基層醫師對實施健保IC卡制度之看法及使用情形之研究

Primary Physicians' Attitudes and Use in IC Card System

陳家榆(Chia-Yu Chen) ； 許佑任(Yu-Jen Hsu) ； 林恆慶(Herng-Ching Lin) ； 陳楚杰(Chu-Chieh Chen)

《台灣家庭醫學雜誌》 15卷2期 (2005/06) Pp. 63-76

https://doi.org/10.7023/TJFM.200506.0063

摘要

本研究旨在探討基層開業醫師對健保IC卡的看法與使用情形。本研究採問春調查法，以郵寄結構式問卷的方式蒐集所需的資料，以2002年在衛生署醫政處登記執業的10,223位基層開業醫師為母群體，再以等距抽樣抽取全國十分之一的基層開業醫師共l,022位做為本研究之研究對象，回收167份，因退休、移民、歇業及地址遷移等因素被退回問卷27份，回收率為16.8%，回收後進行樣本與母群體基本特性的適合度檢定(goodness-of-fit test)，在年齡(p=0.220)及性別(p=0.157)上並無顯著差異。先以t檢定及卡方檢定進行雙變項分析，再依據分析結果進行邏輯斯迴歸(logistic regression)模式之建立，並藉由迴歸分析結果來探討基層醫師對健保IC卡的看法。
研究結果發現有29.9%的受訪醫師“滿意”及“很滿意”健保IC卡的硬體設備，有28.1%“滿意”及“很滿意”健保IC卡的操作流程，有30.5%整體上“滿意”及“很滿意”健保IC卡。在邏輯斯迴歸分析中，在控制其他變項後，發現那些同意健保IC卡對民眾是便利的（勝算比＝2.714，95%信賴區間為1.258-5.852）及同意健保IC卡可使健保局降低虛浮報及有效控制醫療成本者（勝算比＝1.924，95%信賴區間為1.047~3.538），整體上較滿意健保IC卡。
研究發現大多數受訪醫師使用健保IC卡所遭遇到的問題中，依發生的頻繁程度排名前三名依序為：(l) IC卡讀寫異常；(2) 讀卡機故障；(3) 電腦當機；本研究也同時發現，基層醫師高達74.8%在IC卡硬體設備出現異常狀況時，“不清楚”或“很不清楚”或“普通”瞭解異常排除的方法。依據研究結果，建議衛生主管機關 (1) 適度補助健保IC卡維護成本；(2) 加強健保IC卡資訊系統與改善其硬體設備；(3) 建立健保IC卡異常管理系統。

並列摘要

The purpose of this study was to explore primary physician's attitudes and uses toward the implementation of IC card. This study used survey research. A structured questionnaire was mailed out to collect data. The study population was 10,223 primary physicians registered with the Department of Health. A systematic sampling was used to select 1,022 primary physicians as our study subjects. The number of returned questionnaires was 167. Because of retirement, immigration the change of address, and some other reasons, 27 in 167 questionnaires without responses were returned. The response rate was 16.8%. The tests of goodness-of-fitness show that there was no significant difference between the respondents and study sample in terms of age (p=0.220) and gender (p=0.l57). The student t and Chi-square tests were used to explore the unadjusted relationships. A logistic regression was also conducted to explore physician's attitudes toward the implementation of IC card.
The results show that 29.9% of respondents were ”very satisfied” and ”satisfied” with the IC card equipments, 28.1% ”very satisfied” and ”satisfied” with the operation of the IC card, and 30.5% ”very satisfied” and ”satisfied” with the IC card, in general. With controlling other factors, the logistic regression found that those who agree that the IC card is convenient (OR=2.714, 95% CI =l.258~5.852) and that the IC card can reduce medical costs (OR=1.924, 95% CI=1.047~3.538) were more satisfied with the IC card.
The difficulties the majority of respondents found in the use of IC cards were: (1) abnormal reading; (2) machine breakdown; and (3) computer system failure. This study also found that 74.8% of respondents ”very unclear”, ”unclear”, or ”so so” understand the ways to remove the difficulties. It is suggested that the health authority could (1) support the maintenance costs for clinics; (2) strengthen and improve the IC card system; and (3) establish a system to deal with the difficulties of the IC card system.

並列關鍵字

IC card ； primary physicians ； logistic regression

參考文獻

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