探討醫療組織誘因制度、權益公平認知對醫師工作績效之影響－－以預算強調做為權變因素

The Effect of Hospital Incentives and Equity Fairness Perceptions on Physicians' Job Performance: Budget Emphasis as a Contingent Variable

由於中央健保署透過總額預算制度來管制與限制醫療機構的財務資源，再加上台灣地區醫院擴張過速且競爭激烈，其結果導致醫師面臨相當大的工作負擔與績效壓力。因此探討醫療組織現行誘因制度對醫師工作績效之影響，是一重要研究議題。然而有關誘因制度對個人層級工作績效之研究上，以往研究呈現不一致的結論。因此本文同時整合權變理論與中介效果之觀點來強化與解釋其間的關連性。在權變因素上，本文加入預算強調之觀點，以配合醫界受制於政府介入醫療規範的研究背景；而在中介變數上，本文則延續權益理論下的權益公平認知觀點。研究樣本包括國內區域級以上醫院的130位醫師，實證結果發現：（1）非財務誘因與醫師工作績效之間並不存在權益公平認知之中介影響效果，反而非財務誘因會正向顯著地提昇醫師工作績效。（2）財務誘因與醫師工作績效間並未存在權益公平認知之中介影響效果，同時財務誘因亦未顯著影響醫師的工作績效。（3）當預算強調程度高時，非財務誘因和權益公平認知的正向連結，會比預算強調低時有更增強的效果。（4）當預算強調程度高時，權益公平認知和醫師工作績效的正向連結，亦會比預算強調低時有更增強的效果。

The global budget system adopted by National Health Insurance Administration to control the financial resources for hospitals in combination with intensifying competition has led to considerable performance pressures on physicians. The influence of incentive systems on physicians' job performance has become a crucial research issue. This study aims to explain the connection between incentives and physicians' job performance from the integrative perspective of mediating effect and contingency theory. Budget emphasis is incorporated as a contingent variable in align with the restriction on medical practices imposed by government intervention as the research background. Equity fairness perception is taken as a mediate variable. The samples for analysis consist of 130 physicians from hospitals above the regional level. The results show that: (1) Nonfinancial incentives positively affect physicians' job performance at a significance level, which cannot be accounted for by the mediating effect of equity fairness perceptions. (2) The mediating effect of equity fairness perceptions does not exist between financial incentives and physicians' job performance. (3) The positive effect of nonfinancial incentives on equity fairness perceptions is evident with high budget emphasis. (4) The positive effect of equity fairness perceptions on physicians' job performance is also more evident with high budget emphasis.