中醫師對總額支付制度滿意度、醫療產出及醫療行為的相關研究－－以雲嘉南地區為例

The Satisfaction, Productivity, and Behavior of Traditional Chinese Physicians Under the Global Budget Payment System--A Case Study in YunChiaNan Area of Taiwan

本研究目的在探討中醫師對總額支付制度的滿意度、醫療產出、及醫療 行為之關係；研究工具為自行設計之結構式問卷；研究設計是依健保局雲嘉 南地區所有特約中醫師進行普查，研究母群體共415 人，採用郵寄方式收集問 卷資料，有效問卷108 份，回收率為26.02% 。 研究結果發現：樣本中醫師對於中醫實施總額支付制度略為不滿意，以 「與專業團體關係」之得分最高，而男生、年齡較長者、執業年資較長者、在 診所執業者、自己開業者、及特考者之滿意度較高；樣本中醫師的醫療產出 略為減少，其中以「平均每週門診病人的數量」減少的最少，而男生及年齡 較長者醫療產出較低；樣本中醫師之醫療行為， 「醫療品質」與「醫病關係」 均略有提升，特考者之醫療品質較高。 中醫師之醫捧行為與滿意度各構面的相關分析，醫捧品質變項與「與專 業團體關係」、「病歷書寫規定」、及「輔導機制」變項間為正相關；醫病關 係及「與專業團體關係」變項間為正相關。中醫師滿意度構面中的「專業自 主權」變項為醫療產出的重要相關變數，而中醫師滿意度構面中的「與專業 團體關係」則為醫療品質及醫病關係的重要相關變數。 研究結果期望能提供健保機關修訂總額支付制度之參考，進而能提昇中 醫師對總額支付制度之滿意度及醫療產出；並提供醫院及診所中醫師改善醫 療行為之參考，使病患能得到良好的醫療品質及醫病關係。

The purpose of the study was to probe the traditional Chinese physicians' (TCP) level of satisfaction, medical productivity, and practice behavior after the implementation of the global budget payment system (GBPS). The study instruments included a survey questionnaire. The population of the study was defined as all the TCPs who participated the National Health Insurance Plans in YunChiaNan area of Taiwan. The survey questionnaires were distributed to the population, 415 in total, through mail. There were 108 surveys returned are usable. Therefore, the usable return rate was 26.02%. The findings of the study included that the TCPs' samples were slightly not satisfied with the GBPS and relationships to professional groups were ranked the highest. The satisfaction levels were positively associated with male, older one, better experienced in practice, solo practitioners, and nonformal Chinese medical trainers. The samples of TCPs' productivities reduced slightly, 'average weekly outpatient's numbers' ranked highest in the reduced medical productivity; the subjects with male and older one had less productive than their counterparts. Regarding the samples of TCPs' behavior, both medical quality and Doctor-Patient relationship improved slightly, and nonformal Chinese medical trainers had better medical quality than their counterparts. Medical quality was effective positively associated with relationships to professional groups, regulations of medical records and guidance mechanism, and relationships to professional groups. Doctor-Patient relationship was effective positively associated with relationships to professional groups. TCPs' satisfaction on professional autonomy effectively related to their medical productivity.