台灣西醫基層診所聯合執業的變化：1998年與2003年

Changes of Private Western Clinics' Group Practices in Taiwan: 1998 and 2003

10.6288/TJPH2007-26-02-08

楊涵妃(Han-Fei Yang)；文羽苹(Yu-Ping Wen)

診所 ； 執業型態 ； 聯合執業 ； 全民健康保險學術研究資料庫 ； clinics ； practice mode ； group practice ； National Health Insurance Research Database

台灣公共衛生雜誌

26卷2期（2007 / 04 / 01）

161 - 168

繁體中文

目標：描述私立西醫診所的執業規模、科別組合等變化，分析影響診所聯合執業的因素。方法：利用1998年(n=8,544)與2003年(n=8,571)「全民健康保險學術研究資料庫」，採用對數迴歸，分析地區人口數、競爭程度等因素對診所是否聯合執業的影響。結果：台灣私立西醫診所以單獨執業為主要型態，1998至2003年聯合執業的比例由17%增加至23%，且平均規模略為上升。控制其他變項之影響後，人口數愈多，65歲以上人口比例愈低，競爭程度愈高的地區，診所為聯合執業的機率愈高。骨科、耳鼻喉科、眼科等聯合執業的機率較高。結論：診所執業型態的轉變可視為基層診所努力擴充資源、提升競爭力的表現，相較於一般基層醫師參與聯合執業意願調查結果，雖然高達62%醫師有意願參與聯合執業，真正付諸行動的卻佔少數，顯示聯合執業的實施仍有相當障礙。

Objective: To profile the practice modes of privately-owned clinics, in particular the average changes in scale and specialty mix, and to analyze factors associated with group practice. Methods: Data from the 1998 (n=8,544) and 2003 (n=8,571) National Health Insurance Research Database were used. Logistic regressions were used to examine whether local population and competition are significantly associated with establishment of group practice. Results: Single practice has been the major mode of practice in Taiwan. However, the proportion of group practice increased from 17% in 1998 to 23% in 2003, along with a slightly larger average scale. Controlling for other factors, greater population, younger population, and higher competition are positively and significantly associated with the probability of group practice. Specialties such as orthopedics, otolaryngology, and ophthalmology are more likely to form group practice than is general medicine. Conclusions: We consider the changes in practice modes as clinics' ways to expand resources and to gain an edge over competitors. Compared to documented willingness as high as 62% to participate in group practice, physicians in Taiwan have yet to transfer that willingness into action. Barriers to group practice still remain.

1. 文羽苹、江東亮(2002)。全民健康保險學術資料庫基本檔的應用經驗。台灣衛誌，21，150-5。
   連結：
2. 林恆慶、董鈺琪、李淑雅、陳楚杰(2002)。影響基層不願意參與聯合執業的因素。醫護科技學刊，4，90-103。
   連結：
3. (2004)。行政院衛生署：衛生統計動向。
4. (2004)。中央健康保險局：全民健康保險統計。
5. Freshnock L J,Goodman L J(1980).The organization of physician services in solo and group medical practice.Med Care.
6. Freshnock L J,Jensen L E(1981).The changing structure of medical group practice is the United States, 1969 to 1980.
7. Gaynor M,Haas-Wilson D(1999).Change, consolidation, sad competition in health care markets.J Econ Perspect.
8. Goodman L J,Wolinsky F D(1982).Conditional logit analsis of physicans` practice mode choices.Inquiry,19,262-70.
9. Graham J(1979).Oral surgeons in geographic regions and selected metropolitan areas.J oral surg,37,50-63.
10. Hornbrook M C,Berki S E(1982).Practice mode and payment method: effects on use, costs, quality, and access, method.Med Care.
11. Korcok M(1985).Group medicine a growing force worldwide.Can Med Assoc J,133,134-7.
12. Lin H C,Chen C S,Liu T C,Lee H C(2006).Differences is practice income between solo and group practice physicians.Health Policy,79,296-305.
13. Parkin M(2006).Economics
14. Rice B(1998).Flying solo-and still flying high.Med Econ.
15. Rossiter L F(1984).Prospects for medical group practice under competition.Med Care.
16. Tillinghast S J(1998).Competition through physician-managed rare the case for capitated multispecialty group practices.Int J Qual Health Care.
17. Williams A P,Vayda E,Stevenson H M,Burke M,Pierre K D(1990).A typology of medical practice organization in Canada. Data from a national survey of physicians.Med Care.
18. Williams S,Torrens P R(2002).Introduction to Health Services
19. 林恆慶、石賢彥(2003)。現階段醫師參與聯合執業之優點。臺灣醫界，46，49-50。
20. 邱玉蟬(1997)。看病像住大飯店。天下雜誌，199，296-302。
21. 洪文棟(1991)。群體醫療執業中心質疑。臺灣醫界，29，6。
22. 高森永(1987)。美國群體醫療執業現況。公共衛生，13，13-7。
23. 張錦文、黃淑雅(1998)。臺彎醫療制度的四大問題與解決之道。醫院，31，1-4。
24. 許志怡(1991)。推行聯合執業以解決當今基層醫療問題。臺灣醫界，34，21-3。
25. 黃偉堯、張睿詒、江東亮(2001)。台灣醫師人力地理分布之變遷，1984-1998。醫學教育，5，13-20。
26. 楊逸菊(1998)。你適合「聯合執業」嗎。臺灣醫界，41，82-4。
27. 蔡淑暖、張錦文(1995)。醫師對聯合診所經營型態的看法之研究。醫院，28，23-9。
28. 鄭守夏、何玉雪(1997)。群體執業與單獨執業醫師之生產力比較。中華衛誌，16，428-34。

1. 蔣靜怡、郎慧珠(2017)。台灣診所之歇業與存活研究及其相關因素探討—以2000年至2010年新設西醫診所研究為例。臺灣公共衛生雜誌，36(6)，626-639。