中醫師對中醫門診總額支付制度不滿意的癥結探討

中醫門診實施總額支付制度迄今已將近四年，雖然健保局認為中醫師對該制度的滿意度頗高，但是中醫界人士與學者的研究結果發現中醫師對該制度的的滿意度並不如健保局所言。本研究的目的是以台北區、中區、高屏區將近3000位中醫師為研究母群體，探討中醫師對於專業審查、專業自主、同儕制約及給付點數等構面的看法與滿意程度，並找出中醫師對於總額支付制度感到不滿意的可能癥結所在。本研究於92年7~8月以分區分層系統取樣方法選取400位中醫師為研究樣本，寄發結構式問卷，回收有效問春184份，回收率為46%。結果香現專業醫師審查作業與給付點數（值）的滿意度偏低（平約值分別為2.95與2.81)；中醫師感到最不滿意的項目為每日藥費、核減理由、總付點值。中醫師對專業審查醫師遴選方式感到不滿意與他們認為各縣市公會理監事有個人好惡具有顯著相關；中醫師對申覆結果感到不滿意與他們認為申覆不可能得到補付具有顯著相關；中醫師對專業醫師審查作業感到不滿意與他們認為專業審查醫師之間的審查尺度不一致具有顯著相關。本研究結果可以做為健保局與中醫師全聯會日後改進中醫門診總額支付制度的重要參考依據。

關鍵字

中醫門診；總額支付制度；滿意度

並列摘要

Since the global budgeting system (GBS) encompassed traditional Chinese medical services in the year of 2000, the Bureau of National Health Insurance (BNHI) repetitively proclaimed that Chinese medical doctors (CMDs) were satisfied with the system; however, leaders of traditional Chinese medicine and researchers' findings did not support BNHI's assertion. This study intended to investigate CMDs' perception and satisfaction levels of GBS (e.g., process of peer review auditing, autonomy, and reimbursement), and to explore the probable factors of dissatisfaction among CMDs of Taipei, Central, and Kao-Ping Precincts. This study revealed low satisfaction levels of reimbursement and process of peer review auditing among CMDs, and demonstrated individual items with the lowest satisfaction level (i.e., the reimbursement of prescription per day, the reason for deduction, as well as the actual dollar amount for each reimbursement point). In addition, this study identified three major factors (i.e., administrators' personal preference in the selection of peer review auditors, the vainness of filing for appeal, and the inconsistent standard among peer review auditors) as the probable sources of CMDs dissatisfaction. The National Union of Chinese Medical Doctors Associations and BNHI would be able to make use of the findings of this study as important references for developing improvement strategies accordingly.