健保總額預算期間桃園地區執業中、牙醫師的工作壓力

Job Stress among Chinese Medical Doctors and Dentists in Taoyuan during Global Budget Payment System

健保總額預算後，醫療院所為節制醫療費用的成長，造成市場化衝擊，醫療人員的工作量、壓力增加。本研究探討中醫師、牙醫師在實施全民健保總額預算期間的工作壓力及影響因素。對桃園縣執業中醫師、牙醫師以分層比例隨機抽樣獲得樣本，邀請被抽中之中醫師、牙醫師填寫醫療工作的壓力源感受量表(QMWS)。2006年7-12月得有效問卷81份(51位中醫師、30位牙醫師)。QMWS總分為15.73±6.57，百分位為37.5；在維持醫療院所的營運、薪水的給付制度皆是中醫師高於牙醫師且達統計顯著差異。對薪水滿意者高達70.4%。醫師別與QMWS有統計顯著差異，可解釋8.9%的變異量。總額預算期間，中醫師的工作壓力源感受高於牙醫師，尤其在維持醫療院所的營運、薪水的給付制度最為明顯，但大部分的中醫師、牙醫師對薪水滿意。

After implementation the global budget of the National Health Insurance in order to reduce the hospital’s high rising expenditure, job stress was increased among medical workers. This study was to investigate stress at work among Chinese medical doctors and dentists and their factors during the implementation of the global budget payment system. A questionnaire survey with a stratified and proportional random sampling in Taoyuan was used to obtain the sample. Questionnaire on medical workers stress(QMWS) with acceptable reliability and validity was used. From July to December 2006, 81 valid questionnaires were obtained (51 Chinese medical doctors, 30 dentists). The total score of the QMWS was 15.73±6.57 and the percentile was 37.5. Two individual scores of QMWS (running a hospital, and paying employee’s salary) were significantly worse for Chinese medical doctors than those for dentists. Satisfaction with their salaries was as high as 70.4%. Category of doctor were significantly associated with the QMWS, explaining 8.9% variation of QMWS. During the global budget payment system, Chinese medical doctors had higher occupational stress than dentists did, especially running a hospital, and paying employee’s salary. Most of them were satisfied with their pay.