透析給付方式認知影響透析醫護人員處方行為之研究

The influences of healthcare professional's cognition of dialysis reimbursement on prescription behavior

李佩珍(Lee,Pei-Chen)

指導教授 ： 李月華

淡江大學/管理學院/企業管理學系碩士在職專班/碩士(2012年)

https://doi.org/10.6846/TKU.2012.01110

摘要

在健保局財務日漸困難又須照護全民民眾健康的使命下，如何讓健保資源充分發揮醫療照護責任是最重要的課題。透析預算在門診透析小總額的支付制度下，由於腎臟透析病患每年增加的速度超過總額費用成長的幅度，因此門診透析點值持續下滑在未來是必然會發生的狀況。由於腹膜透析的成本效益優於血液透析，但是台灣當前的透析治療仍是以血液透析為主。故本研究之主要目的在探討台灣地區腎臟照護醫療人員對於血液透析及腹膜透析的健保給付方式認知對其選擇透析模式的影響，在兼顧成本效益及透析醫療品質的前提下，進而調整現行選擇模式，適度提高腹膜透析比率，期能達成減緩門診透析點值滑落速度以及照護透析患者權益的雙重目標。
本研究先針對相關文獻進行整理，再透過問卷調查的方式蒐集資料，以探討醫護人員處方行為。大多數醫護人員最關心的是成本及利潤，本研究以統計方法探討醫護人員對健保給付之認知，並進而探討業務信任度與考量處方因素對處方行為之關係。
研究結果發現：（一）腎臟科醫療人員對透析治療健保支付制度及成本的認知正確度高者，選擇血液透析處方比例高於腹膜透析；（二）腎臟科醫療人員對腹膜透析治療銷售業務的信任度高低不影響對血液透析的處方選擇（三）醫護人員考量透析治療的給付價格及治療成本會影響處方選擇行為。

關鍵字

末期腎臟疾病 ； 透析治療 ； 血液透析 ； 腹膜透析 ； 成本效益

並列摘要

The financial status of BNHI is getting worst in recent years, however, their main mission is still to provide the health care for the Public. How to maximize the health care efficiency provided by the limited resources would be the most important task for BNHI.
Dialysis budget is designed as an overall capped budget by BNHI. Due to the increased rate of new ESRD patients is higher than the increased rate of total dialysis budget, the point value of outpatient dialysis will be continuingly decreased in the future. Although PD has better cost effective than HD, HD is still the majority of dialysis therapy used in Taiwan.The study purpose is to investigate the influence between health professionals’ general cognition on the Health Reimbursement payment scheme of PD and HD and their decisions on dialysis therapy options. On the premise that to keep the balance of dialysis care quality and cost effective, we suggest to adjust the dialysis therapy decision making model by moderately increasing the PD usage rate, which to achieve the goal of keeping the high quality of dialysis care and maintenance the point value of outpatient dialysis.
In this study, we focused on collaboration of relevant literatures in the first step, and conducted data collection by questionnaire survey for investigating prescription behaviors of healthcare professional . It revealed that most of healthcare professional concern about cost and profit . Therefore, we intended to investigate about cognition of dialysis reimbursement and prescription behaviors between trust of sales representation and consider factor of prescription.
The study result revealed: (1)The professionals of nephron have right cognition of dialysis payment and budget control, the prescription the HD penetration rate higher than PD ; (2) The trust level on PD sales representative can’t influence the professional’s prescription for HD; (3) The professionals consider the dialysis reimbursement and cost effectiveness will influence the prescription behavior.

並列關鍵字

ESRD ； Dialysis ； HD ； PD ； Cost effective

參考文獻

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