全民健保制度下影響醫學系學生選擇醫療科別之因素分析

Medical Specialty Choice under National Health Insurance

劉彩卿(Tsai-Ching Liu) ； 陳欽腎(Chin-Shyan Chen) ； 鄭雅靜(Ya-Ching Cheng)

《醫務管理期刊》 5卷4期 (2004/12) Pp. 473-494

https://doi.org/10.6174/JHM2004.5(4).473

摘要

全民健保的實施，是否影響醫學系學生的選科意願；而扭曲既有醫療生態，頗受眾人矚目。由統計資料顯示：全民健保自民國84年實施以來，外科及婦產科皆明顯呈現人力不足的現象，一般大眾質疑健保給付過低為其重要因素。因此究竟是否因健保支付標準未能充份反應實質報酬，促使醫師科別分佈不約，值得深入探討。本研究以台灣地區九所醫學院的醫學系學生為樣本，採多重logit模型檢定醫學系學生在健保制度下選擇醫療科別的影響因素。
實證結果顯示，相對於家醫科，外科及婦產科的選科意願，並未受健保支付標準的影響而有所差異。但是工作時問及醫療糾紛的考量，卻顯著降低該二科的選擇機率。因此，欲解決住院醫師科別不約問題，提高健保支付並非良策。尤其外科及婦產科住院醫師供不應求的問題，相關單位應著手配套措施，降低其工作時問及醫療糾紛風險等，以提昇選擇意願。
此外，公費醫師的分發制度對醫學生選擇醫療科別，亦具有重要的影響力，為了改善婦產科醫師的人力不足，當局者可考慮依一般外科模式，將婦產科同時列入特殊醫療科組，縮短其服務年限，以增加該科之選擇誘因。

關鍵字

全民健保 ； 支付標準 ； 醫療科別

並列摘要

National Health Insurance (NHI) was implemented in 1995, whether it leads to specialty mal-distribution of physicians has become one of the foremost issues of current health manpower policy. According to statistic, the proportion of general surgeons and obstetrician and gynecologist has an apparent decrease since NHI's implementation. The payment system was considered to be one of the most important contributors.
The objective of this paper was to examine the factors that influence specialty choices for medical students. Data used in this study were from the survey of medical students from 9 medical colleges. The survey was conducted in the end of 2000. The effective samples contained 1551 observations. The analytical method was a multi-logit model.
The results showed that the payment system of NHI did not play a significant role in the medical specialty choices (general surgeons, obstetrician and gynecologist versus family practice). However, considering of working time and malpractice suit, medical students were less likely to choose general surgeons, obstetrician and gynecologist than family practice. Therefore, instead of increasing the payment, the health authority needs to pay more efforts on reducing the working time and malpractice risks to improve the lack of medical manpower on such three medical specialties.

並列關鍵字

National Health Insurance NHI ； The Payment System ； Medical Specialty Choice

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