- 期刊
醫師主管對醫院總額管理實務態度之探索性研究
The Study of the Attitude toward Medicine Practice by physician-managers Performed Hospital global-budget System in Taiwan
摘要
目的：應用醫學的自主性與管理的控制間「制度距離」以及「權力」觀點，探討醫師主管對醫院總額管理實務接受性之影響。 方法：採立意取樣法，於二○○五年十月至十二月調查參加醫院總額管理卓越計畫十八家醫院，含括公私立和各評鑑層級醫院，針對醫療部門主管以自陳式問卷蒐集量化資料，回收有效問卷262份，進行因素分析、變異數分析、迴歸及結構方程模式。 結果：醫師主管對醫院總額管理實務態度經因素分析產生四因子，並命名為財務誘因（3.13分）、自主性（3.93分）、成本與品質（3.19分）、夥伴關係（3.96分），均達三分以上，顯示無敵對態度。就工作系絡分析，和立醫院受試者對財務誘因接受性顯著高於公立醫院，外科系統受試者對自主性的接受水準顯著高於內科系統。就權力來源分析，年齡（或臨床年資）愈高、受僱於區域層級以上醫院，醫師主管感知的專業威權較大，有研習醫管課程（或具管理學位）者感知行政職權和專業威權皆較高。兩種權力皆對醫院總額管理實務接受水準具正向效果，此外，專業威權之影響力大於行政職權。 結論：台灣實施醫院總額支付制度後，醫師主管斡旋在醫學與管理次文化中，對於衝擊專業自主性、成本與品質和財務誘因的管理實務並無負面態度，可視為心理上接受醫院總額管理實務的證據。惟醫院權屬別（公和立）、專業導向（執業科別）在接受水準上略有差異。依權力觀點，當醫師主管感知被賦予行政職權愈多，或專業威權愈大，皆對醫院總額管理實務有較正向態度。後者與預期不一致，可能因台灣醫學教育文化不同，有待進一步研究。
並列摘要
Objectives: Applying institutional distance and power view to evaluate the attitudes toward medicine practices by physician-managers after Hospital Global Budget System (HGBS). Methods: We used data from 18 Taiwan hospitals participated in managed-care plans. Information was collected by self-administered questionnaires using the Likert 5 point scale during October to December in 2005. The valid sample consisted of 262 physician-managers. All data was analyzed by factor analysis, ANOVA, regression and structural equation model to validate our conceptual model. Results: We created four dimensions of attitudinal assessment toward HGBS practices comprised of 21 items and labeled as ”cost and quality” (3.19), ”autonomy” (3.93), ”incentive tool” (3.13), ”partnership” (3.96). Our findings indicate that there is no significant difference on acceptance of the HGBS practice by physician-managers among various types of hospital. However, the acceptance of incentive tool receives more positive responses by subjects from private hospitals than those at publics. The perception of autonomy by subjects at surgery system is higher than that in internal medicine. The analysis on power source, our data shows that physician-managers perceived more professional power among older or seniority group, and affiliated larger hospitals. Both authority and professional power of physician-managers affect positively the acceptance of HGBS practice. Conclusions: The data shows the institutional environment forces physician-managers don't harbor hostile attitude and hence adapted to accept institutional change. Contrary to expectations, professional power seems don't mitigate the acceptance in HGBS practices. It perhaps the effect of Taiwan medical education culture, remains to study further.