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台灣在2018年正式邁入高齡社會,銀髮海嘯下孩子身影更顯稀落,過去一年來孩子生得少、卻死得多,逾1,800名兒童死去,死亡率名列已開發國末段班,當出生的孩子都留不住,催生口號更顯空洞。
台灣擁有諾貝爾獎得主都盛讚的「世界最佳健保體系」,為什麼他們來不及長大?兒童醫療體系出了什麼問題?我們是否能及時補破網,不再漏接?
註:本專題所述「兒童」為19歲以下兒童
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2月總體死亡人數 高於出生人數
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今年(2018)2月,台灣全年齡死亡人數高於出生人數1,025人。在少子化與高齡化雙重夾擊下,每一個小生命的離去,不僅令一個家庭心碎,整個社會也都會付出「動搖國本」的代價。
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台灣嬰兒死亡率 在OECD國家中第5高
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台灣1歲以下嬰兒死亡率在由先進國家所組成的「經濟合作暨發展組織」(OECD)中排名第5高,偏高的嬰兒死亡率反映兒童醫療照顧和資源分配不均的問題。
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嬰兒期相關疾病佔兒童死因大宗
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兒童主要死因,不僅歸咎於破了洞社會安全網(例如交通事故、故意傷害等),醫療體系是否完善也是關鍵。其中高達45%死因,為嬰兒期發生的「先天畸形」與早產相關的「周產期疾病」。
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兒童急診人數中 以0~4歲嬰幼兒最多
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根據統計,19歲以下兒童急診人數約有103萬人,其中以0~4歲嬰幼兒比例最高。當嬰兒有突發狀況,第一時間的診治可能就是生死一瞬。
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山地鄉嬰兒死亡率 近20年居高不下
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對依賴醫療照顧的嬰幼兒來說,居住在都會區或山地鄉,便有截然不同的命運。近20年來,台灣山地鄉嬰兒死亡率都是都會區的兩倍以上,醫療資源分配不均問題長年未解。
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近3成台灣兒童 就醫路迢迢
許多兒童無法及時接受合適治療。台灣本島有2000多個村里在其15公里道路距離內,完全沒有小兒科專科醫師。
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5縣市沒有加護型救護車 病童轉運能力低
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孩童的轉運過程也潛藏危機。除了離島地區,台灣本島也有5個縣市,連一台加護型救護車都沒有。
與一般救護車相比,加護型救護車配備可攜帶式心臟監視器、電擊去顫器、甚至可接葉克膜,是病童轉運重要的設備。
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兒童急診醫療資源艱困區擴大中
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2011年全台有27%縣市缺乏兒科急診醫師,到了2015年擴增至61%,迄今仍維持同樣比例。每年,4萬5千個孩子到急診就醫,沒有兒科醫師診治。
衛福部2016年雖然於辦理「提升兒科醫療品質及資源整合計畫」,補助15縣巿增聘兒科醫師看急診,但並未減少兒急醫療艱困區域。
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兒童重症醫師人數不足 醫病比與美國相差3倍
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兒童重症醫療照護也是失落的一塊,兒童重症科醫師需受完整訓練,在加護病房24小時監控病情。
全台僅142名兒童重症科醫師,負擔全年近9萬人日住院病童的照護,平均每個醫師要照顧3到4床,但美國醫師幾乎可以一對一照護。
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嬰兒病床不足 新竹縣最嚴重
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被病痛所苦的嬰兒,有時連病床也求不到。相較成人病床平均一床給243人,全台嬰兒病床普遍不足,新竹縣最嚴重、其次為新北市、苗栗縣。
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5早產率高縣市 沒有早產兒合作醫院
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台灣早產兒出生率由2006年的7.3%,上升至2016年的9.77%,一年約有1,800個低體重早產兒,需要新生兒加護病房照料。但台灣早產兒比例高的地區,卻面臨沒有早產兒合作醫院的困境。
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通過兒童公約的台灣兒童預算卻僅有2%
2014年台灣簽署《聯合國兒童權利公約》,將公約國內法化。明確規範,無論社會福機構、法院、政府機構,均應以兒童最大利益為第一優先考量。
但在台灣,佔全國人口數約19%的兒童,僅佔健保支出的7.87%。兒少預算僅佔整體預算2.43%,為美國的三分之一。
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坑坑洞洞的兒童醫療網,孩子陷落只是一瞬之間。
政府大張旗鼓催生的同時,應正視兒童醫療資源不足、不均的問題。
每個來到世上的孩子,都有活下去的權利。
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