全民健保已全面採用總額支付制度來分配醫療資源,將醫療財務風險轉由醫療提供者負擔,不同層級別的醫療機構經營管理者均面臨很大的營運壓力;西醫基層院所是我國區域醫療體系中一種基礎照護機構,為滿足民眾就醫可近性,故數量多且民眾利用率相當高;西醫基層總額支付制度實施後,在有限醫療資源且面臨競爭的情形下,西醫基層醫師健保收入將會產生影響,本研究旨在探討西醫基層總額支付制度實施後一年,對西醫基層醫師健保收入的影響。 本研究以全民健康保險研究資料庫2000年7月至2002年6月台灣地區西醫基層醫療機構之執業醫師為對象(n=11,513),排除執業未滿一年之醫師(n=2,917)共計8,596個研究樣本。以描述性統計分析醫師性別、年齡、執業地區、執業科別等人次及百分比,了解西醫基層醫師執業分佈情形。以配對t檢定分析各執業科別醫師特質及執業地區與醫師健保收入之相關性,並探討西醫基層總額支付制度實施後一年對醫師健保收入之影響。 本研究結果發現,由醫師特質(性別、年齡)、執業地區別(健保六大分局)探討,西醫基層總額支付制度實施後一年醫師健保收入均呈現增加,且達統計上顯著意義;然而不同執業科別醫師之健保收入,因科別不同而產生增減不一致,且並未全部達統計上顯著意義。
National health insurance (NHI) has comprehensively used the Global Budget System to allocated the medical resources, and the Global Budget System transferred the medical finance risk to the health care providers. Thus, there might have some impacts on primary care physicians’ income from NHI. The aim of this study was to find out that before and after the intervention of Global Budget System policy, how it influenced the primary care physicians’ income from NHI. A retrospective analysis was performed with the Taiwan claims data of the National Health Insurance (NHI) from July, 2000 to June, 2002. There were 8,596 physicians included in this study, excluding physicians who practiced less then one year (N=2,917). In this study, we used the descriptive analysis for physicians’ socialdemographic; pair t test for the correlation between the different specialties’ socialdemographic and their income from NIH. Further more, to find out that before and after the intervention of Global Budget System policy, how it influenced the primary care physicians’ income from NHI. This study found out that, by physicians’ characteristic (sex, age), and the areas (the six branches of NHI) where the physicians practiced, after the intervention of Global Budget System policy, there was a significant increase in physicians’ income. But when it comes to different specialties, the results were not all significant. For example, in the General Practice, there were all significant in six branches; in Internal Medicine, there was not significant in Taipei branch.
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