基層醫師對實施基層分科總額預算之意願及影響因素

Factors Associated with the Willingness of Primary Care Physicians to Implement the Department Global Budget

10.6288/TJPH2011-30-02-05

陳文侯(Wen-Hou Chen)；龔佩珍(Pei-Tseng Kung)；蔡文正(Wen-Chen Tsai)；李亞欣(Ya-Hsin Li)；曾盈甄(Ying-Chen Tseng)

總額預算 ； 基層醫師 ； 分科總額預算 ； global budget ； primary care physician ； department global budget

台灣公共衛生雜誌

30卷2期（2011 / 04 / 15）

150 - 164

繁體中文

目標：探討實施基層分科總額管理試辦計畫對醫師執業之影響及滿意度，並了解基層醫師對實施分科總額預算之意願及其影響因素。方法：針對中部四縣市所有健保特約西醫基層醫師，利用結構式問卷以郵寄方式進行普查，回收579份問卷。除描述性與雙變項統計分析外，以羅吉斯迴歸分析探討影響基層醫師是否贊成實施分科總額預算之相關因素。結果：55%的基層醫師認為分科方式不合理，54.63%認為分科管理對未來發展為負面影響，整體滿意度認為滿意者20.67%，但是有38.52%表示不滿意。在較都市化區執業競爭較激烈而整體滿意度較低。不贊成實施分科總額預算者佔57.99%。對於實施繼續分科總額之意願，泌尿科、外科、骨科、耳鼻喉科及婦產科明顯較贊成，而精神科、皮膚科及家醫科傾向不贊成。由羅吉斯迴歸分析結果發現「實施後基層醫師間之競爭度」、「實施後平均每週看診次數之變化」、「執業年資」、「分科方式合理性」、「對該科未來之影響」及「科別」會影響醫師是否贊成實施分科總額預算。結論：基層醫師對於分科管理的滿意度偏低，對於在都會區中執業之醫師較不利，多數基層醫師不贊成進一步實施分科總額預算。

Objectives: This study investigated the influences on implementation of the department global budget (DGB) demonstration project in primary care physicians' practices and their satisfaction with DGB. In addition, this study explored the factors associated with the willingness of primary care physicians (PCPs) to implement DGB. Methods: This study adopted the survey method with a structured questionnaire. All national health insurance-contracted PCPs practicing Western medicine s in four cities/counties in central Taiwan were surveyed, and 579 valid responses were received. In addition to descriptive statistics and bivariate analysis, this study utilized a logistic regression analysis to explore the factors associated with the PCPs' willingness to accept DGB implementation. Results: Fifty-five percent of PCPs thought that the methodology of DGB was unreasonable; 54.63% thought the DGB had a negative effect on departmental development; 20.67% were satisfied with DGB while 38.52% were dissatisfied. The level of satisfaction was lower in more urbanized areas, probably due to a higher rate of competition. A total of 57.99% of PCPs disagreed with the implementation of DGB. The PCPs in urology, surgery, orthopedics, ENT, obstetrics and gynecology agreed more with continuing the implementation of DGB, but PCPs in psychiatry, dermatology and family medicine were inclined to disagree. According to logistic regression analysis, the factors that affected agreement with DGB included the level of competition after DGB, alteration in work time after DGB, years of practice, perception of the rationality of DGB, the anticipated effect on departmental development and the field of the department. Conclusions: Satisfaction with the DGB demonstration project was relatively low. The DGB is disadvantageous to PCPs in more urbanized areas and the majority of PCPs disagreed with implementation of the DGB.

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