總額支付制度下影響基層醫師轉診意願之相關因素探討

Exploring Factors Influencing the Willingness of Primary Care Physicians for Patient Referrals under the Global Budget Payment System

徐仙中(Hsien-Chung Hsu)

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

全民健保自九十一年七月起全面施行總額支付制度，對整體醫療服務業產生重大轉型影響，可見的未來將由治療疾病朝向健康促進，由提供醫療服務走向促進預防保建。健保制度的走向，讓醫療機構間合作服務的轉診制度重受矚目，而分級醫療及雙向轉診互惠制度也勢將再度受到重視。 本研究目的可歸納為以下三點： 一、瞭解基層開業醫師對轉診制度的認知。 二、探討影響基層開業醫師轉診意願的因素。 三、將研究結果提供給衛生政策制定者參考。 本研究以基層開業醫師為對象，共發出問卷2,045份，問卷回收率25.5﹪。研究結果發現，「轉診可以使病人得到持續性的醫療照護」為基層醫師共識、「受轉醫院實施半開放式醫院制度」為基層醫師首選、「指定受轉醫院轉診醫師，比較有利於病人回診」有利於基層醫師取信病人、「轉診可以有效減少醫病紛爭」、「怕病人流失（有去無回）所以不想轉診」、「怕遭受轉醫院的醫師中傷所以不想轉診」醫療院所間相互敬重，有益於彼此形象維護、「限制醫院少看門診」由基層醫師篩選病人，避免醫療資源耗損等變項，影響基層醫師轉診之意願。 對相關機構之建議： 一、IC卡已上路，可善加利用隨時查核病人最新病情，除可避免重複就醫之浪費，兼可有效監測疫病，避免發生如九十一年底以來，漫延全球之SARS疫病風暴。 二、衛生主管機關宜擔責建立全國醫療資訊網，整合轉診相關資訊，批露於官方網站，提供民眾正確可靠醫療資訊。 三、簡化醫療分級，將現行醫療機構自三級改為（教學及非教學）兩級。 四、提供轉診誘因，加重教學醫院的轉診給付，或鼓勵病人如經轉診至教學醫院者，免除病患應自付藥費及檢查費之部份負擔，或加重未經轉診直接就診醫院的病人部份負擔。

關鍵字

轉診 ； 基層開業醫師

並列摘要

Since the Bureau of the National Health Insurance initiated the “Global Budget Payment System” in July 2002, it has created a significant impact on the overall healthl service industry. In the foreseeable future, medical service providers will work from curing illness to disease prevention. The Bureau of the National Health Insurance also highlights the importance of the “Referral System” among medical institutions. The three purposes of the survey were following: 1.Knowing primary physicians’ understanding about the “Referral System.” 2.Exploring factors influencing the willingness of primary care physicians for patient referrals. 3.Providing the study results to health policy makers. The survey subjects were primary care physicians. A total of 2,045 questionnaires were mailed, while there was 25.5% returning rate. The survey showed that the majority of primary care physicians believed that referral can ensure patients to receive medical treatment constantly. Also, they prefer “half-open hospital system.” That “appointing physician helps patients to return” is good for primary care physicians to be entrusted by their patients. That “referral can eliminate malpractice efficiently” benefits both patients and hospitals. Additionally, primary care physicians were concerned that patients may not return once they were transferred or whether physicians of hospitals may insult them. Mutual respects among medical institutions can keep the good images of each other. The factors of primary care physician’s decision of referral their patients lie on the restraint on hospitals’ clinical service, the avoid of the waste of medical resources, and so on. Suggestions for related authority: 1.IC circuit card should be put into effect as soon as possible, which helps to follow the card holder’s latest physical condition. In addition to avoid the waste of providing the repeat services by receiving hospitals, the card helps to monitor diseases. Therefore, severe epidemic such as the worldwide outbreak of SARS can be traced and avoided. 2.Health authority should be responsible to build up a website of the national medical service information network which integrates the referral information. 3.Medical service level should be simplified. The current three-level system should be changed to two-level system. Medical institutions should be categorized into teaching (referral hospital) and non-teaching (front-line medical providers). In that case, referral system can be carried out in an easier way. 4.Health authority should provide more incentive for referral. For example, the referral payment should be raised so patients don’t have to pay for co- payment such as medicine and check-up fee. Or, the co- payment for patients who receive medical service without being transferred should be raised.

並列關鍵字

Referral system ； Primary care physicians

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