管理式醫療對醫師的影響：美國經驗

The Impacts of Managed Care on Physicians ：US Experience

林恆慶(Herng-Ching Lin) ； 陳楚杰(Chu-Chieh Chen)

《Journal of Medical Education》 7卷3期 (2003/09) Pp. 210-217

https://doi.org/10.6145/jme.200309_7(3).0002

摘要

傳統上，在美國醫師被公認為是接受高教育水準、坐享穩定豐裕收入及擁有高度自主權的專業。然而自1980年代開始大量使用管理式醫療來控制持續高漲的醫療費用後，對醫師的執業收入、執業意願、型態及醫病關係等，都產生極大的影響。本文擬以美國實施管理式醫療經驗為例，介紹管理式醫療對醫師的影響，進而提出對台灣未來實施管理式醫療的建議，以供衛生專業人員及衛生政策制定者之參考。美國管理式醫療對醫師的影響，主要有下列十一項：（１）醫師的收入減少；（２）醫師的自主權受到限制；（３）醫師產生的角色衝突；（４）導致病人對醫師的不信任；（５）醫師的行政負擔增加；（６）醫師必需承擔財務風險；（７）醫師執業的意願降低；（８）醫師的醫療行為受到評量；（９）參與聯合執業醫師的人數增加；（１０）醫師需具備商業技巧及管理技術；（１１）對基層照護醫師的需求增加。在台灣全民健保財務持續的惡化情形下，相信管理式醫療將是衛生政策制定者考慮可行的主要方案之一，現在需要對未來全面實施管理式醫療做好準備。依據美國管理式醫療對醫師影響的經驗，對台灣未來實施管理式醫療提出三點建議：（１）教育醫師有關管理式醫療的知識及優缺點；（２）建議醫學院可多開設管理課程供學生選讀，以培養學生的管理能力；（３）倡導醫師參與聯合執業。

關鍵字

管理式醫療 ； 醫師 ； 醫學教育

並列摘要

Traditionally, the physician is considered to be a well-educated, high-income, and highly autonomy professional. However, the adoption of managed care since the 1980's has dramatically affected the income, the willingness to serve, and the behavior of physicians as well as the physician-patient relationship. The purpose of this article is to identify the impact of managed care on physicians and to propose possible recommendations to both health professionals and policy makers with respect to the future implementation of managed care in Taiwan.
The impacts of managed care on physicians can be classified into:(1)a decrease in the physician's income;(2)a limitation of the physician's autonomy;(3)a conflict between the various roles that physicians have to play;(4)an increase in the distrust of physicians by patients;(5)an increased administrative;(6)a share in the financial risk of the practice;(7)a reduction in their willingness to practice medicine;(8)the introduction of assessments of the physician's behavior;(9)a larger number of physicians in each group practice;(10)a requirement for business and management skills; and(11)an increased demand for primary care physicians.
Managed care is a possible solution to escalating national medical expenditure. Therefore, there is a need to prepare for implementation of managed care in Taiwan. We proposed three suggestions:(1)that physicians should be educated about the advantages and disadvantages of managed care;(2)that more business-oriented classes are provided for medical school students; and (3)that physicians are encouraged to join group practices.

並列關鍵字

managed care ； physician ； medical education

參考文獻

(1999).Survey: Physicians dissatisfied with managed care.JAMA.282,712.

(1997).Physician attitudes toward managed care surveyed.Health Finan Managem.51,22-23.

(1998).National study finds seven of ten physicians are anti-managed care.Med Mark Media.33,26.

Baldor RA(1998).Managed Care.Worcestor, MA:Blackwell science.

Bradford GH(1997).Trust and trustworthy care in managed care era.Health Affairs.16,34-49.