探討單獨開業牙醫師參與聯合執業之意願及其影響因素

Exploring the Determining Factors of the Willingness of Solo Practice Dentists to Join Group Practices

曾明清(TSENG MING CHING)

指導教授 ： 林恆慶

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2003年)

摘要

長期以來牙醫診所的經營模式大多數以單獨開業為主，牙醫師單打獨鬥的執業方式，在面對近幾年來大型醫院牙科的蓬勃發展、健保財務的緊縮、民眾對高品質、高效率醫療服務的要求，以及醫病關係的惡化等外在因素，使得單獨開業牙醫師愈來愈難經營。〝牙醫聯合執業〞是相對於牙醫單獨開業的另一種經營模式。歐美國家於二十世紀初期即開始出現醫師聯合執業，至今在美、加、英等國已成為醫師執業的主要型態。從國外的文獻中得知，聯合執業模式的確對病人、牙醫師都會產生正面的影響。既可提昇口腔醫療及服務品質、增加醫療可近性並可節省醫療成本，更可改善牙醫師的醫療水準與生活品質。 因為牙醫聯合執業在國內尚屬新興的觀念，並且成功的案例不多，再加上台灣研究聯合執業的專家學者極為有限，以致無法提供具體有效的成功經驗，導致一般牙醫師對聯合執業的參與裹足不前。 因此本研究的目的，在於探討單獨開業牙醫師對聯合執業的認知程度，並瞭解單獨開業牙醫師喜好的聯合執業模式，最後更希望得知影響單獨開業牙醫師參與聯合執業意願之因素。 本研究方法是以2001年於中華民國牙醫師公會全國聯合會登錄之會員名單中，針對單獨開業之牙醫師4210人，以地區別排序後，再以每隔3人抽取1人的等距系統抽樣法，共抽樣出1403名，採取郵寄問卷的方式來蒐集所需的資料。有效回收樣本為358份，回收率為25.9%。 本研究結果發現：對於牙醫聯合執業的優缺點及相關法規之瞭解程度，有65.3%表示非常不瞭解和不太瞭解，21.1%表示普通瞭解，只有約13.5%表示非常瞭解和瞭解。在參與聯合執業的意願方面，則有26.5%的單獨開業牙醫師表示非常願意及願意，23.9%表示非常不願意及不願意，而表達不一定的卻高達43.4%。 以邏輯式迴歸分析得知，有顯著影響單獨開業牙醫師參與聯合執業意願的相關因素有四，分別為：(1)對聯合執業之瞭解程度。亦即對聯合執業瞭解程度越高的單獨開業牙醫師有較高的參與聯合執業的意願；(2)是否能降低營運成本。亦即較同意參與聯合執業後「儀器及材料的使用率高，可降低營運成本」的單獨開業牙醫師有較高的參與意願；(3)缺乏自主權的重視程度。亦即比較不在乎是否因「參加聯合執業後牙醫師會缺乏部分自主權」的單獨開業牙醫師，有較高的機率願意參與聯合執業；以及(4)可提高生活品質。亦即較同意參與聯合執業後，「可提高生活品質，自我充實」的單獨開業牙醫師有較高的參與意願。 至於有意願參與聯合執業的獨執業牙醫師其較喜好的聯合執業模式為：1.在法律型態(所有權)方面，約有50.4%的獨執業牙醫師偏好合夥模式；2.在期待的牙醫師數目方面，有62.7%的獨執業牙醫師期待2~3位牙醫師聯合執業；3.在期待的聯合執業科別方面，排名前三項為牙周病科、齒顎矯正科、人工植牙科；4.在管理方式方面; 排名前二項為，聘用專職管理人才負責、由合夥人自組董事會管理；5.在收入分配方式方面，最受歡迎的是協商固定薪水加上績效(按抽成或分紅)來分配。 結論：為提高獨執業牙醫師參與聯合執業的意願，本研究對衛生主管機關的建議為對牙醫師進行聯合執業的宣導、修改聯合執業之相關法規、現行稅法明確化。

