影響整形外科服務量與成長趨勢之因素探討

Factors Associated With Service Volume and Growth Trend in Plastic Surgery

林盈君(Ying-Chun Lin)

指導教授 ： 林能白

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02024

摘要

背景與目的： 雖然近年來國內研究者對於醫學美容市場的議題越來越感興趣，以消費者為議題者從消費者體驗效果、消費者行為意象加以討論，而以醫學美容中心為對象者主要探討經營議題或是提出創新的商業模式，對於影響服務量的研究則主要還是以醫師面的執業型態做探討，但由於整形外科大多為自費項目，影響服務量的因素不止服務提供者會造成影響，顯示缺乏從外部市場去探究影響服務量成長的相關原因，而國外雖然在整形外科服務量上的變化有多年的資料統計，但也沒有相關的研究去探究可能影響其變化的因素，故本研究欲藉此機會，希望透過內外部因素兩個面向加以探討；另一方面將著重於趨勢成長的討論上，在公共衛生的領域，趨勢分析被視為一種用於監督與預測的方法，早期多用於流行病學的相關議題，近年來在醫療產業的領域已逐漸倍受重視，例如江東亮教授便於2002年發表了一篇台灣醫療健保支出的趨勢分析結果，也有學者透過趨勢分析探討醫療保健支出的成長因素，或是透過衛生署的統計資料，配合相關工具及預測模型，預測未來西醫診所增加的趨勢，顯示台灣醫療產業對於趨勢分析的重視程度，但在醫學美容或是整形外科相關的領域則尚未有研究探討趨勢成長的變化，故本研究將藉此機會，加以整理整形外科的成長趨勢與探討影響其服務量變化之因素。

方法：本研究為一橫斷性研究，藉由結構式問卷針對全國共471位整形外科醫師
做普查，調查整形外科醫師其在2008年之個人背景特性、執業型態、工作投入現況、市場競爭情形和服務量後，與2007年回收之問卷結果比較，瞭解成長趨勢，藉此探討整形外科服務量變化與成長趨勢之影響因素。樣本回收剔除無效問卷後，有效問卷共有95份，有效回收率為20.2%。

研究結果：一、整形外科醫師服務量：(一)整形外科醫師之個人背景特性、執業型態、工作投入與市場競爭情況均會影響其服務量。(二)整形外科醫師之「重建整形手術年總件數」會因醫師的工作職稱、醫師服務院所等級、機構權屬別、平均每週門診診次、平均每週工作時數、醫療工作或教學工作佔總工作時間的比重、整體市場競爭環境與鄰近整形外科醫師與我在非美容手術之競爭情況不同，而有顯著的差異。(三)整形外科醫師之「美容整形手術年總件數」會因醫師的畢業學校、平均每週門診診次、整體市場競爭環境、鄰近整形外科與我在美容手術或非美容手術之競爭情況及鄰近皮膚科醫師與我在美容手術之競爭情況不同，而有顯著的差異。(四)整形外科醫師之「低侵入性美容治療年總件數」會因醫師服務院所等級、執業機構權屬別、平均每週門診診次、醫療工作及教學工作佔總工作時間之比重、整體市場競爭環境及鄰近皮膚科與我在非美容手術之競爭情況不同，而有顯著差異。(五)整形外科醫師之「全部整形外科服務年總件數」會因醫師服務院所等級、醫師分佈密集程度、平均每週門診診次、整體市場競爭環境、鄰近整形外科與我在美容手術或非美容手術上之競爭情況及鄰近皮膚科與我在美容或非美容手術上之競爭環境不同，而有顯著差異。
二、整形外科醫師服務量變化：(一)整形外科醫師之個人背景特性、執業型態與工作投入狀況均會影響服務量之變化。(二)整形外科醫師之「重建整形手術服務變化量」會因醫師是否擔任教職、醫師學歷高低、住院醫師訓練醫院、服務院所等級、醫師分佈密集程度、平均門診診次及醫療工作佔總工作時間的比重不同，而有顯著的差異。(三)整形外科醫師之「美容整形手術服務變化量」會因醫師是否擔任教職、工作職級、服務院所等級與平均門診診次不同，而有顯著的差異。(四)整形外科醫師之「低侵入性美容治療服務變化量」會因醫師工作職級、住院醫師訓練醫院、服務院所等級、平均每週門診診次、醫療、教學或研究佔總工作時間之比重不同，而有顯著差異。(五)整形外科醫師之「全部整形外科服務變化量」會因醫師的工作職級、服務院所等級及平均每週門診診次不同，而有顯著差異。

