大台中地區基層醫師委託檢驗機構代檢需求與相關因素之研究

委託代檢服務乃是因應基層醫療院所突破儀器設備不足及成本因素等限制的策略之一。而總額支付制度的實施及九十一年九月新制部份負擔的調整，更有助於在大醫院就診的病人回流到基層診所，基層醫師對於檢驗服務的需求將與日俱增。因此本研究之目的在於探討：1.目前基層醫師對於代檢的需求、2.基層醫師對於實施代檢的現況、3.委託代檢的因素、4.影響基層醫師對於代檢的選擇因素、5.基層醫師對於代檢單位的滿意度，以作為未來日後政策上思考方向之參考。本研究以台中市及台中縣之一般科、內科、外科、婦產科、小兒科、家醫科科別的健保特約基層院所為對象，依地區、科別系統隨機抽取386位基層師為研究樣本，以電話訪問或人員問的方式進行結構式問卷調查，回收有效樣本124份，回收率為32.12%。研究發現有78.23%的基層醫師目前有委託代檢的情況，考慮委託代檢機構的因素中以成本考量、儀器設備不足為主要考量因素；執業科實施代檢的比率明顯高於其他科別；委託代檢的對象有69.07%是醫事檢驗所。此外，有77.32%認為委託代檢對於診所業務有提升，在整體滿意度的調查結果顯示基層醫師對於目前代檢單位感到滿意。

關鍵字

委託代檢；基層醫師；合作策略

並列摘要

General practitioners facing equipment limitations and cost concerns inevitably turn to contracted laboratory services as a solution. After the implementation of the new payment policy (global budget and adjusted co-payment regulations) in 2002, most patients will likely prefer visiting clinics rather than hospitals for their outpatient services. Demand for contracted laboratory service thus will increase. For future policy-making reference, this study identifies the followings: current demand for contracted laboratory services by general practitioners, utilization of contracted laboratory services, factors related to the utilization of contracted laboratory services, factors influencing the utilization of such services by general practitioners, and extent of satisfaction with contracted laboratory services. The sample in this study comprises general practitioners offering services related to general practice, internal medicine, surgical medicine, obstetrics, pediatrics, or family medicine. Totally 386 general practitioners were randomly surveyed using a structured instrument and 32.12% successfully completed the questionnaire. The result demonstrates that 78.23% of general practitioners adopt contracted laboratory services because of cost concerns and equipment limitations. Among all primary care clinics, obstetric physicians are the heaviest users of contracted laboratory services. Notably, 69.07% of all contracted laboratory services are provided by non-hospital laboratories. Moreover, 77.32% of general practitioners consider contracted laboratory services helpful for their outpatient business, and most (67%) are satisfied with these services.

並列關鍵字

Contracted laboratory ； general practitioner ； corporate strategy

參考文獻

Halm, E. A.,Causino, N.,Blumenthal, D.(1997).Is gatekeeping better than traditional care: a survey of physicians` attitudes.Journal of the American Medical Association (JAMA).278(20),1677-1681.