| 摘要: | 台灣自從於民國八十四年三月實施全民健康保險後，由於醫療費用不斷上漲。成本、品質、可近性是民眾選擇就醫之三大要素，為降低醫療費用，提昇民眾就醫品質，近年來衛生主管機關陸續推動相關策略，其中於民國九十二年三月實施「全民健康保險家庭醫師整合性照護制度試辦計畫」，計畫之施行是希望落實分級醫療和轉診制度，讓基層醫師團隊之醫師發揮家庭醫師弁遄C衛生計畫實施成本P否需考慮實施對象對制度的接受性，並了解各項可能影響因素。
本研究藉由93年度加入南區「家庭醫師整合性照護制度試辦計畫」
之診所醫師進行問卷調查，以了解93年度南區「家庭醫師整合性照護制度試辦計畫」之目標達成率及診所的服務情形、醫師對此試辦計畫的滿意和認同程度，來探討93年度南區「家庭醫師整合性照護制度試辦計畫」之施行成效。
研究結果發現多數醫師表達願意參加及贊成「家庭醫師整合性照護制度試辦計畫」的實施且有92.4%的醫師對「家庭醫師整合性照護制度試辦計畫」感到滿意。從迴歸分析中可了解在「診所特性」中開業年資、醫療資訊系統是否與合作醫院連結、是否建立平行轉診及「醫師特性」中是否為社區醫療群執行中心長、參與「家庭醫師整合性照護制度試辦計畫」動機、是否贊成「家庭醫師整合性照護制度試辦計畫」實施及醫師對「家庭醫師整合性照護制度試辦計畫」認同度都會影響醫師對計畫的滿意度。而影響醫師加入「家庭醫師整合性照護制度試辦計畫」的主要影響因素為病患照護品質、衛生單位宣導家醫、公會或學會宣導及能自我成長等因素。在社區醫療群費用評核指標達成的成效方面會員指定率比會員固定就診率、子宮頸抹片檢查率和成人預防保健率多社區醫療群達成衛生主管機訂定之目標，其中會員固定就診率和子宮頸抹片檢查率都未達到目標值，成人預防保健率達成度也是相當低的，社區醫療群對費用評核指標之成效不好。
研究顯示診所醫師對「家庭醫師整合性照護制度試辦計畫」普遍有不錯的評價，實施計畫後能使病患對健康觀念及醫病關係有正面影響甚至能提升機構間的合作關係，且能使病患更有效利用醫療資源，「家庭醫師整合性照護制度試辦計畫」對提升醫療服務品質確有一定成效。因此，建議衛生主管機關在健保政策形成的過程中必須有規劃完善的配套措施及舉辦教育宣導說明會，讓醫師、民眾充分瞭解「全民健保家庭醫師整合性照護制度試辦計畫」之實施內容、目的之重要性，並且能適時傾聽醫師對計畫的看法，給予回應及改善，讓醫療資源能有效利用，並達到醫師以病人為中心的全人照護。
關鍵字:家庭醫師、醫師看法、滿意度
The National Health Insurance System(NHIS) in Taiwan has been established since 1995. The medicial expenditure has been steadily increased. Cost, Quality, and Accessibility are three major factors to consumers for choosing primary care physicians. The ROC Department of Health carried out the relevant tactics in order to reduce the hospitalization cost and to improve medical quality in recent years. It was implemented of the National Health Insurance System of Family Physician Integrated Care System on March, 2003. The plan is to carry out hierarchical medical care and referral system. Let primary physician's team play family physician's function. Whether the health policies are successful they need to consider the acceptance of the system of implemented objects , and to understand every possible influence factor.
This study used a mailing survey research those clinic physicians who joined the Family Physician Integrated Care System in Southern Taiwan of physicians in 2004. A questionnaire survey was conducted by mailing to objects to understand the achievement rate of target and the service of the clinics, satisfaction and agreement of physicians about this plan, and to discuss the executing effectiveness of this plan.
The result of findings of detection most physicians willing to attend and approved the Family Physician Integrated Care System.And 92.4% of participating physicians feel satisfied to the Family Physician Integrated Care System.The Multiple Linear Regression analysis understand service age ,the medical information system links with the cooperative hospital and set up parallelly referral for the clinic’s characteristic, and administer for the communtiy medical group,participate in the motive for the Family Physician Integrated Care System, agree the Family Physician Integrated Care System implement for the physicians’s characteristic,and physicians’s agreement affect physicians’s satisfaction on the Family Physician Integrated Care System. Patients’ being taken care quality, propaganda of the Health Department and institute society of the physicians in this plan.The community medical group expense index reach the effect aspects, the enrollment rate of healthcare family members reach objectives more than the regular medical visit rate, the examination rate of adult's preventive healthcare services, the cervical smear examination rate. The regular medical visit rate and the cervical smear examination rate have reach the objectives . The examination rate of adult's preventive healthcare services reach the objectives rate is low . The community medical group expense index results are not good.
The results of study show physicians’ views are good appraisal to the Family Physician Integrated Care System. The physicians feel health concept to patients. The relation between physicians and patients have positive affection, even improving the cooperation among the organizations. And patients can utilize medical resources effectively. The Family Physician Integrated Care System for improving medical care quality has certain effects. We suggest that the ROC Department of Health should establish a thorough strategic plan with series of action plans, invite physicians to the conferences and hold meetings regularly.It should be come to that physicians and patients can fully understand about the administration subject matters and the importance of the purpose for the National Health Insurance System of Family Physician Integrated Care System. Timely hearing physician s’ views, and giving response and improvement to achieved patient-centered of holictic health care should to done bypolicy maken health.
Key word : Family Physician, Physician Views, Satisfaction |
