台灣醫院醫師薪資制度調查

A National Survey of Physician-Compensation Arrangements at Hospitals in Taiwan

薛亞聖(Ya-Seng Hsueh) ； 洪幼珊(Yu-Shan Hung) ； 湯澡薰(Chao-Hsiun Tang) ； 楊志良(Chi-Liang Yuang) ； 王采薇(Tsai-Wei Wang)

《Journal of Medical Education》 Volume 6 Issue 2 (2002/06) Pp. 173-184

https://doi.org/10.6145/jme.200206_6(2).0007

Abstracts

目的:本研究的目的在了解與探討我國醫院醫師薪資制度的類型、組成結構及公私立醫院間; 不同評鑑等級醫院間醫師薪資制度的差異。研究方法:本研究採橫斷面的調查研究法，於1998年間以120家地區教學醫院以上醫院為對象，郵寄結構化自填式問卷進行調查。結果:(1)有效回收率為75%;(2)無論公私立醫院，均以固定加變動薪資為主，公立醫院為固定薪加績效獎金，私立醫院則多為固定薪加醫師費;(3)無論公私立醫院，80%的醫院其變動薪資部分超過總薪資的50%;(4)在計算變動薪時，均以有健保收入的服務項目的數量為最主要考量，但公立醫院比私立醫院另外加計的考慮因素較多;(5)私立醫院對新進主治醫師、冷門科醫師及住院醫院大部分會給予保證薪，但公立醫院則極少給予這些醫師保障薪;(6)當健保支付制度改變時，私立醫院會較公立醫院更積極快進的對醫院費制度作調整。結論:我國目前的醫院醫師薪資制度主要是以健保支付項目為基礎，鼓勵提高服務量的設計。

Keywords

人力資源 ； 薪資制度 ； 醫師費 ； 績效獎勵金 ； 醫院成本 ； 健康保險

Parallel abstracts

The principal purpose of this study is to understand and investigate the pattern and structure of hospital-based physician-compensation arrangements, and further, to investigate the differences between such arrangements as practiced by public and private hospitals. In addition, we intend to investigate the differences in the hospital-accreditation status for various Taiwanese hospitals, namely medical centers, regional hospitals, and district teaching hospitals. We conducted a cross-sectional survey in 1998. A structured self-administered questionnaire was mailed to appropriate representatives of the 120 target hospitals. ? The findings are as follows: 1) The response rate was 75%. 2) The most popular compensation arrangements is the mixed base-salary plus performance pay for public hospitals and mixed base-salary plus physician fee for surveyed private hospitals. 3) Most of the hospitals surveyed, whether public or private, have made the variable portion of the compensation exceeding 50% of physician’s total compensation. 4) The variable portion is determined mainly by the volume of a physician’s service according to the reimbursable items of the national health insurance scheme, although public hospitals appear to take more factors other than service volume into account. 5) Private hospital tend to use guaranteed salary for new-entry physicians, the less-profitable specialties, and residents. By contrast, public hospitals provide little guaranteed salary for the above-mentioned physicians. 6) Private hospitals, as compared to public hospitals, tend to modify physician-compensation arrangements more rapidly according to any changes in the reimbursement method of health insurance schemes. In conclusion, current hospital-physician compensation arrangements focus mainly upon a physician-incentive program, itself based upon volume of services.

Parallel keywords

human resource ； compensation arrangements ； physicican fee ； performance pay ； hospitalcost ； health insureance

References

張錦文()。,未出版。

Schuler RS,Mac Millan IC(1984).Gaining competitive practices.Human Resource Management.73,241-255.

Gold MR,Hurley R,Lake T,Ensor T,Berenson R(1995).A national survey of the arrangement management-care plans make with physicians.New Engl J Med.333(25),1678-1683.

Schieber, GJ,Burrey IL,Goldm JB,Kanus WA(1976).Physician fee patterns under medicare: A descriptive analysis.New Engl J Med.294(20),1089-1093.

Grumbach K,Osmond D,Vranizan K,Jaffe D,Bindman AB(1988).Primary care physicians` experience of financial incentives in managed care systems.New Engl J Med.339,1516-1521.