台灣健保總額預算制度施行對藥師的工作感受及工作壓力之影響

Work Perception and Job Stress among Pharmacists While Implantation of Global Budget Payment System in Taiwan

鍾佳玘(Chia-Chi Chung) ； 蔡玉霞(Yu-Hsia Tsai) ； 陳偉立(Wei-Li Chen) ； 林雪蓉(Sheue-Rong Lin) ； 史麗珠(Lai-Chu See)

《中華職業醫學雜誌》 22巻1期 (2015/01) Pp. 31-43

摘要

全民健保實施後，上漲醫療費用是用改變給付制度（特別是總額預算）來控制，而醫療品質則由醫院評鑑來監督。而醫療院所則採用開源節流、加強管理來因應，使得醫療人員的工作量及壓力大增。有許多研究探討護理人員、醫師、治療師、醫檢師的工作壓力，卻未看到探討藥師工作壓力的議題。本研究採問卷調查，在桃園地區對執業醫療人員採分層比例隨機抽樣獲得樣本。研究工具為具信效度的健保總額預算前後工作感受改變量表(WPGB)，及醫療工作的壓力源感受量表(QMWS)。探討藥師在實施健保總額預算的工作感受、工作壓力，及兩者之關係。在2006年7-12月間，共收集63份有效問卷。WPGB平均總分為29.45±4.00，百分位為45；由高至低為：薪資、醫藥物品的運用、人力調整、醫療品質、文書處理量、工作量、與病人關係、工作時間、工作流程。而QMWS平均總分為30.27±6.96，百分位為45；由高至低分別：面對醫療糾紛、應付醫院評鑑工作、病患病情穩定度、升等或學術研究、薪資的給付制度、維持醫療院所的營運、個人考核的制度、與病人關係的維持。WPGB的影響因子依序為薪資滿意、醫療院所層級、年齡，共可解釋39.8%的變異量。QMWS的最佳影響因子為年齡，可解釋30.6%的變異量。研究結果能夠提供相關單位在人力資源管理時的參考，以提供藥師一個合理的工作環境。

關鍵字

藥師 ； 工作感受 ； 工作壓力 ； 健保總額預算

並列摘要

Since the National Health Insurance founded, the payment system have been changed several times, especially the global budget payment system (GB), to reduce the high rising expenditure. The hospital accreditation was important in maintaining the quality of medical care. Increase inflow, cut cost and enforce management were predominant means being used by hospitals in order to survive. Thus, the workload and job stress was increased among medical workers. There are many studies exploring the workload and job stress for nurses, physicians, therapists, and medical technologist, but not pharmacists. A questionnaire survey with a stratified random sampling among medical employees in Taoyuan was performed. Two questionnaires with acceptable reliability and validity, questionnaires of work perception about global budget for medical employees (WPGB) and questionnaire on medical worker's stress (QMWS) were used. This study examined pharmacists' WPGB, QMWS, and relationship between them. From July to December, 2006, 63 questionnaires were obtained. The total score of WPGB was 29.45 ± 4.0, with a percentile of 45. The ranking of WPGB from high to low were: salary, medical resources, manpower, treatment quality, paper work, workload, relationship with patients, working hours, and working procedure. The total score of QMWS was 30.27±6.96, with a percentile of 45. The ranking of QMWS from high to low were: managing medical disputes or lawsuits, preparing the hospital for accreditation, maintaining patients' disease conditions, seeking a job promotion or doing academic research, paying employees' salaries, running the hospital, having a good job performance, and maintaining a good relationship with patients. Factors associated with WPGB were salary satisfaction, hospital level, and age, explaining 39.8% variation of WPGB. Factor associated with QMWS was age, explaining 30.6% variation of QMWS. We expect our results can help hospital administrators to improve the good working environment for pharmacists.

並列關鍵字

pharmacists ； work perception ； job stress ； global budget payment