西醫基層醫師之風險趨避態度與相關因素──以中部地區為例

Factors Associated with Attitudes about Risk Among Clinic Physicians in Central Taiwan

目的：不確定性與風險存在於醫療服務的過程，醫師對風險的態度往往影響其執醫行為。本研究應用風險趨避態度理論，探討基層醫師對執業的風險趨避態度與其相關因素。方法：本文研究主要針對西醫基層醫師，以健保局中區分局所管轄之四縣市之西醫診所為研究對象，合計1,842家。在2004年2月至3月，採用郵寄問卷方式進行資料收集，回收有效問卷232份。在分析方法上，除一般描述性分析外，另採用複迴歸分析來探討影響西醫基層醫師風險趨避態度之因素。結果：受訪之基層醫師在風險趨避程度分佈情形為風險趨避程度較弱者有16.4%，趨避程度中等者佔59.5%，風險趨避程度較強者有24.1%。眼科醫師平均風險趨避最強，婦產科次之；皮膚科醫師平均風險趨避最弱。以複迴歸分析在控制其他變項之後，不同科別醫師風險趨避態度無顯著差異(p>0.05)；與基層醫師風險趨避程度顯著相關因素僅有醫師的「年齡」、「看診量」與「是否採取任何防禦性醫療行為」達到統計上的顯著水準(p<0.05)，年齡越大或每週看診人次越高者，其風險趨避程度傾向越強。結論：基層醫師風險趨避態度較不受科別影響，影響基層醫師風險趨避態度主要在於年齡及看診病患量。

Uncertainty and risk exist in the practice of medicine. Physicians’ practice behavior is influenced by their attitudes about risk. Based on the theory of risk aversion, this study investigated clinic physicians’ attitudes about risk in providing medical services and determined the associated factors. Physicians from 1,842 clinics in the central region branch bureau of national health insurance were surveyed by a mailed questionnaire in February and March 2004. There were 232 useable responses. In addition to descriptive statistics, multiple regression analysis was conducted to examine the factors associated with physicians’ attitudes about risk. Among clinic physicians, 16.4% of respondents were classified as low risk avoiders ‘ 59.5% as medium risk avoiders‘ and 24.1% as strong risk avoiders. Ophthalmologists and obstetrician-gynecologists-were the strongest risk avoiders and dermatologists the least; however, there was no significant difference in the risk aversion attitude among physicians in different specialties (p<0.05). After controlling for other factors, the results of multiple regression analysis showed that ‘physician’s age”, “patient service volume” and “whether adopting any medical defensive behaviors” were statistically significant (p<0.05) factors affecting the degree of risk aversion. Physicians’ risk aversion attitudes tend to become stronger as they age or the weekly patient service volume becomes higher.