牙醫門診總額支付制度專科轉診加成作業 之現況分析研究

Research of the Current Dental Global Budget Payment System of a Special Courser Referral Markup Task

吳淑女(She-Nu Wu)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2004年)

摘要

背景：全民健保實施後人人享有就醫的權力與義務，而轉診制度的推動正是健保重要政策之一，自八十八年一月起實施牙醫門診總額支付制度專科轉診加成作業，其目的在於1.提升牙醫門診醫療品質2.提高轉診病例報酬趨向合理3.增加雙向轉診之可能性。
研究目的：本研究在探討專科轉診制度實施後牙醫醫療資源利用、處置科別的分布、轉診率、及再回診率，並配合牙醫師對制度的滿意度調查進行統計分析。
研究方法：依據健保資料庫（資料庫擷取時間自1999年1月至2003年12月止）及問卷調查法（以健保局南區分局轄區內的牙醫師為問卷對象）分析牙醫師們對現行牙醫轉診加成支付制度之滿意度、看法及意見，其中有效問卷250份，回收率38﹪，本研究結合資料庫與問卷內容加以分析探討，期望將資訊回饋給醫療決策單位參考作為修正方向。
研究結果：一、健保資料庫：（一）牙醫專科轉診率：以南區分局最高；5年平均占0.0856%、其次為北區分局：0.0206%。（二）層級別之轉診率：以醫學中心最高為：0.4728%、其次為區域醫院：0.2916%、地區醫院（含地教）醫院：0.0214 %、 基層診所：0.0004%，顯然基層診所轉診率最低。 （三）縣市別之轉診率：以台南縣、嘉義市佔最高分別為0.1804﹪、0.1582〈屬南區分局〉其次為新竹市佔0.525﹪(屬北區分局)，而科別以：口腔顎面外科占５４.５１﹪最高、（其中以複雜齒切除術最高占該科之60.98﹪）、其次為牙周病科占２４.８４﹪、（其中以齒銀下刮除術-1/2顎占該科之66.35﹪）、牙髓病科占１３.２７﹪（其中以根管治療三根占該科之47.51﹪）。二、問卷結果顯示：臨床牙醫師較常接受處置之專科轉診項目：以口腔顎面外科最高佔２４.２﹪、其次為兒童牙科佔２１.２﹪、牙髓病科佔１８.２﹪、牙周病科佔１６.７﹪，非屬專科轉診範圍之身心障礙者牙科也佔了１２.１﹪。因此；結合資料庫與問卷結果顯示：最常接受轉診之科別均為口腔顏面外科，而專科轉診(治療後一年內)再回診率：以牙體復形最高佔9.54﹪、根管治療1.52﹪。
結論：總體而言；其研究假設推論，臨床牙醫師們對現行專科轉診支付制度之滿意度達七成，由轉診率來看逐年增加中，顯示不同年度其轉診率有顯著性差異，對於制度的推行其成效顯著，惟基層單位之轉診率有待提昇將更有利於民眾之可近性，又一年再回診率以牙體復形最高，未來是否應就需求面修正或調整內容做為醫療提供者及相關單位參考。

關鍵字：專科轉診加成、轉診率、滿意度

關鍵字

轉診率 ； 專科轉診加成 ； 滿意度

並列摘要

Background：Every citizen has the right to receive public
medical care after the implementation of the National Health Insurance in which the promotion of referral system is one of the most crucial policies. The Dental Outpatient Total Payment System was implemented from Jan, 1999. The major goals of such a system are: (1) to improve the medial quality of dental clinic. (2) to rationalize the quantity of the rewards from the referrals (3) to increase the possibility of mutual referrals.
Objectives: This study discuss the situation of the utilization of dental medical resources, distribution of different dental departments, referral rate, as well as the returning rate of the patients after the implementation of the referral system, and conduct a statistical analysis to reveal the dentists’ degree of satisfactory to this system.
Methods: The health insurance information from a data bank (information gathered from Jan .1999 to Dec. 2003) was analyzed, and a survey (the informants were the dentists from the southern branch of the National Health Bureau) was conducted to study dentists’ degree of satisfactory and their opinions toward the report dental referral markup payment system. 250 effective questionnaires were collected. The overall returning rate was 38%. It is expected that the findings of this study can be used as a reference for dental policy makers and future research.
Results：(A) National Health Data Bank: (1) Dental referral rate: the highest rate was in the southern branch (0.0856%), and the second was in the northern branch (0.0206% ). (2) Referral rate of different levels of dental institutions: academic medical centers was the highest: 0.4278 % ; regional hospitals were the second: 0.2916 %; district hospitals came next：0.0214 %; clinics were the final one:0.0004%. Obviously, the clinical referral rate was the lowest. (3)The referral rate of city and county: The highest rate was Tainan County’s and
Chiayi city (southern branch) 0.1804﹪、0.1582, which was followed by Hsinchu citys (Northern branch) 0.0525%. Then, departments which accepted referrals were investigated. The referral rate of oral maxillofacial surgery was 54.51﹪(within which complicated tooth odontectomy was the highest，ccupied 60.98% of the total rate of the department of oral maxillofacial surgery). The following one was periodontics: 24.84% 【within which subgingival curettage(1/2 jaw) occupied 66.35%】 of the total rate of the department of periodontics.Endodontic treatment occupied 13.27%(within which three roots endodontic treatment occupied 47.51﹪)of the total rate of the department of endodontics). (B) The results of the survey by questionnaire indicated that the referrals which clinical dentists accepted the most were: (i) the department of the oral maxillofacial surgery which was also the highest (24.2%). (ii) Pedodontics (21.2%) (iii) endodonics (18.2%) (iv) periodontics (16.7% ). The referral rate of dentistry for disabled conjugate was 12.1%. the information of the data bank and the survey by questionnaire showed that the most frequently accepted referral department was oral maxillofacial surgery which was followed by periodontics, endodontics, pedodontics, dentistry for disabled, and operative dentistry.
Conclusion： Based on the hypothesis of this study, the overall degree of satisfactory of the clinical dentists to the dental referral markup payment system was about 70%. The anniversary referral rate shows significantly increased differences. It is found that the referral rate increased especially in the year 2000 and 2001 when we studied the anniversary referral rate. The referral rate of 2002 and 2003 also grew up. This indicates that the payment system of a special courser for dental referral markup task is efficient currently and should be promoted it continually by increasing motivation.

並列關鍵字

referral rate ； satis ； referral markup