臺灣內科、外科、婦產科與兒科專科醫師人力政策分析

The Policy Analysis of Manpower Shortages in Internal Medicine, Surgery, Obstetrics and Gynecology, and Pediatrics in Taiwan

鄧家佩(Chia-Pei Teng)

指導教授 ： 鄭守夏

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.10793

摘要

2010年監察院黃煌雄委員等人提出，我國醫師人力出現內科、外科、婦產科與兒科「四大皆空」的現象，遂引發社會大眾對於專科醫師人力失衡議題的關注。目前各界對於此議題的現象與原因尚未達成共識，因此，本研究希望藉由政策分析，瞭解此議題的問題嚴重性與急迫程度，分析問題原因並提出可行的改善方案。
透過文獻整理、醫師人力統計資料、醫學生專科選擇問卷調查、民眾就醫經驗調查、教學醫院主管座談與產官學界綜合座談會等方式，本研究認為目前國內四大科專科醫師人力失衡問題，主要是以外科、婦產科與兒科住院醫師招收不足為主，尚未影響到醫療服務的提供與民眾就醫權益，但未來恐有人力不足的隱憂，需盡快擬以對策，防止問題進一步惡化。
造成外科、婦產科與兒科住院醫師人力招收不足的原因有：專科醫師訓練容額數過多、薪資待遇低於期望、少子女化造成服務需求減少等三項市場因素，以及醫療糾紛多、生活品質要求高與評鑑文書作業量大等三項非市場因素。建議政府短期內應先調降專科醫師訓練容額數，並建立配套方案達成「刑責明確化」以減少醫療糾紛，長期則需改善健保支付於各專科間不公的現象，且檢討醫院評鑑目標與規定，同時評估臨床助理制度或其他增加醫療人力方案的適切性。

關鍵字

醫師人力 ； 專科醫師 ； 短缺 ； 政策分析 ； 臺灣

並列摘要

The structure of medical specialists in Taiwan has changed along with social development in the past two decades. The investigation report of the Control Yuan in 2010 indicated the manpower shortage of the 4 major specialties, i.e. internal medicine, surgery, obstetrics and gynecology, and pediatrics, which might lead to a crisis in health care system. However, there was no agreement among stakeholders on the manpower shortage issue. The aims of this thesis were to clarify the situation and causes of the manpower shortage problem, and provide policy suggestions.
This research applied policy analysis methods and collected information and evidence from literature review, questionnaire survey, official statistics, NHI claims data, and expert meetings. We found that the problem of manpower shortage in internist, surgeon, obstetrics and gynecology, and pediatrician were obvious in resident recruitment rather than healthcare services to patients in general practice settings in Taiwan. However, we were worried that the influence might emerge in the near future and the government should take actions to prevent future decline in the inflow of manpower in the 4 major specialties.
Possible reasons associated with the shortage of resident recruitment included 3 market factors: too many training quota, below-expected payment, and declining birthrate. The other 3 non-market factors were increasing medical disputes, higher expectation on quality of life and too much paper works for accreditation. We suggested that reducing resident training quota and established new measures to lessen medical disputes can be done in the short term. In the long term, the health authority should modify NHI payment rates to balance the effort and risk among specialties, revise hospital accreditation criteria and evaluate the feasibility of introducing physician assistant in Taiwan.

並列關鍵字

physician manpower ； specialists ； shortage ； policy analysis ； Taiwan

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