Objective: To fully understand the relationship between supply and demand of healthcare services in Macao. Analyze if healthcare supply meet Macao residents’ health demand, and to forecast the development of demand-supply gap. To provide theoretical basis and rational suggestion for problems of demand-supply gap, utilization of healthcare resource, health planning and resident health. Method: Collect population and healthcare services data of Macao in 2005 to 2015 from the Government of Macao Special Administrative Region Statistics and Census Service (DESC) and the Department of Health. Apply healthcare indicators from World Health Organization (WHO) and Organisation for Economic Co-operation and Development (OECD) Health Statistics Database. Set OECD average level as benchmark, and to analyze health status of Macao residents, constitution of causes of death (Pareto Chart), healthcare expenditure of the government, healthcare organizations and devices, human resources, demands of primary health care and hospital services, and healthcare service utilization (Nurse-patient ratio), in order to evaluate demand-supply gap of healthcare service. From the aspect of healthcare services estimation, apply the Cohort Component Method to forecast the development of Macao population. Acquire population estimation result and to analyze demandsupply gap of healthcare services. In regard to statistical analysis, apply Microsoft Excel 2016 to set up Macao healthcare services database. Then apply SPSS20.0 to calculate and analysis healthcare data. Apply ratio, proportion, rate, and dynamic series to statistically describe healthcare services and demography of Macao. Apply Pearson χ 2 test to analyze if there are significant differences among diseases distribution of the death regular pattern. Set up cure regression model to analyze the relationship between inpatient care average length of stay and occupancy rate. Set level of significance α=0.05 level. Results: (1) Helaht outputs of Macao are in high level. Until 2015, The average life expectancy at birth was up to 83.2. Infant mortality rate was down to 1.6‰. Maternal vi death record remained 0 for more than 11 years. In 2015, crude birth rate rise again to 11.8‰. High life expectancy, low crude birth rate and low death rate accelerate population aging in Macao. (2) From 2005 to 2016, population of Macao raise from 488.1 thousand to 644.9 thousand, and the number was estimated to reach 772.9 thousand in 2036. The development of aging population in Macao was stagnate for a long period but will be accelerated in the future. Macao will enter an aging society in 2026 with 16.76% population older than 65. In 2036, more than 20.70% population older than 65 and the society is becoming super-aging. At the appointed time, aging index will reach 160%, and the aging dependency ratio will up to 31.73%. (3) Causes of death constitution in Macao is steady and centralized. Categorizes by ICD-10 systemic diseases category, neoplasms (33.62%), disease of circulatory system (25.58%) and disease of the respiratory system (15.52%) constitute the type A leading causes of death among Macao residents. When categorizes by monopathy, there are statistical differences in the number of cases between the top 10 underlying causes of death from 2005 to 2010 (χ 2 = 637.94，P < 0.001). Malignant tumor, pneumonia and influenza, and heart diseases occupied and remained to be top 3 for more than 11 years. Cerebrovascular diseases constituent ratio raised from 2.53% to 8.30% from 2005 to 2015. (4) The insufficiency of healthcare supply was embodied in healthcare expenditure and human resources. General government expenditure on health as a percentage of GNI was less than 2% from 2005 to 2015, and was less than the minimum requirement of WHO. Until 2015, numbers of doctor, nurse, dentist and pharmacist per 1000 population was 2.59, 3.52, 0.37, and 0.16. Numbers of healthcare staffs are far less than the OECD countries average level, especially for medical specialists engaged in hospitals and nurses, which have the largest demand-supply gap. (5) Demand and utilization of healthcare services increase continually. However, the development of healthcare human resources supply drop behind the development of demand. General practice (8.94%) and stomatological (8.34%) department have the highest average annual growth rate of visits among primary health care services. The average annual growth rate of hospital visits of population aged ≥ 65 is 6.86%, higher than the average annual growth rate of population which is 5.22%. Healthcare services utilization is tending to be reasonable. Till 2015, the vii inpatient care average length of stay is 7.58 days, the occupancy rate is 76.60%, nurse-patient ratio is 1:7.00, which are very approach to the OECD country average level or the optimal level. According to results of healthcare supply forecasting, gap of doctors will up to 278, gap of nurse will up to 3448, and the nursed-patient ration was estimated to reach 1:10.58 in 2036, which will lead to negative effect on both patients’ and providers’ health and safety. Conclusions: (1) Macao residents’ health status tend to be satisfactory from 2005 to 2015. Outcomes of the average life expectancy at birth, infant mortality rate and maternal death, which are the three main health indicators, are better than OECD countries. (2) Healthcare demands of aging population are increasing while population aging is accelerating in Macao. The average annual growth rate of aging population is higher than the growth rate of the population. Nevertheless, healthcare expenditure and human resource supply hardly meet the demand of future health demands. (3) The insufficiency of healthcare supply was embodied in healthcare expenditure and human resources in Macao. General government expenditure on health as a percentage of GNI is less than the minimum requirement of WHO. Human resource of medical specialists is less developed to respond to threats of malignant tumor, heart diseases and hypertension. Health planning and numbers of nurse are less developed and difficult to meet residents’ healthcare demand.

