台北市醫師對分級醫療成效之滿意度

Satisfaction with the Effectiveness of Hierachy of Medical Care among Physicians in Taipei

近年來健保署推動分級醫療，大型醫院紛紛成立策略聯盟。本研究調查台北市醫師對健保署、大型醫院及民眾推動或配合分級醫療成效滿意度與影響因素。於2021年初進行，共399位台北市醫師填答，47.6%不清楚是否參與策略聯盟。結果顯示除了大型醫院特別轉診名額，醫師對於各項分級醫療成效不滿意的比率（37.1%-59.2%）高於滿意（13.1%-26.6%），最不滿意民眾配合成效，健保署次之，而較滿意大型醫院的推動成效。年齡越大（OR：1.02-1.03）、醫學中心執業（OR：2.73-4.15）對分級醫療成效較滿意；地區醫院執業（OR：0.75-0.81）、無兼職非健保業務（OR：0.61-0.74）或無報備支援他院（OR：0.55-0.78）的醫師較不滿意。醫師觀點顯示當今分級醫療成效有限，健保署應積極導引民眾分級就醫，而大型醫院需持續進行策略聯盟院際合作。

In recent years, most regional hospitals and medical centers have implemented their medical alliance while Taiwan’s National Health Insurance launched and promoted the level of care system. This study aimed to investigate physicians' satisfaction with the effectiveness of level of care in Taipei. The questionnaire was surveyed in early 2021. A total of 399 physicians in Taipei City responded. Among them, 47.6% were not clear if their clinic/hospital participated in any medical alliance or not. The result showed doctors are more dissatisfied with the key roles and related policies (37.1%-59.2%) than those who were satisfied (13.1%-26.6%) aside from the special registration for referral from the medical alliance. Doctors dispute the effectiveness of level of care in the order of the lay population, Bureau of National Health Insurance, and medical alliance. The older (OR􇃉 1.02-1.03), those who practice in the medical center (OR􇃉2.73-4.15) were more satisfied with the current status of level of care. Practicing in the local hospital (OR􇃉0.75-0.81), without other adjunctive jobs(OR􇃉0.61-0.74), and without practice in different levels of hospital (OR􇃉0.55-0.78) were less satisfying. From the viewpoint of physicians, the impact of related policy was limited. Health administration should promote the public on following the level of care and referral system, and the medical alliance ought to continue building up the framework for more intensive cooperation.