台灣整形外科現況及影響服務量與項目組合之因素

The Current Status of Plastic Surgery Practices in Taiwan and the Impact Factors of Volume and Procedure Mix

林詠蓉(Yung-Jung Lin)

指導教授 ： 林能白

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.03131

摘要

背景與目的：隨著國民經濟水準提升和醫療資訊傳播的發達，使得民眾對於整形美容手術的接受度逐漸增高，各醫療院所亦藉此機會亟欲從整形外科中發展各項自費醫療服務，以改善健保總額支付之度下，經營之窘境。相較國外在整形外科服務量方面，已經有完善的歷史統計資料，我國在非健保給付的醫療服務研究上，則極為缺乏。故本研究為國內首次針對我國全部之整形外科醫師做為研究對象，對其服務現況作初步的調查，以探討整形外科服務量與服務項目組合之影響因素。

方法：本研究為一橫斷性研究，藉由結構式問卷針對全國共449位整形外科醫師做普查，調查整形外科醫師其在2007年之個人背景特性、執業型態、工作投入現況和服務量後，對其服務量與服務項目組合之影響因素作探討。樣本回收剔除無效問卷後，有效問卷共有102份，有效回收率為22.7%。

研究結果：一、整形外科醫師服務量：（一）「重建整形手術年總件數」會因學校擔任教職、工作職級、住院醫師訓練醫院、服務院所、權屬別、每百萬人口整形外科醫師密度、平均每週門診診次、醫療服務佔工作時間比重和教學服務佔工作時間比重之不同，而有顯著差異；（二）「美容整形手術年總件數」則會因工作職級、年齡、年資、權屬別、每百萬人口整形外科醫師密度、平均每週門診診次之不同，而有顯著差異。（三）「非手術之美容整形年總件數」（亦即醫學美容或微整型之年總件數）則會因工作職級、住院醫師訓練醫院、服務院所、權屬別、平均每週門診診次和醫療服務佔工作時間比重之不同，而有顯著差異。二、服務項目組合：（一）影響整形外科醫師之「重建整形手術佔服務總量百分比」之因素有：工作職級、住院醫師訓練醫院、年齡、年資、執業機構之服務院所、權屬別和每百萬人口整形外科醫師密度；（二）影響「美容整形手術佔服務總量百分比」之因素有：工作職級、年齡、年資、執業機構之服務院所、權屬別和每百萬人口整形外科醫師密度；（三）而影響「非手術之美容整形佔服務總量之百分比」之因素有：工作職級、住院醫師訓練醫院、執業機構之權屬別和每百萬人口整形外科醫師密度。

結論：整形外科醫師之個人背景特性、執業型態和工作投入均會影響其服務量，而會影響服務項目組合的因素有工作職級、住院醫師訓練醫院、年資和執業機構之服務院所、權屬別及每百萬人口醫師密度。此外整形外科醫師反應，重建整形手術在健保給付上過低，將會是造成重建整形醫師人力流失之原因之一；提供整形外科服務之權限浮濫，需要有更完善的教育訓練與法規；期待政府對新的儀器與藥物採更開放的態度，提升整形外科之競爭力。

關鍵字

整形外科 ； 醫療服務量 ； 美容整形 ； 醫學美容

並列摘要

Abstract

Background & Objectives: With the growing of economic standard and wide broadcast of medical information, nowadays more and more people are able to accept the concept of plastic surgery. Many hospitals were trying to invest on new services, which were out of patients' own pockets, with the hope to improve the short handed revenues under National Health Insurance. In compare with rich and well-organized sources from foreign countries, the exact volume of plastic surgery services in Taiwan has never been surveyed or reported before. This study is the first research tries to explore the current status of plastic surgery practices and the impact factors of volume and procedure mix.

Methods: This is a cross-sectional study. Data were collected from mailing structural questionnaires to 449 Plastic surgeons nation-wide in 2007. The variables covered various status measures of physician characteristics, practice feature, practice inputs, volume and relative mix of plastic reconstructive surgery（PRS）, surgical cosmetic/aesthetic surgery (SC) and nonsurgical cosmetic/medicine cosmetic (NC) procedures of Plastic surgeons. A total of 102 subjects were returned and the return rate was 22.7%

Results: Significant findings of this study were summarized as follows. 1. the practice volume of Plastic surgeons: (1) PRS procedures per year were significantly associated with their professional accreditation in the school, administrative position, the hospital of resident training, medical institutions, ownership type of medical institutions, the density of plastic surgeons, the time for the outpatient service per week, the percentage of medical service, and the percentage of teaching service. (2)SC procedures per year were significantly associated with their administrative position, age, seniority, ownership type of medical institutions, the density of plastic surgeons, and the time for the outpatient service per week. (3)NC procedures per year were significantly associated with their administrative position, the hospital of resident training, medical institutions, ownership type of medical institutions, the time for the outpatient service per week, and the percentage of medical service. 2. The relative mix of Plastic surgeons services: (1) PRS procedures/total operations number were significantly associated with their administrative position, the hospital of resident training, age, seniority, medical institutions, ownership type of medical institutions, and the density of plastic surgeons. (2)SC procedures/total operations number were significantly associated with their administrative position, age, seniority, medical institutions, ownership type of medical institutions, and the density of plastic surgeons. (3)NC procedures/total operations number were significantly associated with their administrative position, the hospital of resident training, ownership type of medical institutions, and the density of plastic surgeons.

Conclusions: Physician characteristics, practice feature, and practice inputs of plastic surgeon are the most significant factors of the practice volume. Administrative position, seniority, medical institutions, ownership type of medical institutions, and the density of plastic surgeons are the most significant factors of the mix of services.

並列關鍵字

Plastic surgery ； Medical service volume ； Cosmetic surgery ； Aesthetic surgery ； Medical cosmetic

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