西醫基層總額預算制度對民眾就醫可近性之影響
Date Issued
2002
Date
2002
Author(s)
楊銘欽
Abstract
目標：瞭解西醫基層總額支付制度實施後，保險對象在醫療服務的利用上按城鄉區分其可近性是否有提升或下降，並探討其提升或下降的因素為何，進而提出具體可行之建議。方法：分別從供給面及需求面蒐集資料。在民眾意見調查方面，由民國90年8月接受由國家衛生研究院及國民健康局共同執行之「國民健康訪問調查」之民眾進行抽樣，於民國92年4月26日至5月5日進行電話訪問，共完成3,034份問卷調查，完訪率約為76％；深度訪談則是自「全民健康保險基層總額支付制度執行委員會」選擇12位醫師（包含六個分區）為訪談對象；次級資料分析則是取自民國88年底至91年底特約基層診所數及基層醫師數。
結果：在民眾醫療服務利用之可近性方面，由民眾意見調查及醫師訪談的結果得知，城鄉之間的民眾在就醫的方便性及交通時間上雖然有達到統計上之顯著差異（即城較為方便），但受談醫師普遍認為一部份是城鄉間交通便利與否所造成的差異，另一方面則是目前台灣地區民眾在醫療服務利用上應已無可近性之問題，亟待解決的則是更為偏遠的山區及離島較缺乏醫師前往服務的問題。而從每萬人口特約基層診所數及醫師數的成長趨勢來看，西醫基層總額支付制度實施後，城鄉均有所成長，其中鄉的成長幅度略高於城，對於民眾在醫療服務利用的可近性上是有所提升的。
建議：根據本研究之結果，提供衛生主管機關以下之相關建議：1）再評估醫療資源缺乏區服務獎勵措施，以便讓較多的鄉鎮地區納入獎勵範疇，進而提昇民眾醫療服務利用的可近性；2）建立雙向轉診制度，將有助於提供民眾高品質的醫療服務；3）適度修正支付標準，以反映科別成本的差異，避免影響民眾在專科醫療利用的可近性；4）健保局儘早提供申報相關資料，以利於執委會或各區委員會分析，提供決策之參考。
ABSTRACT
Objective: The purposes of the research were to examine the effects of the global budget system of primary care on the changes of accessibility of medical care in urban and rural areas. And to investigate the reasons that caused the differences of the accessibility of medical care between the urban and rural areas. Finally, we will draw up suitable suggestions to the Bureau of NHI according to the research outcome.
Method: Data were collected from supply and demand side. In terms of demand side, data were collected by telephone interview from April 26 to May 5, 2003. We had completed 3,034 questionnaires and the respond rate was about 76%. In terms of supply side, we interviewed 12 key members in the Executive Committee for Global Budget System of Primary Care to get the in-depth information. In addition, we analyzed the profiles of clinics and doctors of primary care from the NHI in 1999 to 2001.
Result: Regarding the accessibility of medical care and the traffic time, the urban areas had significantly better accessibility. The physicians who were interviewed thought that this has something to do with the traffic conditions were better in urban areas; and it is of great urgent that the remoter mountains and islands are in need of primary care doctors. From the profiles of clinics and doctors of primary care, the numbers of clinics and doctors pre ten thousands population in rural area increased more rapidly than that in the urban areas. We believe this can help improve the accessibility of medical care in the rural areas.
Suggestions: According to the study results, we provide the bureau the following suggestions: (1) to re-evaluate the reward plans for underserved areas in order to make more villages and townships eligible; (2) to establish two-way referral system which will be helpful for improving the quality of medical care; (3) to modify the payment schedule to reflect the cost of practice in different specialties; (4) the bureau of NHI should provide claims data to the Executive Committee for Global Budget System of Primary Care or Regional Committees as early as possible in order to make better decisions.
Subjects
總額預算
可近性
全民健保
Description
DOH91-NH-1022
Type
report