中醫師對中醫門診總額支付制度滿意度調查－以高屏地區為例

中醫門診總額支付制度實施已屆滿一年，基於中醫界對該制度的期許與配合，實有必要以醫療提供者的角度來做滿意度調查。本研究旨在探討中醫師對總額支付制度的滿意程度，以及該制度對中醫師的執業行為的影響。研究方法為橫斷式郵寄問卷調查，研究母群體是高屏地區與健保局有特約關係的中醫師，以分區隨機取樣選出240位中醫師為研究樣本，有效回收問卷166份，回覆率為69.2%。研究結果發現中醫師對總額支付制度的滿意度偏低，其中最不滿意的指標是給付點數（金額）與專業醫師審查作業；總額支付制度對中醫師的執業行為沒有顯著的影響；具有大學以上學歷、受過正规中醫教育訓練、或資歷較淺的中醫師對給付點數（金額）、專業醫師審查作業、以及補導機制的滿意度較低；平均每週看診病人數愈多的中醫師對專業醫師審查作業的滿意度愈低；單獨執業的中醫師對給付點數（金額）的滿意度較聯合執業的中醫師為高。

關鍵字

中醫師；總額支付制度；滿意度

並列摘要

The Bureau of National Health Insurance (BNHI) had implemented the global budgeting system (GBS) onto trlitiona1 Chinese medical services since July 2000. Due to the exalted expectations and collaborations of traditional Chinese physicians (TCP) prior to the implementation, it's essential to investigate the satisfaction of GBS from providers' perspective. The purposes of this study were to examine TCPs satisfaction levels, and to analyze the effect of GBS on their practice behavior. This study was a cross-sectional questionnaire survey. The universe was NHI-contracted TCPs located in Kaohsiung and Pingtong areas. Two hundred and forty subjects were selected as study samples, using stratified systematic sampling technique; of which, 166 subjects responded to the survey, with a response rate of 69.2%. The results revealed that TCPs' satisfaction levels ranked from medium to low, and the least satisfied indices were reimbursement and operations of peer-review auditing. This study, however, didn't find significant effect of GBS on practice behavior. In addition, the findings indicated that subjects with bachelor degree, formal Chinese medical training, and/or less experienced in practice tended to be less satisfied than their counterparts, in term is of reimbursement, peer-review auditing, and guidance mechanism. The results also indicated that the greater number of patient seen by the subject, the lower satisfaction level of peer-review auditing; and solo pmc1itionei tended to be more satisfied than their counterparts, in term s of reimbursement.