基層醫師對國內實施論人計酬制度可行性認知調查研究

A Survey Study of the Feasibility of Capitation Payment System from Primary Physicians' Point of View

許銘恭(Ming-Kung Hsu) ； 林恆慶(Herng-Ching Lin)

《台灣家庭醫學雜誌》 13卷4期 (2003/12) Pp. 157-170

https://doi.org/10.7023/TJFM.200312.0157

摘要

The purposes of this study were to understand the attitudes of primary care physicians toward the implementation of a capitation payment system and to explore the most appropriate model of capitation payment system for primary care. This study used a mailing survey research. The study sample included 1,022 primary care physicians selected by systematic sampling from the population. The response rate was 21.14%. A multiple logistic regression analysis was performed to identify the statistically significant factors related to the willingness of primary care physicians to join the capitation payment system. The results showed that 24% of respondents understand the capitation payment system. Only 19% were ”very willing” or ”willing” to join the capitation payment system. After adjusting the effects of other variables, the results showed that the physican's age (OR=1.084; 95% CI 1.031~1.141;p=0.002), practice location (OR=12.133; 95% CI 1.372~107.260;p=0.025), practice type (OR=16.524; 95% CI 3.668~74.429;p＜0.001), unwillingness to change the current status (OR=0.409;95% CI 0.208~0.802;p=0.009)and whether a physician understands the capitation payment system (OR=0.184;95% CI 0.043~0.794;p=0.023), were all significantly related to the willingness of a primary care physician to join the capitation payment system. The study indicated that the majority of the primary care physicians did not understand the capitation payment system. It is suggested that health authorities educate primary care physicians regarding the issue of the capitation payment system. This can facilitate a smooth implementation of the capitation payment system in the future.

並列摘要

The purposes of this study were to understand the attitudes of primary care physicians toward the implementation of a capitation payment system and to explore the most appropriate model of capitation payment system for primary care. This study used a mailing survey research. The study sample included 1,022 primary care physicians selected by systematic sampling from the population. The response rate was 21.14%. A multiple logistic regression analysis was performed to identify the statistically significant factors related to the willingness of primary care physicians to join the capitation payment system. The results showed that 24% of respondents understand the capitation payment system. Only 19% were ”very willing” or ”willing” to join the capitation payment system. After adjusting the effects of other variables, the results showed that the physican's age (OR=1.084; 95% CI 1.031~1.141;p=0.002), practice location (OR=12.133; 95% CI 1.372~107.260;p=0.025), practice type (OR=16.524; 95% CI 3.668~74.429;p＜0.001), unwillingness to change the current status (OR=0.409;95% CI 0.208~0.802;p=0.009)and whether a physician understands the capitation payment system (OR=0.184;95% CI 0.043~0.794;p=0.023), were all significantly related to the willingness of a primary care physician to join the capitation payment system. The study indicated that the majority of the primary care physicians did not understand the capitation payment system. It is suggested that health authorities educate primary care physicians regarding the issue of the capitation payment system. This can facilitate a smooth implementation of the capitation payment system in the future.

並列關鍵字

capitation payment system ； primary care physician ； gatekeeper

參考文獻

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