台灣南部某縣市醫師對分級醫療六大策略之認同度及滿意度調查

Physicians’ Agreement and Satisfaction with the Six Strategies for a Tiered Health Care System in a County in Southern Taiwan

目的：衛生福利部於2017年起推動分級醫療六大策略，包含：策略一、提升基層醫療服務量能；策略二、導引民眾轉診就醫習慣與調整部分負擔；策略三、調高醫院重症支付標準，導引醫院減少輕症服務；策略四、強化醫院與診所醫療合作服務，提供連續性照護；策略五、提升民眾自我照護知能；策略六、加強醫療財團法人管理。本研究旨在了解南部某縣市醫師對此政策的認同度及滿意度，並探討醫師在診所及醫院執業的看法差異，期望能作為分級醫療推動之參考。

方法：本研究為匿名問卷調查，於2020年3月5日至8月30日，針對南部某縣市診所醫師354位及區域醫院醫師157位，以郵寄或電子郵件發送問卷。問卷內容包含：（一）基本資料，包含年齡、性別、科別、執業院所層級；（二）對政策之整體觀感；（三）對分級醫療六大策略24項配套措施之政策認同度及實施滿意度。採五分法計分，以獨立樣本 t 檢定，分析診所醫師與醫院醫師之差異。

結果：共95份問卷納入分析，包含63位診所醫師與32位醫院醫師。醫師對六大策略的認同度皆顯著高於滿意度(p<0.001)。相較於醫院醫師，診所醫師對策略二滿意度(p=0.041)、策略三認同度(p=0.025)、策略六認同度(p<0.001)皆顯著較高。

結論：醫師對分級醫療六大策略皆認同，但對政策實施的滿意度明顯不及認同度。建議衛福部加強對醫師宣導分級醫療政策，落實各項配套措施，了解醫師在實務上的困難，包含診所規劃無障礙空間、假日開診、24小時電話諮詢等，及醫院醫師在下轉病人所牽涉的問題，以達到落實分級醫療。

 

Purpose: Starting in 2017, the Ministry of Health and Welfare in Taiwan has been promoting a tiered health care system based on the following six major strategies: (1) Enhancing the capacity of primary care, (2) Encouraging the public to adjust to referral systems and copayments, (3) Increasing payments to hospitals for critical care as an incentive to reduce resources spent on minor illnesses, (4) Strengthening cooperation between hospitals and clinics to ensure care continuity, (5) Promoting health literacy and self-care, and (6) reinforcing the management of medical institutions. This study accordingly aimed to examine physicians’ agreement and satisfaction with this policy and compare the differences between the responses of physicians working at clinics and hospitals. The results can be used to help better implement the tiered health care system in Taiwan.

Methods: An anonymous questionnaire was issued during the period from March 5 to August 30, 2020 to 354 physicians working at clinics and 157 at hospitals in a county in southern Taiwan. The questionnaire incorporated items on (1) Demographic data, including age, sex, specialty, and worksite, (2) Opinions regarding the tiered health care system, and (3) Levels of agreement and satisfaction with the 24 measures of the 6 strategies for promoting the tiered health care system. An independent samples t test was used to measure the differences between the responses of physicians from clinics and hospitals.

Results: A total of 95 valid questionnaires were analyzed, including 63 from clinic physicians and 32 from hospital physicians. In general, physicians’ agreement with the policy was higher than their satisfaction with policy implementation (p< 0.001). Compared with hospital physicians, clinic physicians were more satisfied with strategy 2 (p= 0.041), agreed more with strategy 3 (p= 0.025) and strategy 6 (p< 0.001).

Conclusion: Physicians generally agreed with the policy, but most were less satisfied with its implementation. For successful implementation of the tiered health care, effective measures need to be developed to increase physicians’ awareness of relevant policies and to understand and respond to the concerns and difficulties of physicians, such as the establishment of a barrier-free environment at clinics, regulations of holiday hours at clinics, provision of 24-hour on-call service, and problems about down-referral.