白佳原PAI,JAR-YUAN高璧瑜GAO,BI-YUGAO國際健康產業經營管理碩士在職專班2026-03-232026/12/3120252025/7/8https://handle.ncl.edu.tw/11296/rx4c45https://scholars.csmu.edu.tw/handle/123456789/6460隨著全球人口老化趨勢加劇，偏鄉地區醫療資源不足與可近性低落問題日益嚴峻。相較於既有研究多聚焦於事前評估或滿意度調查，本研究首創採用「事後經濟效益評估」取向，以臺中市和平區為例，深入評估整合醫療服務系統（IDS）與遠距醫療的經濟與社會效益，比較前山與梨山地區醫療服務的成本效益差異，檢視不同醫療服務模式對居民醫療可近性、可負擔性與滿意度的影響，為偏鄉醫療政策制定提供實證依據。 本研究創新整合Penchansky & Thomas的5A醫療可近性理論與社會投資報酬率（SROI）分析方法，採橫斷面研究設計，以立意抽樣蒐集和平區175位居民問卷資料，運用統計方法進行分析。經濟與社會價值評估採用投資報酬率（ROI）、成本效益分析（CBA）與成本效益比（CBR）等指標，從醫院、社會與綜合角度進行多角度分析。 研究獲致突破性發現，前山與梨山地區在醫療可近性呈現顯著差異，梨山地區居民面臨更嚴重的交通時間負擔（M₂=4.37 vs M₁=2.64, p<0.001），充分驗證了Time Toxicity理論在台灣偏鄉醫療情境的適用性。經濟效益分析顯示，IDS整合醫療綜合ROI達119%、梨山遠距醫療達122%，且通過四種情境穩健性分析驗證。特別的是，研究發現典型的「價值悖論」：從純醫院財務角度，兩種服務均呈虧損狀態，但納入社會效益後均呈現顯著正報酬，這是台灣首次針對偏鄉醫療服務提供如此完整的SROI量化效益證據。 本研究具有重要的學術與政策貢獻：（1）填補了偏鄉醫療政策「事後經濟效益評估」的研究空白；（2）建構了可複製的5A理論與SROI整合評估架構；（3）首次驗證Time Toxicity理論在台灣本土醫療情境的適用性；（4）建立了六種角度的ROI評估模型，為政策制定提供科學依據。研究證實偏鄉醫療服務具有顯著的社會投資價值，建議政府建立完善補助機制，確保服務永續發展，並可將成功模式推廣至蘭嶼、綠島等其他偏鄉地區，促進醫療資源合理配置，推動健康公平，提升整體社會福祉。關鍵詞： 整合醫療、遠距醫療、事後經濟效益評估、偏鄉醫療、醫療可近性、社會投資報酬率With the intensifying global aging trend, the problems of insufficient medical resources and low accessibility in rural areas have become increasingly severe. Unlike existing studies that predominantly focus on ex-ante evaluations or satisfaction surveys, this study pioneers the adoption of an "ex-post economic benefit assessment" approach, taking Heping District in Taichung City as a case study to comprehensively evaluate the economic and social benefits of Integrated Delivery Systems (IDS) and telemedicine services. The study compares the cost-effectiveness differences of medical services between Qianshan and Lishan areas, examines the impact of different healthcare service models on residents' medical accessibility, affordability, and satisfaction, and provides empirical evidence for rural healthcare policy formulation.This study innovatively integrates Penchansky & Thomas's 5A healthcare accessibility theory with Social Return on Investment (SROI) analysis methods, employing a cross-sectional research design and purposive sampling to collect questionnaire data from 175 residents in Heping District, which were analyzed using statistical methods. Economic and social value assessments utilized indicators including Return on Investment (ROI), Cost-Benefit Analysis (CBA), and Cost-Benefit Ratio (CBR), conducting multi-perspective analyses from hospital, social, and comprehensive angles.The study achieved breakthrough findings: significant differences in healthcare accessibility were observed between Qianshan and Lishan areas, with Lishan residents facing more severe transportation time burdens (M₂=4.37 vs M₁=2.64, p<0.001), fully validating the applicability of Time Toxicity theory in Taiwan's rural healthcare context. Economic benefit analysis revealed that IDS integrated healthcare achieved a comprehensive ROI of 119% and Lishan telemedicine reached 122%, both validated through robustness analysis across four scenarios. Notably, the study discovered a typical "value paradox": from a pure hospital financial perspective, both services showed losses, but when social benefits were incorporated, both demonstrated significant positive returns. This represents the first comprehensive SROI quantitative benefit evidence for rural healthcare services in Taiwan.This study makes significant academic and policy contributions: (1) filling the research gap in "ex-post economic benefit assessment" of rural healthcare policies; (2) constructing a replicable integrated assessment framework combining 5A theory and SROI; (3) first validating the applicability of Time Toxicity theory in Taiwan's local healthcare context; (4) establishing six-perspective ROI evaluation models to provide scientific evidence for policy formulation. The research confirms that rural healthcare services possess significant social investment value, recommending that the government establish comprehensive subsidy mechanisms to ensure service sustainability, and that successful models can be extended to other rural areas such as Lanyu and Green Island, promoting rational allocation of medical resources, advancing health equity, and enhancing overall social welfare.Keywords: Integrated Healthcare, Telemedicine, Ex-post Economic Benefit Assessment, Rural Healthcare, Healthcare Accessibility, Social Return on Investment整合醫療遠距醫療事後經濟效益評估偏鄉醫療醫療可近性社會投資報酬率Integrated HealthcareTelemedicineEx-post Economic Benefit AssessmentRural HealthcareHealthcare AccessibilitySocial Return on Investmentthesis