全民健保家庭醫師整合性照護制度試辦計畫之評估－以花蓮某社區醫療群為例

Assessing the Outcome of NHI's Family Physician Demonstration Project-A Study of a Community Health Network in Hua-lien City

宋松遠(Sung-Yuan Sung) ； 張慧如(Hui-Ru Chang) ； 陳銘樹(Ming-Shu Chen) ； 錢慶文(Ching-Wen Chien)

《醫務管理期刊》 8卷1期 (2007/03) Pp. 51-66

https://doi.org/10.6174/JHM2007.8(1).51

摘要

全民健保自開辦以來，醫療費用節節上升，已達入不敷出的窘境。醫療支出的成長主要是來自門診醫療費用的增加，和民眾就醫無節制所導致。有鑑於此，健保局特於2004年起開辦「家庭醫師整合性照護制度試辦計畫」，並於次年開始正式擴大實施。希望能藉由家醫計畫導正許多過去因缺乏家庭醫師制度所衍生的問題。本研究主要的目的是以實例評估家醫計畫實施的成效，並提出適當之管理上的建議。
方法：本研究以立意取樣的方式，選擇花蓮市某社區醫療群所組成之家庭醫師計畫做為本研究之個案。該家醫計畫在研究期間內（2004和2005年）並未以任何方式提供誘因改變民眾就醫習慣，亦沒有任何參與醫師人數的改變。本研究收集該家醫計畫內各醫院診所兩年（2004和2005年）之門、住診健保醫療費用申報資料，經整理後透過paired檢定和t檢定，探討實施前後的改變。
結果：本研究的主要發現有兩個：第一、加入家醫計畫會員大多是小家庭，且其平時就對其主要就醫院所具有高度的忠誠度。第二、參與家醫計畫的會員在加入後所使用的總門診申請金額和就醫次數約較加入前增加，且比非會員增加的多。
結論：本研究的樣本所組成的家醫計畫基本上應該不能算成效顯著，因為大部分的會員無論有無家醫計畫都還是會去參與家醫計畫的院所看診。因此未來健保局應該思考家醫計畫的現行做法是否還應該再增加其他的措施或有大力改善的作法，也同時要思考如何將家醫計畫評估的指標加以改良，才能使家醫計畫更能達到當初設立的目的。

關鍵字

家庭醫師 ； 試辦計畫 ； 社區醫療

並列摘要

Objectives: Since the implementation of the NHI in 1995, total expenditure of the NHI has increased tremendously due to a rapid growth of outpatient utilization. Therefore, the NHI Bureau began an experimental Family Physician Demonstration Project (FPDP) in 2004 and formally expanded this experiment in 2005. The main purpose of this experiment is to solve several problems caused by a lack of family physician system in Taiwan. This study aims at assessing the effectiveness of this experiment.
Methods: A FPDP locating in Hua-lien city was selected purposely as the subject of this study because all participating hospital and clinics had not intervened this study by providing any financial/non-financial incentive for its members for two years. Utilization data of all participants between 2004-2005 were collected and analyzed by using t tests and paired t tests.
Results: There are two important findings: 1. most participating members of this FPDP were from small families who already had high patient loyalty toward clinics of this FPDP. 2. Members used more NHI resources before and after joining FPDP; besides, they used more NHI resources than non-members in outpatient and preventive services.
Conclusions: This study concludes that the experimental FPDP should not be regarded as effective since many members of the experiment would visit this FPDP regardless of the experiment. The NHI Bureau should adjust their pace to expand this experiment and carefully re-select their assessment indicators.

並列關鍵字

Family physicians ； Experiment ； Community heath

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