醫療給付改善方案是否影響醫師照護行為-以糖尿病為例

Abstract

中央健保局於2001年11月推行「糖尿病醫療給付改善方案」，希望藉由提供財務誘因的方式引導醫師改變照護行為，提供病患高品質有效率的服務。 本研究以「糖尿病醫療給付改善方案」中，糖尿病病患執行十項重要檢查檢驗的次數與是否遵循「糖尿病醫療給付改善方案」建議之年度進行檢查檢驗次數為門診照護品質指標，探討醫療給付改善方案對醫師照護行為之影響。 本研究主要結果如下： 1. 在收案前一年，參與「糖尿病醫療給付改善方案」之醫師其下病患的門診照護品質優於未參與該方案醫師其下病患，實驗組與對照組三組的門診照護品質有顯著差異。 2. 參與「糖尿病醫療給付改善方案」之病患，其收案後一年的門診照護品質較前一年顯著提升，顯示該方案確能改變醫師照護行為。 3. 受參與「糖尿病醫療給付改善方案」的醫師照護之未收案病患，其收案後一年的門診照護品質較前一年顯著下降，顯示參與該方案之醫師可能專注於收案病患之照護而忽略其未收案病患。 4. 受參與「糖尿病醫療給付改善方案」的醫院中未參與收案的醫師照護之病患，其收案前後年度的門診照護品質進步情形較未參與收案醫院照護之病患為佳，顯示參與「糖尿病醫療給付改善方案」的醫院對品質意識的提升較未參與收案的醫院為高。

The Bureau of National Health Insurance (BNHI) implemented ‘the Pay-for-performance program for diabetes’ in November 1, 2001. Goal of the program conducts health care providers to supply efficient care services by offering financial incentives. This study used ‘the frequency of 10 important examinations’ and ‘whether patients followed schedule of guideline to complete 10 important examinations’ as the indicator of quality of care for diabetic patients, and evaluated the influence of ‘the Pay-for-performance program for diabetes’ on physician practice. The main finding of the study were concluded as below： 1. In base year, compared with the patients cared by physicians not participating in this program, the others had better quality of care. Moreover, there was significant difference among four groups. 2. The diabetic patients participating in the program had significant improvement in quality of care after one year of participation. The result showed that ‘the Pay-for-performance for diabetes’ influenced physician practice. 3. The non-enrollees cared by physicians participating in the program had significant regression in quality of care after one year of participation. The result showed that the physicians participating in this program may focus on the quality of care of enrollees so ignored non-enrollees. 4. The quality of care of non-enrollees cared by the hospital participating in the program improved much than non-enrollees cared by the hospital not participating in the program after one year of participation. The result showed that the hospital participating in the program became more conscious of quality of care than the others.