總額支付制度下區域醫院醫師醫療行為之探討

The Study of the Medical Treatment Behavior among Regional Hospital Physicians under Global Budget Payment System

背景：全民健康保險開辦以來，醫療生態環境隨支付制度階段性調整而 變動。面對醫院總額支付制度的實施，改變了醫院的經營策略，進一步也牽 動醫師醫療行為的變化。 目標：探討醫院總額支付制度實施後的醫師醫療行為，並分析醫師基本 特性與醫師醫療行為之關係。 方法：本研究採用問卷調查方式，問卷完成後延請專家審視並進行前 測，針對台中市區域醫院主治醫師（牙科、X 光科、病理科與急診科、麻醉科 除外） ，進行簡單隨機抽樣，共發出150 份問卷，有效問卷共121 份，回收率為 81% 。 結果：教育程度不同，醫師行為均達到統計上擷著差異，有博士學位者 在總額支付制度實施後其服務量增加且處置行為較積極，處方行為方面具學 士學位者比較配合醫院政策；執業年限不同，其處置行為達統計上顯著差 異，隨著執業年數累積，醫師處置行為越積極且願意創新；醫院權屬別在處 方行為達統計上顯著差異，公立醫院醫師在處方行為方面較配合醫院政策。 結論：提供醫院管理者檢討經營策略之參考，擬定出合宜的人力資源管 理策略，以期在衛生政策與相關法規限制及未來不確定的醫療市場上取得先 機。

This research explored how practicing physician's characteristics influence medical treatment behavior under the Global Budget Payment System. Chief physicians of different departments from different hospitals in Taichung were selected by simple random sampling investigated through semi-open-ended questionnaires to express their feelings toward conducting medical treatment. Descriptive analysis, ttest and single factor analysis of variance were used to verify relevance among characteristics of the participants and their medical treatment behavior. Significant differences were also found in individual service amount and prescription behavior for participants of different educational backgrounds. In this study, the physicians with doctoral degree claimed to be engaging in larger individual service amount. While in terms of prescription behavior, the physicians with bachelors' degree showed a more cooperative attitude toward the policies made by their hospitals. This research also identified significant differences in medical handling behavior from participants with different service years. Physicians with longer service years expressed themselves to be more open to innovations on medical handling. In addition, significant differences in prescription behavior were detected between physicians working in public hospitals and those in private hospitals. Physicians working in public hospitals were found to be more cooperative with hospital policy.