| 摘要: | 目的：台灣地區長久以來都存在著醫療資源分配不均的問題，截至民國90年底中央健保局統計顯示台灣地區有66個無牙醫鄉，因此政府於民國90年度推行「牙醫總額支付制度鼓勵牙醫師至無牙醫鄉醫療服務」，以鼓勵牙醫師至無牙醫鄉執醫。本研究藉由前往無牙醫鄉的牙醫師作深入調查，了解這一群牙醫師至無牙醫鄉之原因與其特性，作為未來政策訂定與支付制度設計之參考，以減少城鄉間的差距與醫療資源分配不均的情形。 方法：本研究對象為申請「民國90年度牙醫總額支付制度鼓勵牙醫師至無牙醫鄉醫療服務方案」的牙醫師，針對這一群至無牙醫鄉執業的牙醫師，以問卷及深入訪談的方式調查，探討牙醫師的個人特性、過去經驗、執業狀況、所得情形、牙醫師願意至無牙醫鄉執業服務的原因及牙醫師對無牙醫鄉鼓勵制度的看法。 結果：至無牙醫鄉執業的牙醫師中，其性別皆為男性，且牙醫師的年齡集中於41-50歲。執業狀況方面，牙醫師本身總執業經驗年數超過10年的人數最多，佔全部牙醫師的80%。在一天平均的看診人數方面，又以平均看診人數5人以下(66.67%)為最多，可知無牙醫鄉民眾的醫療利用率偏低，而與該無牙醫鄉民眾的互動情形來看，又以原住民牙醫師互動情形最為良好。牙醫師選擇至無牙醫鄉執業的動機與因素，以「金錢因素」為最主要的原因，其次是「服務奉獻因素」與「公費生制度之派定因素」。在牙醫師對無牙醫鄉鼓勵制度的觀感，其中又以認為無牙醫鄉鼓勵制度的「初衷立意良好」認同感的牙醫師最多，其次是認為鼓勵制度有「朝令夕改」與「需建構網絡支持系統」。 結論與建議：由本研究結果得知牙醫師願意至偏遠無牙醫鄉執業服務的原因，以「金錢因素」為最主要的原因，可知無牙醫鄉的鼓勵制度在其獎金制度的訂定上，發揮了所謂「重賞之下，必有勇夫」的成效。無牙醫鄉鼓勵制度實施一年後，由於政府對政策鼓勵制度保障月薪的降低，使得部份牙醫師放棄繼續在無牙醫鄉執醫。因此本研究建議中央健保局與牙醫全聯會：(1)無牙醫鄉鼓勵制度的實施，使得偏遠地區民眾都能享有平等的就醫權，政府應持續推行相關計畫；(2)政策鼓勵制度不應朝令夕改；(3)無牙醫鄉應建立適當轉診制度；(4)至無牙醫鄉執業牙醫師的醫療行為應給予品質的監控；(5)宣導偏遠地區民眾應選擇合格牙醫師。; Objectives: The unbalanced allocation of medical resource has long been a problem in Taiwan. Up till 2001, according to the statistics of Bureau of National Health Insurance, there were 66 no Dentists Areas in Taiwan, which triggered the government to promote the system of “Global Dental Budget System Encouraging Dentists to Practice in No Dentists Areas.” With deep exploration, this research seeks to understand the motives and characteristics of these dentists who go down to these areas, so as to serve as a source of reference for future policy formulation and designing of payment system, hopefully to diminish the discrepancy between urban and rural area, and eventually to resolve the problem of the unbalanced allocation of medical resource. Methods：The subjects of this study are dentists who applied for the system of “Global Dental Budget System Encouraging Dentists to Practice in No Dentists Areas” in 2001. In the form of both questionnaire and in-depth face-to-face discussion, we conduct a survey on those dentists into their personal traits, past experience, practice states, income condition, motivation of coming to no Dentists Areas, and their opinion of the entire system. Results：Dentists who come to the no Dentists Areas are males who are mostly in their forties. As for their practicing experience, the percentage of those dentists with more than 10 years of experience reaches 80%. In terms of daily average patient number, those dentists who serve no more than 5 patients makes 66.67% of them, which again accounts for the fact that medical usage rate in no Dentists Areas is relatively low. In terms of residents’ interaction with dentists in these areas, the aboriginals have the best interaction with dentists. We come to understand the first factor that attracts dentists to rural area is monetary incentive, followed by dentists’ personal sense of commitment to be devoted to these areas; with the top third one being that these areas are designated as practicing locations for students who study on government’s expenses. When it comes to dentists’ view of the project, most of them do recognize that government implement this project out of good will and benevolent intent, but they also believe that improvement can be made on the fact that the governmental policies change too frequently and also that the supporting network system needs to be established. Conclusion and Recommendations：based on this research, we learn that monetary factor still top the list of incentives that prompt dentists to serve in rural area, which again evinces that the entire system is under the sway of the principle that “the brave is propelled by handsome reward”. One year after the implementation of this system, part of the dentists just gave up their practice in rural areas, due to the fact that government reduced their monthly wage originally stated in the encouraging policy system. Hence, based on this study, we’d like to strongly recommend the Bureau of National Heal |
