財務誘因與台灣區域醫院醫師服務績效之跨層次分析

A Multievel Analysis of Financial Incentives and Physician Performance in Taiwan's Regional Hospitals

汪秀玲(Hsiu-Ling Wang) ； 羅永欽(Joon-Khim Loh) ； 洪純隆(Shen-Long Howng)

《台灣公共衛生雜誌》 30卷4期 (2011/08) Pp. 337-346

https://doi.org/10.6288/TJPH2011-30-04-04

摘要

Objectives: Previous studies of performance have focused on either organizational or individual-level analysis. Multilevel theory has been used to explore the effect of the method of compensation on the quality and quantity of individual physician services after hospital global budgeting (HGB) was implemented in Taiwan. Methods: We used a sample of convenience of 33 regional hospitals that participated in HGB and surveyed managers and physicians with structured questionnaires in 2008. A total of 210 valid questionnaires from 24 hospitals were returned. We conducted hierarchical linear modeling analyses and demonstrated that both individual-level and organizational-level factors were associated with physician performance. Results: The effect of the variable compensation level on quality of physicians' service, productivity in the outpatient department (OPD) and in the inpatient department (IPD) was not significant (0.250, 0.171, 0.253, all p＞.05). The ratio of beds to physicians negatively affected individual quality (-0.044, p＜.01) while positively influencing productivity in and IPD (0.040, p＜.05). The OPD production of physicians in public or non-profit hospitals was higher than those in private ones (43.7%, 79.1%). Physician quality and IPD production in northern hospitals was higher than that in the southern area (18.3%, 45.1%). Tenure was positively related to physicians’ productivity (0.846, p＜.001; 0.523, p＜.05). The OPD of internists was higher than that of 27.0% of surgeons. Overall, the individual-level factors explained 19.96%, 20.74%, 18.86% of within-hospital variance on performance and hospital-level factors explained 54.13%, 56.93%, 36.26% of between-hospital variance. Conclusions: Variable compensation did not stimulate physicians to reduce quality or productivity. Hospital features and physician performance were co-determinant, thus weakening the contextual effect of financial compensation.

關鍵字

服務績效 ； 成果基礎誘因 ； 系絡效果 ； 層級線性模式

並列摘要

Objectives: Previous studies of performance have focused on either organizational or individual-level analysis. Multilevel theory has been used to explore the effect of the method of compensation on the quality and quantity of individual physician services after hospital global budgeting (HGB) was implemented in Taiwan. Methods: We used a sample of convenience of 33 regional hospitals that participated in HGB and surveyed managers and physicians with structured questionnaires in 2008. A total of 210 valid questionnaires from 24 hospitals were returned. We conducted hierarchical linear modeling analyses and demonstrated that both individual-level and organizational-level factors were associated with physician performance. Results: The effect of the variable compensation level on quality of physicians' service, productivity in the outpatient department (OPD) and in the inpatient department (IPD) was not significant (0.250, 0.171, 0.253, all p＞.05). The ratio of beds to physicians negatively affected individual quality (-0.044, p＜.01) while positively influencing productivity in and IPD (0.040, p＜.05). The OPD production of physicians in public or non-profit hospitals was higher than those in private ones (43.7%, 79.1%). Physician quality and IPD production in northern hospitals was higher than that in the southern area (18.3%, 45.1%). Tenure was positively related to physicians’ productivity (0.846, p＜.001; 0.523, p＜.05). The OPD of internists was higher than that of 27.0% of surgeons. Overall, the individual-level factors explained 19.96%, 20.74%, 18.86% of within-hospital variance on performance and hospital-level factors explained 54.13%, 56.93%, 36.26% of between-hospital variance. Conclusions: Variable compensation did not stimulate physicians to reduce quality or productivity. Hospital features and physician performance were co-determinant, thus weakening the contextual effect of financial compensation.

並列關鍵字

service performance ； outcome-based incentive ； contexual effect ； hierarchical linear modeling

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