影響基層醫療診所醫師轉診意願之因素

台灣自1995年3月開辦全民健保，民眾就醫的可近性更為多元與開放，而且大家也都認為大型醫院的醫療設備與技術都優於基層醫療診所，導致多數人習慣前往區域醫院或醫學中心就醫，但其過大的門診負荷量，使得病患得不到完善的醫療照護，且造成醫療資源浪費及健保財務的負擔。全民健保實施至今已27年，為了改善上述的負面影響，健保署持續致力於如何讓分級醫療更加完善，希望藉由制度政策的建立，以落實雙向轉診，而基層醫療診所的醫師扮演落實醫療轉診的關鍵角色。本研究目的為探討影響基層醫療診所醫師轉診意願之因素。以台中市基層醫療診所醫師為樣本對象，採橫斷式研究(Cross-Sectional Study)，並以線上問卷調查方式蒐集研究資料，回收有效問卷共116份，透過IBM SPSS 25.0統計軟體及Microsoft Excel 2016進行資料分析。本研究共歸納影響基層醫師轉診意願的因素，分別是病患、醫院、醫師、政策等四個因素，並分析上述變數對醫師轉診意願的影響。本研究結果發現：1.病患因素與醫師願意轉診有正向影響、2.醫院因素與醫師願意轉診沒有正向影響、3.醫師因素與醫師願意轉診沒有正向影響、4.政策因素與醫師願意轉診有正向影響。另一方面，在25個問答題項歸納整理得到，當醫師轉診病患就醫時，轉診意願最認同與最不認同的問項分別如下：1.我在轉診時會考量病患的病情(平均值=4.87)、2.轉診會造成病患流失，所以不願轉診(平均值=2.08)。最後，本研究建議衛生部門應加強病患及醫師對轉診的正向觀念，促進診所醫師加入健保資訊網服務系統(Virtual Private Network，簡稱VPN) 的電子轉診平台，以優化醫病雙方就醫行為、醫病決策共享，俾以提升醫病關係與醫療品質。

關鍵字

全民健保；可近性；分級醫療；轉診

並列摘要

Since the launch of Taiwan National Health Insurance (NHI) back in March 1995, the public's access to medical treatment has been more free and diverse. Most patients tend to seek medical treatment at regional hospitals or medical centers with a general belief that the large hospitals medical equipment and technology are superior to medical clinics, overloading large hospital outpatient clinics, preventing patients from required medical care, wasting medical resources, and burdening the health insurance financially. It has been 27 years since the launch of NHI and in order to improve the negative effects listed above, the National Health Service continues to improve the graded medical treatment by establishing comprehensive policies to implement two-way referral and the physicians in the medical clinics playing a key role in medical referrals. The purpose of this study is to investigate the affecting factors of physician’s referral willingness in primary care clinics. The study is based on solicited feedback from Taichung City medical clinics physicians. Analyzed a total of 116 valid surveys utilizing Cross-Sectional Study methods with IBM SPSS 25.0 statistical software and Microsoft Excel 2016. 　　The study assumes four independent variables：the patient, hospital, physician, policy, which are the key factors and analyzes their influence on physicians willingness to execute medical referrals. The result of this study found that：First, patients have a positive influence on physician’s willingness to refer；Second, hospital has no influence on physician’s willingness to refer； Third, physician has no influence on physician’s willingness to refer；Lastly, policy has positive influence on physician’s willingness to refer. On the other hand, in the summary of the 25 questions and answers, when the physicians refer patients for medical treatment, the most agreeable and least agreeable questions about referral willingness are as follows：Frist, I would consider patient's medical condition (average value=4.87)；Secondly, referral will cause the outflow of patients, so I’m reluctant to make referrals (average value = 2.08). 　　Lastly, this study suggests the public health department should emphasize and educate the advantages of two-way medical referral to both patients and physicians and encourage clinic physicians to join the electronic referral platform of the Virtual Private Network (VPN). The goal is to improve the doctor-patient relationship and quality of healthcare by optimizing the medical treatment and consent making process.