because most of those hospitals are of smaller scales. Comparing the anti-SARS experience in Singapore, Hong Kong, and Canada, we observed similar situation as Taiwan in the early-SARS period, due to the lack of information on SARS, governments were unable to develop good strategies. Singapore’s single health authority directed by ministry of defense tends to be the efficient one among the 4 countries. This system makes Singapore quick responses to SARS outbreak without conflict among organizations. Each county all designate one or several SARS hospitals to treat SARS suspect and all these hospitals are government owned or public funded. Final, we suggest that our government should develop a single chain of command for such disease, reassess the compensation system for hospitals, enforce hospital infection control, and implement practices periodically the Anti-infections Disease Medical Commanding System