- 期刊
中醫實施全民健康保險家庭醫師整合性照镬制度之可行性研究－以高屏地區爲例
Feasibility Study on the Implementation of National Health Insurance Family Physician Integrated Care System to Traditional Chinese Medical Services in Kaohsiung and Pingtung Areas
摘要
目的：推動家庭醫師制度及建構社區醫療體系爲後SARS時期國家基層醫療體系改造的重要目標。中央健保局也積極推動家庭醫師整合性照護制度，以健康管理及論人計酬制度，提供全人健康照護，使預防保健和社區醫療得以落實。本研究旨在(1)探討中醫師對家庭醫師制度相關政策的瞭解程度。(2)探討中醫師對中醫之基層醫療功能、符合家庭醫師型態、實施健保家庭醫師整合性照護制度之認同程度。方法：本研究以高屏地區與中央健康保險局有特約關係的執業中醫師（538位）爲研究母群體，採用分區分層系統取樣法選出中醫師200位爲研究樣本，進行橫斷郵寄問卷調查，所提資料利用JMP統計軟體進行資料統計分析。結果：研究結果發現中醫師對於家庭中醫師整合性照護制度認同程度較高61.6%（平均分數3.69），認知程度較低26.5%（平均分數2.87），實施認同度63.0%（平均分數3.70），參與意願54.8%（平均分數3.63），總額支付制度瞭解程度56.8%（平均分數3.55），其中以40歲以下年齡層、執業10年以下、學士後中醫學系、在都會區執業之中醫師在照護制度之認知與同程度較高，呈現統計上的顯著差異。根據本研究在中醫之基層醫療功能、符合家庭醫師型能和實施健保家庭醫師整合性照護制度三項，分別得到73.3%，62.6%，63.0%中醫師之認同，因此，推論中醫實施健保家庭醫師整合性照護制度具可行性。但家庭醫師制度相關政策的認知程度較低。結論：建議主管單位在健保政策形成的過程中必須規劃完善的配套措施及舉辦宣導說明會，讓醫事人員充分瞭解健保政策之實施內容及目的，以促成整合性照護制度提供民衆中醫養生預防保健、中西醫結合門診住院之全人醫療照護模式，達成中醫基層醫療社區化的目標。
並列摘要
Objective: Implementing family physician system and community health care system are the top priorities of national primary health care reform in the post SARS era. In order to enhance preventive and community care, BNHI is promoting family physician integrated care system, which focus on health management, capitation, and holistic health care. This study investigated Chinese medical doctors' comprehension of family physician system and its related policies, as well as the concurrence of their function in primary care, role as family physicians, and BNHI family physician integrated system. Method: The study population was 538 BNHI-contracted Chinese medical doctors in Kaohsiung and Pingtung areas. Of which, 200 CMDs were selected as study samples, using a stratified systematic sampling technique. A self-administered questionnaire was mailed to each subject, and followed-up by telephone calls. JMP statistical software was utilized for data analyses. Results: This study found a high concurrence level and a low comprehension level of CMD in-charged family physician integrated care system. Over fifty percent of the respondents supported and willing to participate in such system. In addition, young and junior CMDs with bachelor degree in Chinese medicine, and practice in metropolitan area tended to have higher comprehension and concurrence levels of family physician integrated system than their counterparts. Conclusions: We concluded that the implementation of CMD family physician integrated care system is feasible. However, CMDs' comprehension level of family physician integrated care system was low. In order to communicate with practitioners effectively, DOH and NHI authorities should plan a series of well-organized strategies during policy-making phase, and make them aware of the contents and aims of NHI policies in various occasions, such as professional conference, regional CMD associations meetings, etc.