結論：整形外科醫師之個人背景特性、執業型態、工作投入和市場競爭情況均會影響其服務量，而整形醫師服務量變化則會因醫師是否擔任教職、醫師學歷高低、工作職級、住院醫師訓練醫院、服務院所等級、醫師分佈密集程度、平均門診診次及醫療、教學或研究工作佔總工作時間的比重不同，而有顯著的差異。

關鍵字

醫學美容 ； 整形外科 ； 醫療服務量 ； 服務量變化 ； 趨勢分析

並列摘要

Background and Objectives：There are more and more domestic researchers interested in issues in the market of medical cosmetic.Ones who interested in consumers discuss about consumer experiences and consumer behavior. Meanwhile, ones who interested in medical cosmetic mainly discuss about management issues or bring up with whole new, creative business models. For researches affecting service volume, doctors’ business operational behavior is considered as the main topic. However, factors affecting service volume are not only service providers because most of the plastic surgery are user-pays. This shows that the domestic researches in current stages are still lack of considerations from external market aspects to explore the related reasons of increasing service volume. Although foreign researches have the statistics on plastic surgery service volume, there are rooms to discuss and find out about the factors affecting the incremental service volume.Therefore, this research is going to discuss about medical cosmetic issues from both of the internal and external aspects.

Methods：This is a cross-sectional study. Data were collected from mailing structural questionnaires to 471 Plastic surgeons nation-wide in 2008. The variables covered various status measures of physician characteristics, practice feature, practice inputs, volume ,Market competitiveness and relative mix of plastic reconstructive surgery（PRS） , surgical cosmetic/aesthetic surgery（SC） and nonsurgical cosmetic/medicine cosmetic（NC） procedures of Plastic surgeons,and compare with the result in 2007 tofind out the factors associated with service volume and growth trend in plastic surgery.A total of 95 subjects were returned and the return rate was 20.2%

Results：Significant findings of this study were summarized as follows. 1. the practice
volume of Plastic surgeons: (1) The physician characteristics, practice feature, practice inputs, volume,market competitiveness of plastic surgeons will affect the volume of services (2) PRS procedures per year were significantly associated with their administrative position, medical institutions, ownership type of medical institutions, the time for the outpatient service per week, the percentage of medical service, and the percentage of teaching service. (3)SC procedures per year were significantly associated with their graduate school, the overall market competition,the plastic surgeons competitive situation in SC and NC nearby me and the dermatologis competitive situation in SC nearby me.(4)NC procedures per year were significantly associated with their medical institutions,ownership type of medical institutions, the time for the outpatient service per week, the percentage of medical service, and the percentage of teaching service, the overall market competition and the dermatologis competitive situation in SC nearby me.(5)The total number of plastic surgery per year were significantly associated with medical institutions, the density of plastic surgeons, the time for the outpatient service per week, he overall market competition,the plastic surgeons competitive situation in SC and NC nearby me and the dermatologis competitive situation in SC and NC nearby me.2.Variation of plastic surgeons service:
(1)The physician characteristics, practice feature, practice inputs and volume will affect the variation of the services volume (2) Variation of PRS procedures per year were significantly associated with their professional accreditation in the school, physician education, the hospital of resident training, medical institutions, the density of plastic surgeons, the time for the outpatient service per week and the percentage of medical service. (3) Variation of SC procedures per year were significantly associated with their professional accreditation in the school, administrative position, the density of plastic surgeons and the time for the outpatient service per week.(4) Variation of NC procedures per year were significantly associated with administrative position, the hospital of resident training, medical institutions, the time for the outpatient service per week, the percentage of medical service, the percentage of teaching service and the percentage of study service.(5) Variation of total number in plastic surgery per year were significantly associated with administrative position, the density of plastic surgeons and the time for the outpatient service per week.

Conclusions: Physician characteristics, practice feature, and practice inputs of plastic surgeon are the most significant factors of the practice volume. The Variation of plastic surgeons Service were significantly associated with their professional accreditation in the school, physician education, administrative position, the hospital of resident training, medical institutions, the density of plastic surgeons, the time for the outpatient service per week, the percentage of medical service, the percentage of teaching service, and the percentage of study service.

並列關鍵字

Medical cosmetic ； Plastic surgery ； Medical service volume ； Service Volume and Growth Trend

參考文獻

3. 江東亮（2002），台灣醫療健保支出之趨勢分析，台灣公共衛生雜誌，21（3），156-163。

5. 行政院衛生署，行政院衛生署1999~2008醫療統計年報。

7. 李宇宙（2005），美容手術的精神醫學與心理社會評估，台灣醫學，9（2），193-197。

14. 林詠蓉（2008），台灣整形外科現況及影響服務量與項目組合之因素，國立台灣大學醫療機構管理研究所碩士論文。

15. 邱雅苓、陳世能（2003），醫療保健支出成長因素之探討－時間序列分析與門檻模型的應用，經濟研究，39（2），197-240。