Exploring Physicians' Perceptions of the Quality of Medical Care Under the Case Payment System

探討醫師對論病例計酬制度下醫療品質的認知

陳怡蒼(Yi-Cheng Chang) ； 林恆慶(Herng-Ching Lin)

《Mid-Taiwan Journal of Medicine》 9卷4期 (2004/12) Pp. 225-232

https://doi.org/10.6558/MTJM.2004.9(4).5

摘要

目的　本文旨在瞭解醫師對論病例計酬制度下醫療品質的認知，確認監控論病例計酬制度下醫療品質所需的品質指標，及探討論病例計酬制度實施對醫療品質的影響。
方法　共發放336份問卷給大臺北地區的11家教學醫院，使用one-way ANOVA及t檢定來探討醫師對論病例計酬制度下醫療品質的認知及醫師性別、年齡、執業年資及專長之間的相關性。
結果　回收202份問卷，回收率爲60.8%。有63.9%的受訪者感覺實施論病列計酬制度之後醫療品質變差，one-way ANOVA檢定發現受訪者對論病例計酬制度之下醫療品質的認知與醫師年齡(p=0.038)及執業年資(p=0.004)呈顯著相關。約有55%的受訪者感覺健保局所採用的品質監測系統成效不彰，受訪者覺得論病例計酬制度之下兩個最重要的監測指標爲合併症或並發症的發生及outlier案件的監測。
結論　大多數的受訪者感覺健保局對論病例計酬制度之下醫療品質的監測系統成效不彰，我們建議健保局參攷醫師的意見，將他們做爲重建論病例計酬制度監測系統的參考。

關鍵字

論病例計酬 ； 醫師 ； 醫療品質

並列摘要

Objectives. The aims of this study were to understand physicians' perceptions of the overall quality of care after implementation of the case payment system in Taiwan, to identify quality indicators for quality assurance under the case payment system, and to explore how the quality of medical care has been influenced by implementation of the case payment system.
Methods In total, 336 questionnaires were delivered to physicians at 11 teaching hospitals in metropolitan Taipei. The relationships between physicians' perceptions of the quality of medial care under the case payment and physicians' gender, age, professional experience, and specialties were analyzed by t test and one-way ANOVA.
Results. A total of 202 questionnaires were returned (60.8%). More than 63% of respondents felt that health care quality in Taiwan had worsened since the implementation of case payment. The Kruskal-Wallis test revealed that perception of healthcare quality under case payment was associated with age and professional experience of physicians. About 55% of respondents felt that the quality monitoring system implemented by the Bureau of the National Health Insurance (BNHI) was poor. The indicators which respondents felt most needed to be monitored under the case payment system were the occurrence of complications and comorbidities.
Conclusions The majority of respondents considered the monitoring system under the case payment system to be inadequate. We recommend that the BNHI take physician inputs into consideration before revising the quality monitoring system to improve the quality of medical care for all case payment items.

並列關鍵字

case payment ； physician perceptions ； quality of medical care