醫院醫療資源耗用管理及醫師醫療自主性對主治醫師工作生涯滿意度相關性之探討

The Study on the Association between Utilization Management in Hospital, Medical Autonomy, and Job-Career Satisfaction among Attending Staff

陳宏恩(Hung-En Chen)

指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.03136

摘要

研究目的：探討目前醫療院所的醫療資源耗用管理及醫師醫療自主性與醫院主治醫師工作生涯滿意度的相關性。
研究材料與方法：本研究為次級資料分析，資料來源為台大醫管所陳端容副教授於民國93年底至94年初，針對任職於50所地區教學醫院以上之醫師所進行之醫療管理結構式問卷調查，選取其中的主治醫師共674人。問卷結果以SPSS 12.0軟體進行描述性統計以及雙變項、多變項廻歸統計分析。
研究結果：問卷整體回收率為17.05%。填答的醫師中男性佔84.7%，年齡集中在30到49歲，具管理學位者佔9.4%。醫師對工作及生涯感到滿意及非常滿意者大約佔三成，其中僅極少數醫師感到非常滿意(1.6%)。多變項廻歸精簡模式的結果中，50歲以上的醫師比年輕醫師有較高的工作生涯滿意度。醫師專業地位愈高工作生涯滿意度也愈高，統計上呈現有意義的正相關(β=0.141, p<0.01)。在醫療資源耗用管理方面，處方金額及掛號人次的非强制性管理與工作生涯滿意度成負相關(β=-0.133及β=-0.121, p<0.5)。此外，在臨床自主性方面，驗證了醫療自主性是醫師工作生涯滿意度最重要的正向因子(β=0.163, p<0.001)。
結論與建議：本研究顯示現階段台灣醫師有較低的工作生涯滿意度，且受到醫療資源耗用管理及醫療自主性的影響，全民健康保險局在實施變革前，應考慮週詳，妥善規劃，以保障國民健康，創造醫師與病人雙贏的局面。醫院對於各種醫療資源耗用管理項目的管控，應考慮選擇適合的方式，此外在追求管理措施成效的同時，也要避免過度影響受到醫師相當重視的醫療自主性，影響醫療成效。

關鍵字

工作生涯滿意度 ； 醫療自主性 ； 耗用管理

並列摘要

Objectives: To Study the Association between Utilization Management in Hospital, Medical Autonomy, and Job-Career Satisfaction among Attending Staff
Material and Methods: The study is a secondary data analysis from the survey of Prof. Duan-Rung Chen on medical managements. The survey was conducted between late 2004 and early 2005 with structured questionnaires. A total of 674 attending staffs practiced in 50 hospitals acrreditated as district teaching hospitals or higher was included for analysis. SPSS 12.0 was used for descriptive statistics as well as bivariate analysis and multivariate logistic regression.
Results: The overall questionnaire response rate was 17.05%. Most respondents were male physicians aged between 30 to 49 years old (84.7%). Few respondents had bachelor of management (9.4%). About 30% of attending staffs felt satisfaction for current practice work and medical career. Among them, only 1.6% of physicians reported very satisfied. Older physician (over 50 years old) were more satisfied in job and career than their younger colleagues. Positive statistically significant correlation was also noted between physicians’ status of professionalism and job-career satisfaction (β=0.141, p<0.01). Multivariate logistic regression revealed that the non-compulsive utilization management of prescription cost and patient number per outpatient clinic were related negatively to job-career satisfaction. The results were statistically significant (β=-0.133 and -0.121 respectively, p<0.5). Besides, medical autonomy was proved to be one of the most important positive predictors for job-career satisfaction (β=0.163, p<0.001).
Conclusions: Low job-career satisfaction of attending staffs was noted in Taiwan. Two factors including utilization management and medical autonomy posed such results. Detailed considerations and planning should be made by Bureau of National Health Insurance before policy revision. In front of financial crisis, hospital managers needed more wisdom to perform adequate utilization management.

並列關鍵字

Job-career satisfaction ； medical autonomy ； utilization management

參考文獻

49. 莊逸洲, 黃崇哲, 鄭明智. (2003). 台灣醫院總額支付制度運作模式的初步探討. 醫務管理. 4(3), 1-17.

50. 陳端容, 鍾國彪, 吳麗竹, 曾靜瑤, 張金堅. (2006). 同儕資訊回饋與內科醫師開立TG檢驗次數之關係的探索性研究. 25(1)26-36.

1. Baker, L.C., and Cantor, J. C. (1993). Physician satisfaction under managed care. Health Affairs, 12, Supplement1, 258-270.

2. Buciuniene, I., Blazeviciene, A., and Bliudziute, E. (2005). Health care reform and job satisfaction of primary health care physicians in Lithuania. BMC Family Practice, 6(10), 1-6.

3. Burdi, M. D., and Baker, L. C. (1999). Physicians’ perceptions of autonomy and satisfaction in california. Health Affairs, 18, 134-145.