肯亞與台灣醫療資源分配機制之比較： 醫療專業人員知覺與態度的結構方程式模型分析

Comparison of National Health Care Resource Allocation Mechanisms in Kenya and Taiwan: A Structural Equation Modeling of Perceptions and Attitudes of Health Professionals

帕崔克(Patrick Opiyo Owili)

指導教授 ： 許怡欣

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(2012年)

https://doi.org/10.6831/TMU.2012.00134

摘要

背景：肯亞使用一個部長級預算委員會（MBC）和資源分配標準（RAC，以需求為基礎）的公式來分配醫療資源，而台灣使用總額預算分配機制（GBAM，投入基礎）。醫療專業人員在這些不同的國家擁有不同的經驗，因為他們親自體會到醫療資源分配機制對他們工作的影響。
目的：本研究之目的為評估及比較肯亞與台灣醫療專業人員對國家醫療資源分配機制之看法和態度。
方法：本研究使用結構方程模型，比較肯亞和台灣的醫療專業人員對資源分配機制上的知覺與態度。該模型包括五個潛伏構念和九個路徑假說。在肯亞與台灣分別回收 300及299份醫療專業人員所填之問卷，並使用LISREL統計軟體針對模型進行驗證性因素分析。
結果：本研究發現分配機制利益與醫療專業人員的看法和態度密切相關。在肯亞和台灣醫療專業人員之滿意度皆與「分配機制利益」、「正向影響」、「負向影響」密切相關。然而，肯亞有負相關時，而台灣卻呈現正相關。有三個的正相關與負相關直接影響肯亞的整體滿意度，台灣的研究結果顯示，除了分配機制「正向影響」及「負向影響」之路徑假說，其他皆呈正相關，而肯亞則僅在分配機制「負向影響」與分配機制態度有統計上顯著差異。
結論：本研究發現，儘管肯亞運用MBC和RAC方式以達到醫療資源分配，但醫療專業人員認為此對於發展、公平、效率及經濟仍造成負面的影響，其認知、總體滿意度和態度呈現負面看法。而在已實現全民納保的台灣，醫療專業人士對於實施總額預算分配機制有正面的看法。

關鍵字

Resource allocation mechanism ； health professionals ； attitudes ； perceptions

並列摘要

Background: Kenya uses Ministerial Budgeting Committee (MBC) and Resource Allocation Criteria (RAC) formula to allocate health care resources while Taiwan uses Global Budget Allocation Mechanism (GBAM). Health professionals in Kenya and Taiwan have different experiences as they witness the effects of resource allocation mechanism in their work.
Objective: The aim of this study was to assess and compare perceptions and attitudes of health professionals in Kenya and Taiwan on national health care resource allocation mechanism.
Methods: This study compared a structural equation model of health professionals’ perceived impacts and attitudes on resource allocation mechanisms used in Kenya and Taiwan. The model consisted of five latent constructs and nine path hypotheses. 300 and 299 questionnaires were answered by health professionals in Kenya and Taiwan respectively and Confirmatory Factor Analysis using LISREL software was employed to test the model.
Results: It was found that benefits of allocation mechanism are significantly related to perceptions and attitudes of health professionals. In both Kenya and Taiwan, satisfaction was significantly related to ‘benefits of allocation mechanism’, ‘perceived positive’ and ‘perceived negative’ impacts of allocation mechanism. However, Kenya had six significant negative and two significant positive relations while Taiwan had three significant positive and two significant negative relations. Three negative and one positive relation was directly affecting ‘overall satisfaction’ in Kenya contrary to Taiwan that had three positive and one negative relation. The hypothesized path relationships between ‘perceived positive’ and ‘perceived negative’ impacts of allocation mechanism and attitude on allocation mechanism were not significant in Taiwan while only the path relationship between ‘perceived negative’ impacts and attitude on allocation mechanism was not significant in Kenya.
Conclusion: This study found that even though Kenya uses MBC and RAC in the allocation of health care resources, health professionals observed a negative effect on development, equity, efficiency and the economy which results in a negative effect on perceptions, overall satisfaction and attitudes of health professionals while GBAM used in Taiwan has a positive effect.

並列關鍵字

資源分配機制 ； 醫療專業人員 ； 態度 ； 看法

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