關鍵字

單獨開業牙醫師 ； 聯合執業 ； 執業模式

並列摘要

The solo practice has been a major operation model for the majority of dental clinics for a long time. Lately the operation of solo practice by dentist has become difficult because of the prosperous development of dental departments of hospital, tightness of public health insurance financing, demand of high quality and efficiency of dental treatment by consumers, and the aggravation of dentist-patient relationship. “Group dental practice” relative to solo practice is another operation model for dentists. Group practice, which started in the late nineteen century in western countries, has become major practice type in America, Canada and England. Group practice indeed has positive impacts on patients and dentists based on the literature review. It does not only improve quality of dental treatment and services, but also increases dental access and reduces dental costs. Moreover, group practice elevates the level of dental treatments and improves quality of dentist’s life. Because dental group practice in Taiwan is still a newly developed concept, successful cases are few, and researchers in this field are limited, it is impossible to provide realistic and effective successful experience for dentists. These all stop dentists from joining the group practice. Therefore, the purposes of this research were to understand solo dentist’s level of recognitions toward group practice, to realize the types of group practice dentists prefer, and to explore the factors affecting the willingness of solo practitioners to join group practices. The research population of this study was 4210 solo practice dentists who registered in National Chinese Dental Association in 2001. The systematic sampling was used to randomly select 1403 subjects from the research population. A mailing survey was performed to collect information. A total of 358 questionnaires were returned and yielded a response rate of 25.9%. As to the understanding level of advantage-disadvantage and related laws of group dental practice, 65.3% of respondents expressed extremely not understanding and not understanding, 21.1% express average understanding, and only 13.5% express understanding very much and understanding. For participating aspects, 26.5% express extremely willing and willing, 23.9% express extremely unwilling and unwilling, and 43.4% express “not sure”. According to multiple logistic regression analysis, the four factors influencing will of solo dental practitioners participating in group practice are: (1) level of understanding, namely, the higher understanding of solo practitioners, the higher of their will to participate; (2) whether it could reduce operation cost, namely, solo practitioners whoever agree that group practice “increase using rate of apparatus and material and keep operation cost down” have higher participating will.; (3) the extent of care of lack of autonomy ,namely, solo practitioners whoever are careless about “after participating in group practice , lack of partial autonomy could happen” have higher participating will. And (4) improving life quality of dentists, namely, solo practitioners whoever agree that group practice “can enhance life quality and fulfill themselves” have higher participating will. For the group practice models which solo dental practitioners interested about are: 1. Legal type (ownership). About 50.4% solo practitioners prefer partnership; 2. The numbers of expected dentists: 62.7% solo practitioners expect 2-3 dentists in group practice; 3.Specialty (practice) type anticipated: the first three specialties are periodontics, orthodontics and implant dentistry. 4. Management type: the first two are hiring full time manager to manage and organizing board to manage by partners; 5.Income distribution aspects: the most welcome one is negotiation─fixed salary plus work performance (by percentage or bonus) to distribute. Conclusion: To promote will of participating in group practices by solo practitioners, the suggestions provided by this study for related health service will be propaganda for solo practitioners, modification of related laws of group practice, and clarification of modern tax laws.

並列關鍵字

solo dental practitioner ； group practice ； practice model

參考文獻

林恆慶(2001)。實施聯合執業的利弊得失。中華民國基層醫療協會會訊，9，第四版。 林恆慶(2002)。影響基層醫師不願意參與聯合執業的因素。醫護科技，4(1)，90-103。

鄭守夏、何玉雪(1997)．群體執業與單獨開業醫師生產力之比較．中華衛誌，16(5)428-434。

American Dental Association. (2000). USA Dental Market Data. http://www.ada.org/prof/pubs/advert/media/data.html. American Medical Association. (1996).Medical Groups in the U.S.: A survey of practice characteristics. Chicago. Anonymous, (1996). Doctors flocking to group practices. H&HM: Hospitals & Health Networks, 70, 47. Aspen Health Law and Compliance Center(2001). Medical Group Practice :Legal and Administrative Guide. Gaithersburg : Maryland. Backer, J.R. (1986 ). Group practice in the Netherlands. International Dental Journal, 36(2), 99-101.

Burns LR, DeGraff RA, Singh H. (1999). Acquisition of physician group practices by for-profit and not-for-profit organizations. Quarterly Review of Economics & Finance, 39,465-91.

Freshnock, L. J., & Goodman, L. J. (1980).The organization of phyician service in solo and group medical practice. Medical Care, 18(1), 17-29.