台灣實施一般醫療制度之特殊考量

一般醫療醫學(Primary care medicine)的基本宗旨在於(1)提供給病人一個方便而且連貫性的看診制度；(2)杜絕不必要的細專科看診；以及(3)降低醫療成本。有鑑於台灣在過去20年來細專科醫師的急遽增加與基層醫療醫師的相對減少，此時此刻正是探討實施一般醫療的時候。但是，當我們欲仿效美國目前正在進展的一般醫療制度時，我們必須同時考慮存在于本國的一些特殊因素，這些因素包括(1)文化差異，(2)健保制度，(3)大眾環境，(4)醫師及醫院的收入，(5)病人與醫師對一般醫療的認同，(6)實施一般醫療所需的人力與資源等。爲了能有效地推動一般醫療醫學，個人認爲以下幾點方向值得考慮：(1)先建立對一般醫療醫學的共識與其重要性的認同，(2)修改健保政策，要求每位病人都需先到一般醫療醫師(primary care physician)看診（急診除外），(3)提升一般醫療醫師的收入與升遷機會，(4)鼓勵開設基層一般醫療門診，同時裁減設立大型醫院，(5)刪減細專科住院醫師的訓練名額，(6)增進門診作業及開業醫的看診，(7)加强一般內科，一般小兒科與家庭醫學科的住院醫師訓練，(8)強化一般醫療知識與技能的教學與訓練，(9)成立一個獨立自主性的特別工作小組（或諮議小組）來監督與評估一般醫療制度的實施，(10)廣泛地向民衆與病人傳授一般醫療應有的常識。總之，在台灣實施一般醫療制度是需要長時期，有耐性，多方面的整體性醫療制度的革新與醫學教育的改革，它必須由教育、行政、立法三方面同時進行，才能達到永久的成功。

關鍵字

一般醫療醫學；一般醫療醫師；管理式醫療制度；健保政策

並列摘要

The fundamental goals of the primary care medicine are to provide convenient ambulatory(or office-based)health care service to the patients, to serve as a gatekeeper for the subspecialty field so as to curtail the loading to the sub-specialists, and to reduce the cost by avoiding unnecessary medical tests and treatment. In Taiwan, there has been sharp escalation in the number of physicians practicing in the sub-specialty fields and there has been horrendous diminution in the primary care physicians in the past decade. By raising the concerns and with the attempt at reversing the situation, it would be timely and appropriate to seriously consider the application of primary care medicine in Taiwan. However, to adopt the systems of primary care medicine currently exerted in the foreign countries, some special considerations would need to be kept in mind. The factors for consideration include 1)the traditional culture difference, 2)the national health insurance policy, 3)the existing environment, 4)the incomes of the physicians and the hospitals, 5)the recognition and identity of the primary care medicine by the patients and physicians, 6)the attitude and cooperation of the administrative officers, and 7)the availability of the experienced personnel in primary care medicine. With the understanding of the above factors, it is conceivable that several task forces need to be achieved so that the primary care medicine program can be successfully implemented in Taiwan. Some of these task forces could be painstaking and time consuming. The task forces that may be considered important and feasible include the followings: 1)to first establish identity and recognition of the need and importance of the primary care medicine program; 2) to demand an insurance policy that would require a primary care physician as a gatekeeper for every patient; 3)to subsidize the income and promotion for physicians devoted to primary care; 4)to build more office-based professional buildings rather than building bigger hospitals; 5)to curtail the sub-specialty training in each specialty field; 6)to encourage more out-patient care; 7)to strengthen the residency training in General Internal Medicine, General Pediatrics, and Family Medicine to produce more experienced personnel (physicians, nurses, etc.); 8)to emphasize teaching in primary care medicine in medical school and the allied health professional schools; 9)to appoint an independent committee (or a council) to oversee the primary care program; and 10) to wide-scale educate the patients and general population. In summary, after years of overemphasis and overproduction of sub-specialty training in Taiwan, it is time to rectify the foreseeable tragedy and to seriously and carefully implement the primary care medicine program that must be tailored to the conditions and needs in Taiwan under some special considerations. To this end, a stepwise and integrated reform of the medical education, residency training and the health insurance policy will become essential to ensu re a long-term success in the primary care medicine program in Taiwan.

並列關鍵字

primary care medicine ； primary care physician ； managed care health plan ； health insurance policy

國際替代計量

台灣實施一般醫療制度之特殊考量

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