試以相對價值表（RVS）訂定醫師費計算基準－以牙科79個處置為例

Establishing the Relative Value Scale (RVS) of Physician Fees in Taiwan - A Review of 79 Dental Procedures

陳琇玲(Hsiu-Ling Chen) ； 溫信財(Hsyien-Chia Wen) ； 楊志良(Chih-Liang Yaung) ； 張孝新(Hsiao-Hsin Chang)

《中華公共衛生雜誌》 19卷6期 (2000/12) Pp. 411-422

https://doi.org/10.6288/CJPH2000-19-06-02

摘要

目標：本研究圖訂定牙科處置的相對價值表，以作為未來醫師費計算基準。方法：由牙醫師全聯會推薦專家小組，選家問卷調查的處置及四個次專科基準處置。以全體會員為研究對象全層隨機抽樣，德菲（Delphi）法進行二次問卷調查，請樣本醫師依據該次專科基準處置等級估測每個處置的相對值。問卷結果依照各組樣本數比例修正後，由小組專家外推未調查之處置的相對值，再將各次專科之相對值調整為全科相對值共同量表。結果：(1)在問卷結果信效度可接受情況下，探討出79個牙醫師總工作量的相對值。(2)雖未包含執業成本的投入，研究結果與現行健保支付標準表之相關性高。四個次專科中，口腔顎面外科相對值與健保支付標準相關性最高，根管治療科相關性最低。(3)影響牙醫師處置之時間、體力、技術及風險四個構面（dimensions）中，作時間長短並非決定其工作量之主要考量因素。(4)除了「髓腔開擴＋根管治療（三根以上）」外，牙醫師對總工作量之估測，並不會因為執業地點位於城鄉，及執業場所為醫院或診所而有不同。結論：(1)以RBRVS方法適宜探討牙醫師工作評量方法。(2)建立79個本土牙醫師工作量相對價值表。(3)可考慮對目前健保部份處置的支付標準進行修正。

關鍵字

牙醫師 ； 相對價值表 ； 支付標準 ； 醫師費

並列摘要

Objective: The purpose of this study was to establish the relative value scale (RVS) of dental procedures, which may serve as the basis for a dentistry payment system. Methods: Upon the recommendation of the National Dental Association of the Republic of china, a Technical Consultating Group (TCG) was organized to select the Services/Procedures (S/Ps) to be investigated by survey and to establish the basic reference S/Ps for each of the four sub-specialties. After stratified random sampling, the Delphi Technique was used for two rounds of survey. In the questionnaire, we asked the respondents to magnitude estimate the weight of the S/Ps against the base S/P of each sub-specialty respectively. After adjusting the survey results to the sample size, we then asked the TCG to evaluate the results and to estimate the workload of the un-surveyed S/Ps. Finally, we readjusted them to a common scale for all S/Ps of the four sub-specialties. Results: (1)Both the validity and reliability of the survey were acceptable. We have set up a local RVS for 79 dental procedures. (2) Although other factors such as practice costs were not included, the results of the present study correlated well with the dental payment system of the NHI. Of the four sub-specialties, the RVS of Oral Surgery (OS) correlated best with the payment system of the NHI, while the lowest was the RVS of Endodontics (Endo). (3)Time is the least important of the four dimensions of a dentists’ workload. (4)The workload of a dentist is not affected by the location of his practice place, urban or rural, hospital or clinic. Conclusion: (1)It is appropriate to use the RBRVS method to establish a RVS for the workload of dentists in Taiwan. (2)We have set up a local RVS for 79 dental procedures. (3)The NHI dental fee scale for some S/Ps needs to be re-evaluated.

並列關鍵字

dentist ； relative value scale ； payment system ； physician fee