醫師照護品質與家庭醫師制度

Quality of Physicians Care and The System of Family Doctors

吳哲維(Wu Zhe Wei)

指導教授 ： 林小嫻

亞洲大學/健康學院/健康管理研究所/碩士(2003年)

摘要

在不完全訊息下，意識型態與認知將影響行為決策，決定制度的選擇演化及體系的成敗。強調以「全人」、「長期」健康維護為導向的家庭醫師制度，台灣數年來卻不易建立。本研究嘗試由醫療本質問題出發，應用經濟學理論及歐美醫療體系的比較分析，檢驗現有的制度與意識型態來探討醫師照護品質問題。全民健保開辦之後，在需求面提高了民眾就醫的可近性，但供給面缺乏有效的產業組織協調，病患自由選擇專科醫療時產生較高的交易成本問題。本研究結果發現，論量計酬支付制度長時間下來，強化醫師在醫療服務上生物醫學模式(以症狀治療為主，專科醫療為上)的意識型態，造成片段照護品質的問題，同時也加強了短期失信的醫病關係，自由就醫的意識型態與產業組織缺乏有效的協調。依每年的醫療費用及醫療量逐漸增加，在提供較多的醫療量，以及短暫的醫病關係之下，加深了醫療多於健康的概念，長期下來也造成家庭醫師制度之落實阻礙重重。家庭醫師制度是將醫療體系垂直整合，降低交易成本問題並促成醫療產業組織專業分工合作。因此本研究建議實施「長期信任、全人醫學」之家庭醫師制度，並先從改變支付制度平衡各層級照護的發展著手，與培養家庭醫學醫師。

關鍵字

家庭醫師制度 ； 醫療品質 ； 醫病關係

並列摘要

With imperfect information, one’s ideology and personal perspective would take place and affect decision-making on forming important policies. By this dreadful fashion, an institute’s structure improvement, and its subsequent success, or failure will be determined without any sound and reliable means.
Although the system of family doctor provides a long-term and a complete health service, there are obstacles that prevent this system to be established in Taiwan. This study attempts to argue about the quality of physician’s services in the relationship to the current system and the common ideology, by conducting comparative analysis of economic theories and the current Trans-Atlantic health systems, to examine the quality of our existing health delivery system, and the ideology behind this.
Despite the fact that, since the start of the National Health Insurance, the demand side (the general public) has been greatly taken care of with improved accesses to medical and health treatment. Nonetheless, on the contrary, the supply side has always been seriously lack of consolidation and organization. Subsequently, it was resulted in higher-costs for the patients who have to opt for their own specialist health treatment. This article also discovered that, due to the long existing of Fee for Service systems, doctors tend to biomedical (to counter symptoms only by specialists treatment), while representing discontinuous clinical treatment that may well in terms, widen the gap of distrust between doctors and patients. In short, let people opt physician services freely without any regulation or systematic support is further highlighting the lack of organized consolidation of the medical and clinical entities.
As the medical and physician costs and treatments increase year by year, and the demand for services are growing correspondingly, the time spent on practice engagement between each doctors and patients are getting shorter and shorter. Such circumstance would then, accordingly, produce the idea that medical treatments are more effective than the proper health conservation. What’s more, it further makes the idea of Family Doctors System vulnerable in the public’s opinion.
The system of family doctors is the fruit of the vertical integration of the entire health and medical services. Along with this system, the medical and clinical costs can be reduced by division of labor that is professional and well-organized. Thus, this article would recommend to adjust the current compensation management in the health and medical services, and to nurture family physicians, and consequently to form a system of family doctors that is persistently trustworthy, and to balance the different levels of care by changing payment system.

並列關鍵字

The system of family doctors ； quality of physicians service ； Doctor-patient relationships

參考文獻

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