醫師對全民健康保險意見隱性結構的相關因子研析

Factors Associated With the Latent Structure of Physicians' Opinions toward National Health Insurance

林芸芸(Yun-Yun Lin)

《中華民國公共衛生學會雜誌》 12卷3期 (1993/09) Pp. 266-281

https://doi.org/10.6288/JNPHARC1993-12-03-06

摘要

本研究目的在於分析醫師對全民健康保險意見隱性結構的相關因素。以分層隨機、等距系統抽樣法，自醫師公會全國聯合會18029名會員中抽出7500名樣本醫師。於1990年年初郵寄調查，共得1619名有效樣本，回收率爲22%。
全民健康保險看法結構：醫院醫師具「固守型」看法者較「改行型」多爲甄訓或特考醫師。若進一步將醫師分爲「改行型」及「不改行型」（包括「因守型」及「跳槽型」），則發現：醫院醫師以年齡較輕、住院醫師訓練年數及執業年數較短者，較傾向「改行型」。而診所醫師則以年齡較輕，具專科資格者，較傾向「改行型」。衝擊結構：醫院醫師具「不利型」或「悲觀型」，較「不變型」者年輕；又「不利型」較「不變型」者多爲醫院負責人；「悲觀型」較「不變型」者有較高比率未取得專科資格。診所醫師「悲觀型」及「不變型」者的執業年數、住院醫師訓練年數，皆高淤「調適型」。工作預期結構：醫院醫師「減少型」較「增加型」多爲男醫師、未取得專科資格、且多爲醫院負責人。診所醫師「減少型」較「增加型」多爲男醫師、年齡較輕、保險病人百分比較少；「不變型」較「增加型」的保險特約比率較高。執業理想結構：診所醫師「下鄉型」較「傳統型」的執業年數較短，且有較高的專科資格比率。醫療支付期望結構：醫院醫師「同酬評等型」、「專科同酬型」較「評等專科型」的住院醫師訓練年數長，又有保險特約的「同酬評等型」較「評等專科型」者有較低的保險病人百分比。「同酬專科型」較「評等專科型」者多爲醫院負責人、但具專科實格比率較低。診所醫師「評等型」及「城鄉型」較「同酬型」有較高比率未取得專科資格，而「混合型」較「同酬型」的得專科資格比率較高。

並列摘要

Thes study examined the characteristics of physicians with the different latent structure of opinions on National Health Insurance (NHI). The data source came from a mail survey of 7500 physicians (resulted in 1619 respondents with 21.6% response rate) in Taiwan, 1990.
Structure 1. Physicians' viewpoint on NHI.
Hospital physicians with change-career pattern were younger, had shorter period of internship or practice years than the steady ones. Clinic physicians, who were younger or more by certified specialist, were more intended to change career.
Structure 2. Physicians' expected impact of NHI.
Hospital physicians with pessimistic or disadvantaged expectations were younger, more in charge of the hospitals, or more had a specialist certificate than those with the constant expectation. Clinic physicians, who had longer period of internship or longer practice years, were more intended to be pessimistic.
Structure 3. Physicians' expected workload change.
More of the hospital physicians, who expected a decreasing workload change after the implement of NHI, were male, without specialist certificate, or in charge of hospitals than those expected to be increasing. Clinic Physicians with decreasing expectation were more male, younger, and had less insured patients than those with increasing pattern. Also, clinic physicians with no-change expectation on workload had a higher percentage of having an insurance contract than those with the increasing pattern.
Structure 4. Ideal practice pattern.
Rural-orientated clinic physicinas had longer practice years, and higher rate of certified specialists than the traditional ones.
Structure 5. Expected reimbursement methods for Physicians.
Hospital physicians, who preferred to be reimbursed by the uniformed payment level for the same service item, or based on credentiality-base, had a longer period of internship, or lower rate of insured patients than those who preferred the speciality-base. Clinic physicians, who preferred credentiality-base or urbanization level-base, had a lower rate of having a specialist certificate than those who preferred to be reimbursed on the uniformed payment level for the same service item.

並列關鍵字

National Health Insurance ； Physicians' opinion ； Latent Structure