基層醫師對“家庭醫師整合性照護試辦計畫”成效評估

The Evaluation of the Efficacy of "The Trial Plan for the National Public Health Insurance Family Doctor Comprehensive Care System" from Primary Care Physicians

10.7023/TJFM.200603.0013

許佑任(Yu-Jen Hsu)；徐富坑(Fu-Keng Hsu)；李顯章(Hsien-Chang Li)；陳端容(Duan-Rung Chen)；林恆慶(Herng-Ching Lin)

Trial Plan for the National Public Health Insurance Family Doctor Comprehesive Care System ； community medical group ； gatekeeper

台灣家庭醫學雜誌

16卷1期（2006 / 03 / 01）

13 - 26

繁體中文

本研究旨在探討參與「家庭醫師整合性照護試辦計畫」基層醫療院所醫師對計畫之成效評估。研究對象以中央健康保險局於2005年3月3日公佈於官方網站之全國參與「家庭醫師整合性照護試辦計畫」1,575家基層醫療院所醫師為研究母群體。採「普查」方法，使用郵寄方式發放研究測量工具。首先以卡方檢定進行分析，探討醫師特質與試辦計畫整體成效之相關性，隨後在控制「社區醫療群實際組成方式」下進行羅吉斯迴歸(logistic regression)分析，探討影響醫師對「家庭醫師整合性照護試辦計畫」整體成效觀感產生差異之因素。 研究結果發現，儘管現行家醫試辦計畫已受到多數參與醫師主觀肯定，但需注意部分「醫師特質」（從事基層服務總年資及性別）與「社區醫療群實際運作情形」（社區醫療群組成方式及夜間非門診時段諮詢人員）會影響醫師對家醫試辦計畫「整體成效」之觀感。從事基層服務總年資11-15年者、16-20年者及26-30年者，對家醫試辦計畫之整體成效觀感較佳；男性醫師觀感優於女性醫師；社區醫療群組成方式為其他者（聯合診所或門診具有五位專任醫師以上，且結合該地區其他三家特約診所以上者）對家醫試辦計畫整體成效可能優於甲型者（一半以上醫師具備內、外、婦、兒或家醫科專科醫師資格）。 茲針對研究結果，對衛生主管機關提出三點建言：（一）重新檢視「家醫試辦計畫」內容是否不利於具備某些特質醫師；（二）可推薦基層院所醫師採用醫病雙方評價較佳之社區醫療群運作方式；（三）審慎使用限有資金補助既有社區醫療群與核准新成立之社區醫療群，並給予正確理念宣導。

This study aims to evaluate the efficacy of ”Trial Plan for the National Public Health Insurance Family Doctor Comprehensive Care System” which was initiated by the Bureau of Central Health Insurance in 2005. The study subjects comprised of 1,575 physicians from family medical clinics that were noted publically on the web site by the Bureau on March 3, 2005. A self-reported questionnaire was mailed to each subjects. Chi-square tests were used to evaluate the associations between the characteristics of primary care physicians and the achievements of the Plan. A logistic regression analysis was also used to explore the factors contributing to the perceived achievements of the Plan after the different models of the Plan were presented. In the study, we found the characteristics of physicians might affect their perceived evaluations toward the achievements of the Plan. Those who with professional practice experience between 11 and 15 years, 16 and 20 years, and 26 and 30 years perceived more achievements of the Plan than those who had the experience between 1 and 5 years. Male physicians perceived more achievements than the female ones. From the study, we would like to provide the following 3 suggestions for health authority in country: (1) to investigate whether the family physician trial plan is inappropriate for certain physicians; (2) to recommend primary care physicians adopt more appraised models of the family physician trial plan; and (3) to carefully allocate funds to the existing groups or potential candidates of the profession.

1. 林恆慶、吳傳頌、許佑任、陳楚杰(2005)。台灣基層醫師對家庭醫師制度的認知、態度及認可之模式。台灣家醫誌，15，11-24。
   連結：
2. 許佑任、陳家榆、林恆慶、陳楚杰(2004)。台灣民眾對實施家庭醫師制度之意願及相關因素研究。台灣家醫誌，14，159-172。
   連結：
3. Bodenheimer T,Lo B,Casalino L(1999).Primary care physician should be coordinators, not gatekeepers.JAMA,281,2045-2049.
4. Franks P,Clancy CM,Nutting PA(1992).Gatekeeping revisited--protecting patients from overtreatment.N Engl J Med,327,424-429.
5. Grumbach K,Selby JV,Damberg C(1999).Resolving the gatekeeper conundrum: what patients values in primary care and referrals to specialists.JAMA,282,261-266.
6. Halm EA,Causino N,Blumenthal D(1997).Is gatekeeping better than traditional care? A survey of physicians` attitudes.JAMA,278,1677-1681.
7. Kerr EA,Hays RD,Mitchinson A(1999).The influence of gatekeeping and utilization review on patient satisfaction.J Gen Intern Med,14,287-296.
8. 中央健康保險局網站
9. 中央健康保險局網站
10. 健保醫字第0930059488號公告修正
11. 健保醫字第0920005210號公告
12. 中央健康保險局網站
13. 吳哲維(2003)。台中健康暨管理學院健康管理研究所。
14. 蔡佳洵(2003)。國立中央大學企業管理研究所。

1. Yeh, Jih-I,Wang, Li-Yu,Lin, Hans Hsien-Hong,Li, Yin-Ming,Fu, Chen-Chung(2008).The Association of Paternal and Maternal Body Mass Index on Childhood Overweight.臺灣家庭醫學雜誌,18(1),1-10.
2. 賴韻如、葉琬喻、陳慶餘、郭斐然、徐愫萱、邱泰源(2012)。以實證醫學回顧全民健康保險家庭醫師整合性照護計畫之成效。臺灣家庭醫學雜誌，22(1)，11-24。
3. 劉怡君、陳惠芳、陳俞成、陳怡君、林爲森(2008)。南區診所醫師對參與家醫計畫看法及滿意度之研究。嘉南學報（人文類），34，727-741。
4. 潘湘如,楊皓宇,彭鈺婷,陳如意(2019)。居家整合醫療及雙向轉診困境之調查－某區域醫療網參與醫師之觀點。台灣家庭醫學雜誌，29(3)，144-151。
5. 詹雅嵐,黃慧雅,林名男(2021)。台灣南部某縣市醫師對分級醫療六大策略之認同度及滿意度調查。台灣家庭醫學雜誌，31(3)，214-226。