新制獎勵金制度實施後對衛生署所屬醫院經營績效與醫療服務品質的影響

The Effect of the New Financial Incentive Program of the Department of Health on Its Hospital Operation Performance and Quality of Medical Care

陳碧玉(Pi-Yu Chen)

指導教授 ： 鍾彩焱

元智大學/管理學院/管理研究所/碩士(2004年)

摘要

政府每年用在健保醫療上的支出超過3仟億，醫師在這些龐大資源的分配上扮演了非常重要的角色，又由於薪資是醫院非常重大的成本因素，因此各醫院莫不希望藉由合理的醫師費制度給付醫師報酬，激勵醫師提高醫療服務品質與醫療專業工作績效，達到醫院與醫師的目標。衛生署於民國89年7月實施提高服務績效比例並實施按健保給付的抽成原則為主的新制獎勵金制度，復於91年2月取消基本獎勵金，獎勵金完全按照績效評核原則支給，希望能藉此改善衛生署所屬醫院的經營績效，並留住優秀的醫師以提高醫院的醫療服務品質。
本研究是以衛生署所屬11家區域醫院及9家地區醫院為對象，蒐集論量計酬新制醫師績效獎勵金制度實施前後以及取消基本獎勵金前後四年期間之門診人次、住院人日、醫療收入及醫師生產力等四項績效指標，以及平均住院日、剖腹產率、死亡率及感染率等四項品質指標各960個觀察值，分析其實施新制獎勵金制度後以及取消基本獎勵金前後對醫院經營績效及醫療品質之影響
本研究主要結果如下:
1.服務績效論量計酬的新制獎勵金制度實施後以及取消基本獎勵金之後，區域醫院及地區醫院的各項經營績效有持續成長；新制實施後除區域醫院及地區醫院的門診人次以及基本獎勵金取消後區域醫院的門診人次及醫療收入的增加未達統計上顯著意義外，其餘不同獎勵制度下的門診人次、住院人日、醫療收入及醫師生產力皆達統計上顯著意義。顯示醫師的醫療行為明顯的受到財務誘因的影響。
2. 服務績效論量計酬的新制獎勵金制度實施後以及取消基本獎勵金之後，區域醫院的感染率及地區醫院的平均住院日呈負顯著相關，死亡率及剖腹產率的變動亦沒有因為實施新的獎勵制度而產生正面的影響。

關鍵字

獎勵金制度 ； 經營績效 ； 醫療品質 ； 財務誘因 ； 目標收入

並列摘要

The annual health care and medical expenditure of National Health Insurance (NHI) exceeds three hundred billions NTD in Taiwan. Because a significant portion of annual expenditures goes to physicians, hospitals strive to improve operating performance and quality of medical care through compensation and incentive programs. In July 2000, The Department of Health implemented the new program of fixed bonus based on seniority plus fee-for-service to replace the old system where only fixed bonus based on seniority and bonus on subjective performance evaluation. In February 2002, the Department of Health further modified the incentive program by canceling the fixed bonus. Through the total fee-for-service incentive program, hospitals hope to attract and keep outstanding physicians to improve the operating performance and the quality of medical care.
This research aims at analyzing the effects of the implementation of the fee-for-service financial incentive program on operation performance and medical care quality. By selecting 11 district hospitals and 9 community hospitals under the Department of Health, the research conducts the evaluations on:
1.Four performance indicators: the numbers of outpatients, the patient-days of admissions, the medical income and the productivity of physicians.
2.Four quality indicators: average length of stay, cesarean rate, mortality rate and infection rate.
The main results of this research include:
1.The performance indicators have continued to improve after canceling the fixed bonus and implementing the new financial incentive program. Except for the numbers of outpatients in the community hospitals and district hospitals, the numbers of outpatients in the district hospitals after canceling the fixed bonus, and the medical income. All other improvements are statistically significant. Thus, the medical behavior of physician is obviously affected by the financial incentives.
2.After canceling of the basic incentive fee and implementing the new financial incentive program, there appears to have significant negative correlations on the infection rate in the district hospitals and the average length of stay in the community hospitals. Furthermore, the cesarean rate and the mortality rate are not positively affected by the new financial incentive programs.

並列關鍵字

Compensation and Incentive Program ； Operation Performance ； Quality of Medical Care ； Financial Incentive ； Target Income

參考文獻

25.陳佩妮、鄭守夏、鍾國彪、林王美園(1997)，「台灣地區醫療品質指標適用性之探討」，中華雜誌，第16卷第2期，133-141。

27.郭信智、楊志良(1994)，「醫師目標收入理論之試證」，中華衛誌，13(2) ，149-154。

41.韓揆(1994)，「醫療品質管理及門診服務品質定性指標」，中華衛誌，

40.薛亞聖等人，「台灣醫院醫師薪資制度調查」，台灣醫界，第6卷第2期，49-59。

1. Adams, JS. (1965), Inequity in social exchange, In L. Berkowite(ed.), Advances inexperimental social psychology, 2. New Joir, Academic Press,