本研究旨在評估臺灣政府於 COVID-19 疫情期間實施之「COVID-19 醫療分流指定政策」對護理人員離職行為的影響。該政策將部分具條件之醫療院所指定為社區採檢與重症收治機構，承擔主要防疫任務，惟其所帶來的工作負荷與人力調度壓力，可能對第一線護理人員之人力穩定性造成衝擊。
本研究使用財政部財政資訊中心提供之綜合所得稅申報資料、個人基本資料檔，以及學雜費繳費明細資料檔等行政資料，建構2012至2022年之個體層級追蹤資料，並結合中央疫情指揮中心公告之指定醫院名單，判定樣本所屬醫療機構是否為政策指定對象。進一步以畢業於護理相關科系者為研究對象，篩選出具有足額薪資之全職醫院護理人員，並根據其任職醫院是否被政府列入 COVID-19 指定名單，將樣本劃分為實驗組與控制組。
研究採用差異中之差異法（Difference-in-Differences, DID）估計指定政策對離職率之影響。結果顯示，相較於非指定醫院，指定醫院之護理人員在疫情後的離職率顯著上升，在控制個人特徵、醫院層級變數與時間固定效果後，主要估計結果仍呈現正向且顯著的效果。延伸分析亦發現，離開醫院體系的比例逐年升高，顯示疫情後期之醫療人力流失風險升高。
本研究提供具體實證證據，揭示防疫政策可能對人力穩定產生潛在外部性。未來公共衛生政策規劃應納入更完善之人力支持與調度機制（如更具彈性且可預期的排班安排），以提升醫療體系面對危機的韌性與永續性。

This study evaluates the impact of Taiwan’s COVID-19 designated hospital policy on nurse turnover during the pandemic. Under this policy, selected hospitals were designated as community testing and severe case treatment centers, assuming frontline pandemic response responsibilities. While effective in concentrating medical resources, the policy may have increased staffing and workload pressures in designated hospitals, with potential implications for workforce stability.
Administrative data from Taiwan’s Fiscal Information Agency—including the Comprehensive Income Tax File, the Individual Basic Information File, and the Tuition and Miscellaneous Fee Payment File—were used to construct an individual-level panel dataset covering the years 2012 to 2022. These data were linked with the official list of designated hospitals published by the Central Epidemic Command Center to determine each nurse’s institutional designation status. The analysis focuses on graduates from nursing-related departments who met the income threshold for full-time hospital employment. Based on whether their employing hospital was designated under the COVID-19 policy, individuals were assigned to the treatment or control group.
A Difference-in-Differences (DID) approach was employed to estimate the causal effect of the designation policy on nurse turnover. Results indicate a statistically significant increase in turnover rates among nurses in designated hospitals following the onset of the pandemic. The main estimates remain positive and statistically significant across specifications that adjust for individual characteristics, hospital-level variables, and time fixed effects. An extended analysis also reveals a growing proportion of nurses exiting the hospital system entirely in the post-pandemic period, suggesting elevated long-term attrition risks.
The findings suggest that hospital designation policies during public health emergencies may affect workforce stability, particularly when response responsibilities are concentrated in selected institutions. Future public health planning should incorporate more comprehensive personnel support and staffing arrangements (e.g., more flexible and predictable scheduling) to strengthen the resilience and sustainability of healthcare systems during crises.

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