臺灣健保制度：以經濟學迴歸方法分析社區聯合診所醫師收入表現
No Thumbnail Available
Date
2014
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
臺灣所實施的全民健康保險制度不僅有極高的覆蓋率，更提供民眾在改善健康上足夠的誘因，當面對疾病發生時得以有許多不同的醫療選項。然而同時，民眾使用醫療資源所衍生的各式相關費用卻遠超過全民健康保險局目前所能徵收的保險費。相對於小型的社區診所，都會區的民眾在面對緊急的醫療需求和慢性疾病治療，例如高血壓和糖尿病等定期回診，皆傾向在大型醫學中心尋求醫療照護。在全民健保制度下，由於缺乏有效的管理機制，無法在醫學中心和小型社區診所間確實作到疾病分流，醫療服務無法有效率地進行且醫療資源也未能正確分配。為了提供因應的對策，必須建立了一個醫師群得以聯合執業的醫療環境，像這樣的社區型聯合診所的醫療機構型態在臺灣十分少見。根據許多研究結果顯示，社區導向的基層醫療在慢性疾病的治療管理相對上能達到較佳的效果。除了探討慢性疾病治療管理之有效性，如何建立一個財務永續性的醫療機構，也是目前在全民健保制度下重要的議題。在本研究中，我藉由分析評估此聯合診所中個別的執業醫師，來檢視和此診所的經濟表現可能相關的變數。我分析了自民國九十八年至一〇一年間四十個醫師的相關資料，根據迴歸分析的結果，將有助於未來診所醫師招募與合理的醫師薪資結構設計，以期診所醫師們和診所的日常管理作業皆因此獲益。在建置這樣一個社區型聯合診所系統的過程之中，經由這些議題深入探討的成果，我得以認知到如何有效經營管理診所。社區聯合診所的目標在確保這些飽受慢性疾病之苦的民眾，能就近在他們所居住的社區內接受具醫療經驗的醫師所提供的醫療照護，同時因為醫病關係的增進，最終能同時幫助醫師和病患更有效的治療特定的慢性疾病。進而將治療導向預防，這樣的結果是全民健康保險制度設立最原始的目的。
With the high coverage rate, the National Health Insurance (NHI) program in Taiwan has provided people more incentives for achieving improved health when choosing from available forms of medical care during their times of sickness. At the same time, however, associated costs and related expenses currently far exceed the income NHI is able to collect for its services. In urban areas people regularly seek medical care in larger medical care centers as opposed to smaller community clinics both for emergencies and for the routine checkup of chronic diseases such as hypertension and diabetes. Without any effectively managed mechanisms of separation between large medical centers and smaller community run clinics under NHI, medical services are often applied inefficiently and medical resources are not allocated appropriately. As a proposed solution, it is important to build a physician group practice environment in the form of a community united clinic of which there are currently only a few of in Taiwan. Many studies have shown that community-oriented primary care is more effective in the management of chronic illnesses. In addition to this suggested effectiveness of chronic disease management, a financially sustainable model is also desired under the current form of NHI. In this study I have examined possible factors that are related to the economic performance of a clinic by evaluating the individual work practices of physicians in this clinic. Focusing on more than forty physicians from 2009 to 2012, I were able to deduce an empirical model to assist in future physician recruiting and also design a reasonable salary structure, which benefits both the physicians and the daily operations of the clinic. By building up a community united clinic system, I’ve realized more deliberate and efficient outcomes in the ways that the clinic can be managed and operated. The ultimate goal is to keep patients who are suffering from chronic diseases, within the reach of knowledgeable physicians in their communities, which should lead to improved patient-physician relationships and ultimately would better equip both patients and physicians with the ability to effectively treat specific diseases. The outcome of this would bring cure toward prevention, which was an original purpose of the NHI program.
With the high coverage rate, the National Health Insurance (NHI) program in Taiwan has provided people more incentives for achieving improved health when choosing from available forms of medical care during their times of sickness. At the same time, however, associated costs and related expenses currently far exceed the income NHI is able to collect for its services. In urban areas people regularly seek medical care in larger medical care centers as opposed to smaller community clinics both for emergencies and for the routine checkup of chronic diseases such as hypertension and diabetes. Without any effectively managed mechanisms of separation between large medical centers and smaller community run clinics under NHI, medical services are often applied inefficiently and medical resources are not allocated appropriately. As a proposed solution, it is important to build a physician group practice environment in the form of a community united clinic of which there are currently only a few of in Taiwan. Many studies have shown that community-oriented primary care is more effective in the management of chronic illnesses. In addition to this suggested effectiveness of chronic disease management, a financially sustainable model is also desired under the current form of NHI. In this study I have examined possible factors that are related to the economic performance of a clinic by evaluating the individual work practices of physicians in this clinic. Focusing on more than forty physicians from 2009 to 2012, I were able to deduce an empirical model to assist in future physician recruiting and also design a reasonable salary structure, which benefits both the physicians and the daily operations of the clinic. By building up a community united clinic system, I’ve realized more deliberate and efficient outcomes in the ways that the clinic can be managed and operated. The ultimate goal is to keep patients who are suffering from chronic diseases, within the reach of knowledgeable physicians in their communities, which should lead to improved patient-physician relationships and ultimately would better equip both patients and physicians with the ability to effectively treat specific diseases. The outcome of this would bring cure toward prevention, which was an original purpose of the NHI program.
Description
Keywords
全民健康保險制度, 醫師表現評比, 醫師收入, 聯合診所, 社區型基層醫療, 永續醫療, NHI program, physician performance, physician’s income, united clinic, community-oriented primary care, sustainable health care