| 摘要: | 摘要 本研究目的為了解開業醫師對本身各種醫療服務之評價及影響因素，並探討開業醫師對全民健保有關基層醫療措施之看法。研究母群體為88年12月底之醫療機構特約檔案中，台灣省所有加入健保特約的私人診所之負責醫師，總共約7560家，抽樣比例為60%，共計郵寄4536份問卷，回收率為16.75%。並針對回收問卷進行描述性統計、迴歸分析、重要性/表現分析等統計方法，分析各自變項對開業醫師自我評價的影響。 結果發現開業醫師認為對診所的「就醫及諮詢方便性」、「醫師的醫術及名氣」、「醫護人員的服務態度」、「醫師的用藥解說」、「診所的環境衛生」自評表現愈好的開業醫師，對本身整體醫療服務的自我評價也愈高；女性開業醫師相較於男性開業醫師有較高的自我評價；小兒科開業醫師相較於內科開業醫師對本身醫療服務的自我評價較低。 並且認為導致民眾偏好至大醫院門診看病的健保措施之原因主要為轉診制度未落實、醫院給付範圍大及醫院藥品給付額較高，而認為若強制實施轉診制、提高越級就醫的部分負擔、降低診所看診的部分負擔、保大病不保小病等健保措施可吸引民眾至診所看病。重要性/表現分析的結果顯示開業醫師對於各因素的重要性程度及自評醫療服務表現大部分皆位於繼續保持區，表示大部分開業醫師對於民眾就醫選擇的因素皆認為很重要，也很肯定自己的服務表現。其中以診所的停車便利性為開業醫師認為最急需改進的因素。 開業醫師要能夠吸引民眾至基層診所看病，主要仍然要靠醫師本身對醫療服務品質的自我提昇，並配合衛生單位修改相關健保措施，例如放寬藥品跨表給付額、降低診所看診的部分負擔等，提供基層診所更良好的生存空間，才能有效達到吸引民眾至診所看病之目的，減少醫療資源的浪費。 關鍵字：基層醫療、開業醫師、醫師行為; The purpose of this research is to understand the self-evaluation of clinic physicians and its related factors, and also to study the views of clinic physicians for primary care services related to National Health Insurance (NHI). The sample of this research is 7560 clinic physicians in the file of NHI contracted medical care organizations, which contained all clinic physicians participating in the NHI in late Dec., 1999. Sixty percent of clinic physicians were randomly selected. A total of 4536 questionnaires was sent, and 16.75% of questionnaires was received. Multiple regression analysis and importance/performance analysis were used to examine the variables that influenced clinic physicians’ self-valuations. The study results showed that clinic physicians have a higher self-evaluation on their overall medical services who also have higher self-evaluations on ”Convenience on Seeking Medical Advice and Consultation”, ”Doctor’s Reputation and Skills”, “Service Attitudes”, “Prescription Explanation”, “Clinic’s Environment Hygiene”. Female clinic physicians have a higher self-evaluation than male clinic physicians, while pediatricians have a lower self-evaluation than internists. Clinic physicians think the reasons that many patients like to visit hospitals are the incompleteness of the referral system, hospital’s care having more insurance coverage, and hospital’s services having higher payments for prescriptions. Clinic physicians think that a complete referral system, higher co-payments for patients visiting hospitals without clinic physician’s referral, lower co-payments for patients visiting clinic physicians, and NHI only covering severe illnesses will attract more patients to visit clinics. The results of the importance/performance analysis indicated that clinic physicians think all of their medical services belong to the sector — “Keeping of the Work”. It means clinic physicians realize all patients’ choices of clinics are important and evaluate themselves doing well. However, the parking inconvenience is the most urgent thing, which needs to be improved for clinics. Based on the study results, clinic physicians will mainly attract patients by continuously improving their medical care quality, and reforming current NHI policies such as increasing clinic prescription payment and lowering co-payment for visiting clinics. Only do clinic physicians attract more patients to visit their clinics that will reduce the waste of medical care resources. |
