基層開業醫師對臺灣基層醫療制度的評估及滿意度調查

Office-Based Physicians' Evaluation of the Primary-Care System

本研究目的旨在探討基層開業醫師對於基層醫療制度和執業上所面臨問題，並瞭解基層醫師對未來基層醫療制度發展之期望。資料來源取自衛生署醫事處，主要抽取2006年衛生署登記執業基層開業醫師名單，採用系統式抽樣法，共得3,407位，以郵寄方式蒐集所需的資料，有效回收樣本總計489份，回收率為14.4%。資料分析首先以Microsoft Excel 2000建檔，再以SPSS 12.0進行資料分析，除基本描述性統計分析之外，推論性統計則採用羅吉斯複迴歸分析。研究結果發現，在影響基層開業醫師是否滿意現行基層醫療制度因素方面，「50歲以上」、「基層醫療執業總年資＜10年」的基層開業醫師，及對「抽審審查標準不一」和「缺乏完善的家庭醫師人力」愈同意的基層開業醫師，其對現行基層醫療制度愈不滿意；愈同意「缺乏對基層診所的評鑑機制」的基層開業醫師，愈滿意現行基層醫療制度。而影響基層開業醫師是否滿意現行基層醫療工作狀況之因素發現，「聯合執業」和「具專科醫師資格」的基層開業醫師較滿意現行基層醫療工作；愈同意「保險不夠完善而害怕醫療糾紛」、「沒有足夠的時間進修」和「醫療收入減少」，愈不滿意現行基層醫療工作。醫師之間的良性合作、個人自我充實以及完善的保險制度，可使基層開業醫師更能滿意基層醫療。而在未來，基層醫師希望藉由良好健保政策的影響以及加強基層診所的內部管理，真正做到提升基層醫療品質，給予民眾更佳的醫療服務。

Objectives: The objectives of this study were to explore office-based physicians satisfaction with the primary-care system, the difficulties faced by office-based physicians, and the future direction of the primary-care system. Method: This study used systematic sampling from a list of office-based physicians provided by the Department of Health. We selected 3,407 office-based physicians as the study subjects. Self-administered questionnaires were mailed to the study subjects to collect the required data. In total, 489 questionnaires were returned, for a response rate of 14.35%. Results: This study found that 13.09% of the respondents felt that the primary-care system had been in recession during the past few years. A total of 49.28% and 32.11% of respondents were not satisfied and very dissatisfied with the present primary-care system, respectively. The three major problems with the primary-care system faced by the office-based physicians were the overlapping of patients with hospitals, lack of an accreditation mechanism, and too many office-based physicians. The three major problems with clinics faced by the office-based physicians were management, blackmail by gangsters, and inadequacy of medical equipment. Conclusion: Cooperation among physicians, continuing education, and a good insurance system can increase the satisfaction of office-based physicians. In the future, office-based physicians believe that implementation of a good health-insurance policy and enhancement of clinic management will improve the quality of the primary-care system and result in better medical service to the public.