管理決策支援系統對醫師處方行為影響之實證研究

在全民健保總額預算制度下，為了有效控制藥品費用，使得醫院達到成本效益之目標，而決策支援系統（DSS）即為其中主要管理工具。導入決策支援系統能夠達到醫院成本管控（CC）之目的，但相關研究亦指出醫師行為（PB）也是影響藥品費用的重要因素。因此，本研究是以實證調查方法和統計分析，探討決策支援系統是否能夠協助醫院進行費用控制改善，及影響相關醫師行為之模式。研究結果發現，決策支援系統確實能夠協助醫院進行藥品費用之改善，且醫師行為亦能影響藥品費用之改善程度。醫院導入系統後，醫師特性變數中學歷越高者或擔任主管職者，其開立藥品費用將較決策支援系統導入前為低。此外，由於醫院同時存在管理與醫療雙軌系統，而部分專業醫療人員可能同時身兼管理職務，因此醫師行為中對文化衝突與角色衝突之變數，亦將對藥品費用之產生顯著影響。

關鍵字

醫院管理；決策支援系統；醫師行為

並列摘要

The dramatically increasing pharmaceutical expenditures in healthcare organizations assumed to be one of the major expenditures, especially under the Global Budget Policy of National Health Insurance in Taiwan. In order to control costs in hospitals to achieve cost-effective management and control objectives, and decision support system is the one of the options, which can provide improved information gathering and analysis, management decision-making to improve decision making and effectiveness. According to several results of researches, all showed that not only the decision support system can make significant contribution to cost control, but also physician behavior. Therefore, this study is designed to investigate the decision support system in controlling medicine expenses, and further explore the physician behavior in influencing on pharmaceutical costs. The results showed that decision support system can statistically assist in controlling costs. In order to achieve the goal of cost control, physician characteristics may also affect the process. The more implementation of decision support system, with the more educated physicians or higher managerial positions of physician, the prescription costs will be much more. Moreover, it indicated that physician with professional and managerial positions at the same time will face more challenges with cultural and role conflicts, which might have implication on cost control.