Introduction to Physician Profiling

從1990年代開始，醫師檔案以品質報告卡的型態出現在美國衛生照護產業中，一般相信醫師檔案為持續品質改善、控制成本、審查使用率及評估醫生表現的可靠工具。本文的主要目的即是以美國經驗來介紹使用醫師檔案的理由、目前使用醫師檔案的情形、醫師檔案所提供的資訊、醫師檔案的成效及使用醫師檔案所遇到的障礙。醫師檔案可賦予消費者選擇最適當醫師的能力、教育醫師瞭解自己的執業型態及幫助保險公司有效的控制成本，醫師檔案已廣為美國聯合執業、保險公司及州和聯邦政府用來督導及審查個別醫師的執業行為。又醫師檔案所提供的資訊可分為醫師背景資料和醫師表現資料。雖然許多美國研究已證實醫師檔案可改善醫療照護品質及降低總醫療費用，但在使用醫師檔案的過程中仍然遇到了一些障礙，例如發展醫師檔案所需的高成本即是其中之一。醫師檔案乃將醫師表現資訊公佈給大眾，其在衛生輸送體系中有明顯的監督效果，建議台灣的衛生照護產業可投資發展醫師檔案，而可藉由提供高品質的醫師表現資訊給大眾，以達到確保醫療品質的目的。

關鍵字

醫師檔案；醫療品質；品質報告卡

並列摘要

The physician profiling has emerged as a kind of report card in the US healthcare industry since the 1990s. It is believed that physician profiling can be regarded as a reliable analytical mean for continuous quality improvement, cost containment, utilization review, and assessment of physician performance. This article examines the reasons for using physician profiling, current uses of physician profiling, information provided by physician profiles, achievements of physician profiling, and barriers to implement physician profiling based on the different US experience. Physician profiling enables consumers to select the most appropriate physician, educate physicians to review their practice styles, and health plans to achieve cost containment. The use of physician profiling to monitor or review individual physician practice behaviors has been widely employed by group practices, health plans, and state and federal governments in the US. The information on physician profiling can be categorized into two kinds, i.e. physician background information and performance information. However, although many US studies have demonstrated that physician profiling improves the quality of medical care and reduces total health expenditures, some barriers still exist. The high costs related to the development of physician profiling is a good example. The physician profiling movement has apparently created a sentinel effect on health delivery for physicians based on the public performance information. The healthcare industry in Taiwan should focus on the physician profiling system to provide high-quality information of physician performance to the public for assuring the quality of medical care.

並列關鍵字

Physician profiling ； healthcare quality ； report cards

參考文獻

Adams, T. L.(1998).Physicians and administrators may be ready to embrace profiling.Healthcare Financial Management.52(6),94.

Google Scholar

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