牙醫師對牙醫門診總額支付制度認知,態度及執業實務調查分析-高屏區為例

中文摘要為瞭解自民國八十七年七月牙醫界率先試辦全民健保牙醫門診總額支付制度以來，高屏區牙醫師對相關議題的看法，乃以《牙醫門診總額支付制度認知、態度及臨床實務調查分析》，對全民健保高屏區的牙醫師問卷調查。以高屏區所有牙醫師為母群體，採郵寄回收樣本。樣本資料經由Excel軟體鍵入存檔，以JMP作統計分析，並以次數分配、百分比、描述性統計、t-檢定、Pearson相關係數矩陣、ANOVA及逐步複回歸分析來處理。分析結果顯示：(1)高屏區牙醫師80.3%為私人獨資院所，94.7%為一般牙科，執業年數6-20年者佔65.9%，每週工作時數31小時以上者佔96%，每日看診人數11-30人者佔78.6%，自費收入為健保收入50%以下者佔80.5%，受過教學醫院住院醫師訓練者佔43.9%，院所地址在"市"者佔77.3%，在"鄉"者佔17.4%。 (2)聘用牙醫助理2位以下者佔79.5%，贊成認證者41.7%，反對者為37.9%，助理工作以行政事務同意度最高佔95%，同時有58.8%的牙醫師不擔心口衛系畢業生會競爭醫療資源。(3)對牙醫門診總額支付制度認知度低，以支付金額計算認知度較高，幹部遴選單位認知度最低。(4)對目前支付制度的滿意度，態度持平，其中以對健保局服務態度、申報與核付流程滿意度較高，對預算成長率、保固期延長、審查結果滿意度較低。(5)與先前支付制度比較滿意度，態度持平。以能增加保健服務動機、促成電腦輔助審查、病歷書寫同意度較高，對能促進內部和諧同意度最低。(6)對牙醫師控管模式的變革措施整體偏向同意，其中以電腦輔助審查，高額折付，偏遠地區專款補助，實地訪查，檔案分析，快速通關及合理門診量等項同意度較高，對工時表或三聯單控管的同意度較低。(7)牙醫師不同特質(含年齡、性別、住院醫師訓練、院所地域性、有否擔任過幹部、收入、公會別)的差異性：1.在認知方面：以擔任過幹部者，40-49歲，收入30-40萬點，及澎湖縣的牙醫師較高；2.對現行制度滿意度及與先前制度比較，有愈年長愈滿意的傾向，其中澎湖縣高於其他縣市；3.對變革措施同意度：幹部高於非幹部，其中澎湖縣最高，屏東縣最低，鄉的院所同意度亦低。以上結果，顯示牙醫界仍應努力的方向為：(1)加強全民健保相關議題的認知。 (2)持續推動口腔衛生教育。(3)團隊醫療結合助理人員，提升品質。(4)自費項目，仍有努力的空間。(5)內部的執行方向，要考量不同特質的差異。(6)對滿意度高和滿意度的控管項目，要探討其恰當性與合理性。(7)對管理階層幹部，加強研討訓練課程，有助於凝聚共識。關鍵字：總額支付制度、認知、態度、臨床實務、滿意度、同意度

關鍵字

總額支付制度；認知；態度；臨床實務

並列摘要

ABSTRACT The purpose of this study was to understand the knowledge、attitude and practice (K.A.P) of the dentist (kaohsiung-Ping Tung area) toward the dental global buget system (GBS). Data were collected by mailing questionnaire. The statistical analysis was conducted by Excel and JMP software, and the description by Frequency, Percentage, Descriptive, Chi-square, t-Test, ANOVA, Pearson's Correlaton Coefficient Matrix and Multiple stepwise Regression Analysis etc. The Result of this study reveal (1)private dental office: 80.3%, general practice: 94.7%, experienced years (6-20 years):65.9%, working hour per day (over 31 hours): 96%, patient number per day (11-20 patients): 51.9%, patient-provided income (less 50% insurance income): 80.5%, trained resident: 43.9%,region (city): 77.3%. (2) Dental assistant (less than 2 persons): 79.5%, license need (agree: oppose): 41.7%: 37.9%, rsource competetion (non worry: worry):58.8%: 29.8%. (3)The knowledge of GBS: level was low. (4)The satisfaction degree of GBS and the satisfaction degree of comparison with previous system, all were near fair. (5)The agreement degree of control model: were higher than fair, computer aid check, percentage payment, remote region aid, resonable quantity. Those item's satisfaction degree were higher than fair, payment increase rate, controlled list, those agreement degree lower than fair. (6)The difference of the characteristic (include: age, sex, resident trained, region, cadre experience, income, different association), (1)the knowledge level of GBS: cadre members, 40-49years old, incom (0.3-0.4M) and penghu county was higher than the others. (2)The satisfaction degree of GBS and comparison with previous systems: the older dentists and penghu county were higher than younger and other area. (3)The agreement degree of the control models: cadre members and penghu county were higher than others, the dental office on Ping-Tung and country side were lower than other area. It was encouraged that: (1)Enhance the knowledge level of GBS. (2) Keep the dental public education. (3)Combine the dental assistants to increase medical quality. (4)To create the patient-provided allowance. (5)Pay attention to the difference between different characteristics. (6)Be aware of the items of different satisfaction on control models. (7)Leader members need reinforce the discussion and training course that will be a benefit to the goals. Key word: Global budget system (GBS), knowledge, attitude, practice, satisfaction degree, agreement degree.