論病例計酬制度下醫院薪資策略對醫師診療行為之影響：以某區域醫院為例

The Impact of Hospital Compensation Strategies on Physician Practice Behavior under the Case Payment System: the Case of a Regional Hospital

許玫玲(Mei-Ling Sheu) ； 張維容(Wei-Jung Chang) ； 黃國哲(Kuo-Cherh Huang)

《台灣公共衛生雜誌》 24卷1期 (2005/02) Pp. 12-21

https://doi.org/10.6288/TJPH2005-24-01-01

摘要

目標：許多醫院實施以服務量為基礎之醫師費制度，故醫院醫師沒有誘因減少服務密度。本研究分析論病例計酬制度下，當醫院改變醫師費制度，以財務誘因鼓勵醫師節約醫療資源時，醫師如何回應。方法：本研究以一區域醫院為例，分析醫師費制度改變後，八種論病例計酬案件醫療資源利用的變化。資料涵蓋期間為1998到2001年。依變項為住院日數、醫療費用差額（論病例計酬減論量計酬金額）、以及九項醫療費用細項之論量計酬金額。結果：迴歸分析顯示，醫師費制度改變後，四種案件之住院日數減少，包括子宮完全切除術、痔瘡切除術、疝氣手術、前列腺切除術。醫療費用差額方面，除陰道生產與子宮肌瘤切除術外，其餘六種疾病個案之醫療費用差額均增加。醫療費用細項方面，除了闌尾切除之特殊材料費外，每種個案的藥費與特珠材料費都減少，但本研究與法證實醫師是否為了增加其醫師費收入而選擇性地減少醫療服務項目。結論：個案醫院新的醫師費措施的確使醫師減少醫療資源耗用，然而減少程度因不同疾病而有差異。

關鍵字

論病例計酬 ； 醫師費 ； 醫師行為 ； 財務誘因 ； 醫療資源耗用

並列摘要

Objective: Hospital physicians do not have incentives to decrease the intensity of services because many hospitals have implemented physician fee policies and compensate physicians based on their guantity of services. This study analyzes how hospital doctors respond to a different physician fee policy that gives them incentives to control health care resources under the case payment system. Methods: This study analyzes how health care resource utilization has changed after the implementation of a new physician fee policy for eight case payment procedures at a regional hospital. The data covers the period from 1998 to 2001. Dependent variables include length of stay (LOS), the amount of savings (defined as the difference between the case payment price and fee-for-service (FFS) expenditure), and the FFS expenditures of nine service categories. Results: The regression results show that after the new physician fee policy was implemented, the LOS had decreased for four types of cases: total hysterectomy, hemorrhoidectomy, herniorrhaphy, and prostatectomy; the amounts of savings had increased for all six types of cases with the exception of vaginal delivery and myomectomy. Except for the special materials of appendectomy, the study found that the FFS expenditures for drugs and special materials had decreased across all types of procedures. However, this study could not confirm whether or not physicians decreased services selectively to increase their physician fee income. Conclusion: Physicians have responded to the new physician fee policy by decreasing the utilization of health care resources. However, the extent to which health resources could be reduced varies among different procedures.

並列關鍵字

case payment ； physician fee ； physician behavior ； financial incentives ； health resource utilization

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