台灣醫師的生產力和健康保險特約相關研究

Productivity of Physicians and Health Insurance Contracts

本研究的主要目的在建立台灣醫師生產力的基本資料；分析醫院和診所醫師的保險特約特質和生產力的關係。以分層隨機、等距系統抽樣方法，自醫師公會全國聯合會18029名會員中抽出7500名樣本醫師。於1990年年初郵寄調查，共得1619名有效樣本，回收率為22％。樣本醫師平均每週實際工作55.8小時，然認為理想的工作時數為42.5小時。每天最多門診人數平均為56.8人，而平均的門診人數，實際為34.1人，理想為38.7人。醫師生產力的差異極大，其標準差標示於括弧內：實際工作時數（16.6小時）、理想工作時數（10.8小時）、平均門診人數（26人）、最多門診人數（43人）、理想門診人數（26人）。醫院醫師每天平均工作10小時；其時間分配為：64%服務病人、20%進行研究及教學、16%執行行政工作。其每週平均看診5次，每次平均看診4.4小時，每次平均看診37.3人而認為34.2人為理想。若以所花的時間換算醫院醫師個診療產出間的關係，推算得醫院醫師看一位門診病人平均為7.1分鐘。且照顧一位住院病人約相當於0.9個門診病人；而手術一個病人約相當於看16個門診病人。有保險特約醫師比無保險特約醫師的理想工作時數較長（7.6小時：6.9小時）、每天最多門診人次亦較多（55.4人：35.3人），但看診一位病人平均花費的時間則較短（7.6分鐘：17.6分鐘）。有保險特約醫院醫師每天平均負責14位住院病人，顯著高於無保險特約的9人。但每天平均查詢病房1.5趟、和照顧一位病人平均5.8分鐘，則顯著低於無保險特約者的2.2趟及10.1分鐘。有保險特約診所醫師平均每週看診6.1天、每天看診9.4小時、周六看診8.6小時；每天平均看診37人、每天理想的門診人數44人，皆顯著大於無保險特約者的6.0天、9.0小時、8.2小時、26人及38人。惟看診每位病人平均所花的時間10.7分鐘，則顯著低於無保險特約診所醫師的12.6分鐘。保險特約的診所醫師每週平均工作57.3小時、理想的門診病人數為44人、看診一位病人平均10.7分鐘，皆顯著大於保險特約醫院醫師的51.0小時、34人和7.6分鐘。而每天實際的平均門診人數則無顯著差異，平均約37人。

This study constructed a database of physicians’productivity analyzing the relationship between the productivity and contractual relations with the social insurance company, and differentiated the productivity of physicians practicing in hospitals from those in clinics. The data for the analysis came from a mailed survery of 1619 physicians in January of 1990（response rate of 22％）. Most of the physicians worked 60.0 hours per week, the average being 55.8 hours. But the mode of the ideal weekly work-hour was 40.0 hours. The ideal and actual outpatients per day averaged 34-39 cases. Based on time spent, 1 impatient case, was equivalent to 0.6-0.9 outpatient; 1 surgery case was equivalent to 12-16 outpatients. Those physicians practicing in hospitals with social insurance contracts had a longer ideal daily average work-hour (7.6 hours), and larger average number of inpatients per day (14 cases) than those without social insurance contracts (6.9 hours; 9 cases). But their average ward rounds per day (1.5 rounds), and the average time spent for one inpatient (5.8 minutes) were shorter than those without contracts (2.2 rounds; 10.1 minutes). Meanwhile, those physicians, practicing in clinics with contracts, had longer mean clinic days per week (6.1 days), longer clinic hours on Saturday (8.6 hours), and a larger actual average number of outpatients per day (37 cases) as well as larger ideal number of outpatients (44 cases) than those without contracts (6 day; 8.2 hours. 26 cases; and 38 cases). But their average time spent on each outpatient case (10.7 minutes) was shorter than those without a contract (12.6 minutes). Among the physicians with social insurance contracts, those who practiced in clinics had longer average weekly worktime (57.3 hour), larger than ideal average number of outpatients (44 cases), and averaged more time on each outpatient (10.7 minutes) than those practicing in hospitals (51.0 hours; 34 cases, and 7.6 minutes). The actual average number of outpatients per day (37 cases) was similar between the physicians who practiced either in hospitals or in clinics.