全民健保對各科醫師消長影響之初探

The Impact of NHI Payment System on Manpower among Medical Specialties in Taiwan

張友珊(Yu-Shan Chang) ； 楊志良(Chih-Liang Yaung)

《中華公共衛生雜誌》 18卷2期 (1999/04) Pp. 123-137

https://doi.org/10.6288/CJPH1999-18-02-06

摘要

全民健保實施後，不少醫界人士及醫務管理人員反應，各科間住院醫師的招收情形有明顯之變化。本研究藉由蒐集健保實施前、後各科醫師人力之相關資料，與健保實施後各科費用申報情形進行比較，以探討費用申報金額高低對醫師選擇執業科別之影響。研究結果顯示，健保各科申報費用、件數與醫學中心各科住院醫師申請人數與錄取人數之消長，及設置診所家數之變化相關性最高，各專科醫師人數之消長則次之；各科間醫師數的增長又以復健科、家庭醫學科、小兒科、眼科、耳鼻喉科、皮膚科尤為明顯。根據研究結果，健保對各科醫師支付金額之高低，具有引導醫學生對日後選擇行醫科別及設置診所科別之作用。雖然財務誘因並非影響各科醫師人數轉移的唯一因素，但其所產生之衝擊值得注意。為免長期以往影響醫療生態之正常發展，建議有關單位於調整支付標準或改變支付制度時，需更加重視科別間平衡發展之考量。

關鍵字

健康保險 ； 支付制度 ； 醫事人力 ； 專科

並列摘要

Since the implementation of National Health Insurance (NHI) program in 1995, hospital executives and medical professional groups have constantly complained about the dilemma in recruiting physicians for certain specialties. To confirm this unbalanced supply in medical manpower, we reviewed and analyzed data on the patterns of demand and training in medical specialties and the growth of practitioners before and after launching NHI. Changes, in numbers of practitioners and health care institutions and reimbursement claims between 1992 and 1997, were compared by specialty to determine whether the NHI payment policy has exerted influence on medical graduates in their career decision. The results showed significant variations amongst all specialties in both monetary reimbursement and number of claims filed to NHI. A significant correlation between the payment policy and the number of resident applications, by specialty, among medical centers was observed as well. Newly established clinics were thus varied by specific specialty. Compared with the number of clinics available by specialty in 1992, the largest growth in specialty until 1997 was Rehabilitation (93.3%), followed by Family Medicine (22.1%), Pediatrics, Ophthalmology, ENT and Dermatology. There was only 1.0% of growth in surgery. The NHI payment schedule did affect both medical graduates' career decisions and the growth of clinics in selected specialties. Although financial incentive was not the only factor influencing the medical manpower structure among all specialties, its impact can not be overlooked. The results suggest that the NHI should carefully review and consider a balanced development across all specialties before any change or reform of the payment system can be undertaken.

並列關鍵字

Health insurance ； payment ； medical manpower ； medical specialty