健保局醫院卓越計畫對醫師醫療行為之影響──以南部某縣立醫院為例

The effect of the Hospital Remarkable plan from the Bureau of National Health Insurance on physicians’ medical behavior-an example of county hospital at the southern of Taiwan

全民健康保險的實施對台灣社會福利發展有重大的意義，自從於1995年3月1日全民健保正式開辦以來，醫療費用支付逐年上升，因此醫院卓越計畫開始由支付制度面進行成本的控制。本研究目的在於探討及分析醫院卓越計畫的施行，對醫院管理與醫師醫療行為是否有明顯的影響。以高雄縣某公立醫院為研究對象，以訪談和問卷調查來搜集研究資料。統計方法包括描述性統計、配對ｔ檢定和ANOVA分析。研究結果顯示卓越計畫實施後，門診時間減少；人次亦減少之；醫院收入也趨向減少，醫院門診自費收入與醫院住院自費收入分別縮減比率分別為15.13％與21.24％，醫院門診自費收入在統計上有顯著差異(p=0.031)，尤其是門診自費健保合計上，縮減18.21％，在統計上有顯著差異(p=0.018)。院內醫師薪水有減少的現象，且醫師提供藥物和給藥天數改變，但是對醫師的醫療行為則無顯著影響。本結果可供醫院管理者、健保局與衛生主管機構、其他相關單位在改革健保支付制度時的參考。

The implement of National Health Insurance has a significant meaning on Taiwan social welfare. The medical expense payment has risen year by year, since the National Health Insurance was set up on March 1, 1995. Therefore, the payment system of National Health Insurance has been changed for the cost control. The purpose of this study is to investigate and analyze the effect of hospital remarkable plan from Nation Health Insurance on both hospital management and medical behavior. The research object was done on a public hospital in Kaohsiung County. Interview, questionnaire survey, and data analysis were used for collecting research data. The statistics methods were included description statistical analysis, and mean value variance analysis (paired t-test and ANOVA). After implementing hospital remarkable plan clinical hours, income were decreased and the number of patients has significantly decreased by 18.21 % (p=0.018). The patient own expenses in clinics and hospitals were significantly decreased by 15.13 % and 21.24 %, respectively. The days of medication has also decreased and medication were changed. The salary of doctors has also been decreased; but, there was no statistics significantly effect on medical behavior. The result of this study can be a reference for hospital, Bureau of National Health Insurance, health center, and other relatively units to reform health insurance payment system.