醫院薪資管理對醫師服務品質影響之探討

A Study on the Impacts of Hospital Compensation Management on the Quality of Physician Services

白居正(Bai Ji Zheng)

指導教授 ： 林小嫻

亞洲大學/健康學院/健康管理研究所/碩士(2003年)

摘要

本文乃參考實證文獻而進行邏輯理論分析，探討現況下醫師服務品質問題，及其與醫院薪資管理的關係。醫療服務存在著產出有風險及品質不能衡量，尤其是需及早預防及時診治之健康維護而言，醫師服務的優劣對醫療服務品質或機構產業整體的效率具關鍵性，因此，醫院之醫師薪資結構設計須有所因應調整。再者，在台灣封閉式雇傭關係下，支付制度以論量計酬為主下，醫師費抽成制度造成醫院資本投資及醫師薪資費用財務混淆，而醫院以
增加服務擴大市場佔有為競爭策略時，醫師專業自主嚴重受限以致病人權益受損。醫師薪資的高度誘因性所造成現象如：醫師超時工作、過度醫藥化及侵入性治療、誘發大型化資本服務投入、片段性看診與醫療糾紛，不僅浪費醫療資源且不符合成本效益。當消費者之搜尋經驗無效且品質之量化指標受限，醫院領導者能否自主帶領專業品質文化，改善醫師服務之薪資結構。探討醫院提高薪資報酬之變動薪的有效性，醫院應考量如何藉由風險分擔來克服員工控制外因素之風險，本文運用當事人代理人模型，詮釋努力無法觀察，面臨激勵與風險的平衡問題時，如何制訂最適有效薪酬契約。此理論分析的意涵之一是，當醫師品質投入無法觀察與醫療產出品質不易衡量，即應降低變動薪，以確保品質。最後，本文就組織及制度面提出，改變薪資結構領導品質文化，注重醫師服務品質改革支付制度之建議。

關鍵字

不確定性 ； 醫師服務 ； 品質 ； 薪資結構

並列摘要

This article is done through the theoretical and logical analyzing of secondary data, to probe into the current problem of the quality of physician services, and its correlations with hospital compensation management.
In view of preventive and timely treatment to maintain health by the clinical service, there are certain key issues that have brought about potential risks and unsteady quality for the medical serves. A case in this point is that the efficiency of a clinical institution would influence the quality of physician services.
To count this problem, it would be quite necessary to adjust the hospital compensation structure for physicians. Further, due to Taiwan’s employing engagement tendency as a ‘closed system’, physicians are paid on the fee-for-service basis. Such commission schemes would habitually confuse and stir up hospital’s capital investment with physician salaries. More often than not, especially when the hospital deploys market-expansion as its main management
objective and strategy, physician’s professional opinion would be jeopardized, and hence risking patients’ well being.
In fact, the commission to physicians as incentives would result in the following phenomenon: physicians work over time, too many medicine prescriptions than necessary, inducement of commercialized service, discontinuous diagnosis and clinical services, and disputes on clinical treatment. Consequently, When consumer’s experience are failed and index of quality are limited. would the leading management of the hospital be actively seek professional quality culture, adjust the compensation structure.
This article would also investigate the effectiveness of increasing floating commission in physician fee, and how should a hospital apply risk sharing to reduce each individual employee’s jeopardy under uncontrolled factors. By using Principal-Agent Model, this article attempts to explicate the best possible way to organize a compensation structure, when it was hard to observe and face with the question of stimulation and risk sharing , how to make the optimal effective compensation contract. This article contends the idea that when the physician’s quality input is not balanced and corresponding to treatment output, the floating commission should be reduced accordingly. In terms of organization and medical institution, this article suggests a change on compensation structure that would pave the way for quality service assurance and emphasis on physician service quality from reform the payment system.

參考文獻

財團法人醫院評鑑暨醫療品質策進會(2003)。醫療品質指標計畫。上網日期：

郭信志、楊志良(1994)。醫師目標收入理論之試證。中華衛誌，13(2)，149-154。

許士軍(1999)。管理學。東華書局。

行政院衛生署統計室(2001)。衛生統計重要指標。上網日期：2003年5月22日

行政院衛生署統計室(2001)。衛生統計重要指標。上網日期：2003年5月22