研究目的： 瞭解澳門醫療衛生服務的供給、需求及其關係，分析澳門醫療衛生供給 是否符合居民的衛生需求，預測供給與需求之間的缺口及其發展趨勢。針對衛 生供給缺口、衛生資源利用、衛生規劃以及居民健康等問題提出理論依據和合 理化建議。 研究方法： 通過澳門衛生局、澳門統計稽查局搜集 2005-2015 年澳門人口和醫療衛 生服務資料。采用世界衛生組織與 OECD 衛生統計數據庫的醫療衛生指標，以 OECD 國家數據作爲標杆，對澳門居民的健康現狀、死因構成（帕累托圖分析 法）、政府衛生開支、醫療衛生機構設備、衛生人力資源、初級衛生服務需求、 醫院服務需求以及醫療衛生服務利用（護病比）情况進行分析，以衡量澳門醫 療衛生服務的供需差異。醫療衛生服務的供需預測方面，主要通過人口變動要 素組成法預測澳門人口發展趨勢，將人口估計、衛生需求預測結果與澳門衛生 供給預測進行對比，分析醫療衛生供給與未來服務需求之間的差異。 統計分析方法方面，以 Microsoft Excel 2016 建立澳門醫療衛生信息數據 庫，應用 SPSS20.0 分析研究數據。對人口與衛生統計資料采用比、比例、率以 及動態數列等相對指標進行一般醫學統計描述；對死因譜中病種的分布差異應 用 Pearson χ 2檢驗進行分析；對平均住院日與床位使用率的分析及預測擬合曲綫 回歸模型。設置檢驗水平 α=0.05。 研究結果： （1）澳門居民健康水平高。至 2015 年澳門出生時預期壽命達 83.2 歲， 嬰兒死亡率下降至 1.6‰，並連續 11 年維持孕産婦 0 死亡。2015 年出生率緩慢 回升至 11.8‰。期望壽命長，低出生率與低死亡率加速澳門人口老化。 （2）澳門人口總數從 2005 年的 48.81 萬增長至 2016 年的 64.49 萬，預 計將在 2036 年達到 77.29 萬。澳門人口老化速度先緩後急，預計澳門將在老齡 人口達 16.78%的 2026 年進入老齡社會，在老齡人口達 20.70%的 2036 年進入超 老齡社會，届時老化指數將達到 160%，老年撫養比將達 31.73%。 iv （3）澳門人口死亡情况較爲穩定，且死因構成非常集中。根據 ICD-10 系統疾病分類，腫瘤（33.62%）、循環系統疾病（25.58%）與呼吸系統疾病 （15.52%）是構成澳門居民死因的 A 類主要因素。按單病種分類，不同年份前 10 位單病種的構成比差異具有統計學意義（χ 2 =637.94，P < 0.001），其中惡性 腫瘤、肺炎和流感、心臟病居前三位且順位在 11 年間並無發生變化，腦血管病 構成比從 2005 年的 2.53%大幅攀升至 2015 年的 8.30%。 （4）澳門醫療衛生服務供給不足主要體現在政府衛生支出與人力資源方 面。2005-2015 年澳門政府醫療保健開支佔 GNI 比例一直維持在 2%左右，低于 WHO 的最低要求（5%）；至 2015 年澳門每千人口配有的醫生、護士、牙醫及 藥師數量分別爲 2.59 人、3.52 人、0.37 人以及 0.16 人，遠低于 OECD 國家的平 均水平，其中又以重大疾病專科西醫與護士的供給缺口最大。 （5）澳門醫療衛生服務的需求與利用量持續上升，衛生人力資源的供給 落後于需求。初級衛生護理服務中全科（8.94%）與口腔科（8.34%）求診人數 的平均增長速度最快；醫院服務中 65 歲或以上長者求診人數年均增速爲 6.86%， 高于全澳的 5.22%水平。目前澳門衛生服務利用情况趨于合理，至 2015 年澳門 平均住院日爲 7.58 天、床位使用率爲 76.60%、護病比爲 1:7.00，均接近 OECD 國家水平或最優指標。但根據衛生服務供給預測結果，預計至 2036 年，西醫缺 口將達 278 人，護士缺口達 3448 人，護病比將達 1:10.58，這將對護理人員與 患者的健康安全造成負面影響。 研究結論： （1）2005-2015 年澳門居民健康狀况良好，出生時預期壽命、嬰兒死亡 率、孕産婦死亡率三個衛生産出指標均優于 OECD 國家平均水平。 （2）澳門人口加速老化，醫療衛生服務的需求量增大，且服務需求比供 給的增長速度快。目前澳門衛生支出與衛生人力供給難以滿足未來澳門人口快 速增長的衛生需求。 （3）澳門醫療衛生服務供給不足體現在衛生財政支出和衛生人力資源方 面。醫療保健開支佔 GNI 比例低于 WHO 的最低要求，心臟科、腫瘤科等專科 醫生數量難以應對惡性腫瘤、心臟病、高血壓等疾病對澳門居民健康造成的威 脅，護理人員數量及其發展規劃嚴重落後于硬件建設和衛生需求。