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  • 學位論文

醫師對於聯合執業之認知、態度與其行為之研究-以台北縣為例

On the Knowledge, Attitude and Practice(K.A.P.)Survey of the Taipei County Physicians’ Group Practice.

指導教授 : 蘇喜
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摘要


台灣基層醫療長期以來的經營模式大多數以單獨開業為主,醫師單打獨鬥的執業方式,在面對近幾年來的重大變革,如醫院大型化、全民健保財務的緊縮、精密儀器的購置費用昂貴加上消費者教育水準的提高、消費行為與習慣的改變等因素刺激下,國內基層醫療不得不重新規劃更適合現況的經營模式。從國外的文獻中得知,聯合執業模式可以提升醫療服務品質、增加醫療可近性、節省醫療成本,更可改善醫師的醫療水準與生活品質。 因此本研究針對台北縣地區醫師進行探討,包含如下之研究目的: 1.瞭解醫師在聯合執業議題上的認知與態度; 2.瞭解醫師在聯合執業相關行為的選擇; 3.探討影響醫師在聯合執業議題上的認知、態度與行為的相關因素; 4.分析醫師在聯合執業議題上認知、態度與行為間的關係。 本研究採問卷調查法,探討醫師對於聯合執業的認知、態度及其選擇行為之影響,聯合執業定義為二位或二位以上醫師所組成之正式組織,用於提供諮詢、診斷及治療等醫療服務,並可共同使用儀器設備與人力資源。針對登錄執業地點在台北縣的5003位醫師進行郵寄問卷調查,有效回收問卷1008份,有效回收率為20.15%。回收之有效樣本與寄發之研究對象經適合度檢定後均沒有顯著的差異,顯示回收有效樣本對寄發研究對象之代表性良好。 將回收問卷之資料區分為個人特質、對聯合執業的認知與態度、對外在條件的不滿程度、行為選項四種分類,進行分析。本研究結果發現:對於聯合執業的定義及優缺點之瞭解程度,有九成以上的醫師表示瞭解。在參與聯合執業的意願方面,則有超過六成的醫師表示願意。 台北縣的醫師對於聯合執業的定義、好處以及相關規定,具有高度的認知得分。但在聯合門診的詳細規定與有關的稅務詳細內容則較不清楚。 在聯合執業的態度問題經過因素分析後,可以區分為「外在激勵因子」、「個人感受因子」、「法令規章因子」三項,台北縣的醫師對於此三項因子皆傾向贊同的態度。 在選擇行為的比較中,大多數的醫師表示希望與不同科別的醫師共同合作;並且是以共同當老闆的模式來處理聯合執業的所有權以及經營管理的方式;收入的分配方式注重績效,而花費的負擔則認為應該由醫師來共同協調訂定。 根據研究結果的發現,本研究提出以下建議:(一)衛生主管機關應對聯合執業的相關法令規定多加宣導,並配合成功案例之說明,以解除醫師之疑慮。(二)建議衛生主管當局取消聯合門診及聯合診所的名稱,而統稱為聯合執業;並修改現行的法律條文,以增進醫師參與的誘因。(三)由於聯合執業的創立不少,但能夠長期維持經營者並不多,因此建議後續的研究者可以加入探討聯合執業的成功關鍵因素。

關鍵字

聯合執業 態度 行為 認知

並列摘要


The solo practice has been a major operation model for the majority of physicians’ clinics for a long time. Lately the operation of solo practice by physician has become difficult because of the prosperous development of hospital, tightness of national health insurance financing, expensiveness of medical apparatus, the increasing of consumers’ educational level, the changes of the consumers’ behaviors and habits, and etc. Group practice can improve comprehensiveness quality of physicians’ treatment and service, increase patients access and reduces medical costs. Moreover, group practice elevates the level of medical treatments and improves quality of physicians’ life. This study is aimed to explore the following issues: 1. To understand the physicians’ knowledge and attitude on the issue of group practices in Taipei County. 2. To understand the physicians’ choice on the group practice behavior. 3. To explore factors related to physicians’ knowledge, attitude and behavior in the issue of group practice. 4. To analyze the relationship among the physicians’ knowledge, attitude, and behavior in the issue of group practice. This is a survey research that discusses the physicians’ knowledge, attitude and behavior in group practices. The definition of group practices is the provision of health care services like consultation, diagnosis and treatment by a group of two or more licensed physicians engaged in a formally organized and legally recognized entity. It also can joint use of equipment and manpower. The research population of this study were 5003 physicians registered at Taipei County, 1008 among the 5003 physicians censored responded(20.15﹪response rate). The goodness of fit tests between the subjects and population show that the subject represents the population well. Data was analyzed by four subsets including demographical characteristic, knowledge and attitude toward group practice, complaint, and practice behavior to serve the purposes. As to the understanding level of definition and advantage disadvantage of group practice, more then 90﹪of respondents expressed understanding, and more then 60﹪of respondents expressed willing to participating group practice. The physicians of Taipei County have high grade on knowledge of definition and advantage disadvantage, and related laws of group practice, except financial affairs. Physicians toward for attitude group practice, by factor analysis, three factors such as “prompting factor”, “personal feeling factor”, and “law factor were dentified”, and the physicians endorsed the attitude questions. On the practice behavior choice, most physicians hope for working with different doctors, sharing out the ownership and management, distributing income based on performance, and sharing cost through consensus building. Three suggestions were made according to research findings. First, the health authorities should communicate more about laws of group practice, and answer the physicians’ worries and anxieties by successful case. Second, the health authorities should legislate some laws to give providing experience physician incentives in participating group practice, and integrate all appellation into group practice. Finally, the study also suggests that future study discuss key successful factors.

並列關鍵字

practice knowledge group practice attitude

參考文獻


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被引用紀錄


胡文萍(2007)。主治醫師對畢業後一般醫學訓練計畫的認知與態度〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2007.00068

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