基層診所未加入全民健保特約之因素探討

Factors Associated with Clinics Not Participating in the National Health Insurance

蔡文正(Wen-Chen Tsai) ； 李柏勳 ； 龔佩珍 ； 陳綾穗

《醫務管理期刊》 3卷1期 (2002/03) Pp. 90-106

https://doi.org/10.6174/JHM2002.3(1).90

摘要

全民健保實施至今，基層診所與健保局平均特約率未及90%，也就是約有10%以上診所仍需要民眾自費就醫，為何部分診所不願意加入健保特約，值得深入探討。本研究試著透過診所特質、負責醫師對健保態度、醫師基本特質三方面，來分析診所加入或未加入健保特約之因素。方法：透過羅吉斯迴歸(Logistic regression)分析未加入健保特約之主要因素。研究對象為88年12月底台中縣市登記開業之中、西醫診所負責醫師，以結構式問卷寄1744位診所醫師，問卷回收率為15.5%，有效問卷270份。結果：診所不加入健保之主要原因為健保規定太多、行政流程過於繁瑣及健保給付偏低。控制其他變項後，發現執業年數較久、學歷為項博士者、認為健保規定太多者及認為健保核減太多者，愈傾向於不加入健保特約；執業地區為都市者、認為加入健保後稅後收入增加者、過去曾加入其他保險特約經驗者及其病人疾病主要為耳鼻喉疾病者比較容易加入特約。結論：影響診所加入健保特約的主要原因為方便民眾就醫及醫療環境競爭壓力；而未加入健保特約的主要原因是對健保相關規定之不滿意。

關鍵字

非健保特約 ； 自費就醫 ； 基層診所醫師

並列摘要

According to data from the National Health Insurance (NHI) program, 96.5% of the population was enrolled in the program in 2000. However, only 90% of clinic physicians participated in the NHI program. Consequently, patients were required to pay out-of-pocket expenses for the medical services provided by the clinics that physicians were not part of the program. The purpose of this study was to detemine factors that influence a physician’s decision to participate in the NHI program. Data were collected by questionnaires mailed to 1744 physicians in the Taichung area; 270 (15.5%) of the questionnaires were completed. Information was collected concerning each physician's demographic variables, practice characteristics and attitudes toward the NHI program. Multiple logistic regression was used to detemine factors significantly related to a physician’s participation in the NHI program. The following factors were found to be related to a physician deciding not to participate in the program: increasing years in practice, having a graduate medical degree, the perception of excessive regulations from NHI, and the perception of excessive denial of claims by NHI. Conversely, the following factors were significantly related to a physician's decision to participate in the program: urban location, an expectation of higher income after contracting with NHI, experience with other health insurance programs, and a preponderance of patients treated for ear, nose and throat diseases. Conclusions: Dissatisfaction with NHI regulations is the major reason for clinic physicians not participating in the NHI program. High market corn petition pressure is a major factor for participation.

並列關鍵字

Not participating in NHI ； Out-of-pocket payment ； Clinic physicians

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