台北市某醫學中心主治醫師績效獎勵金制度之研究

Abstract

本研究以回溯性方法，分析個案醫院於民國85年7月實施主治醫師績效獎勵金制度前後，醫院各項服務、教學、研究指標變動之情形。績效獎勵金之發放，在個案醫院年度財務不虧損的前提下，由門診、住院及急診醫師診療費按月提撥，以15%為上限，主治醫師個人績效獎勵金係依執行治療處置之給付單價及數量，乘以不同提成數加權計算，平均每位主治醫師績效獎勵金佔個人薪資所得約為30％至40％。 獎勵金制度實施之後，主治醫師離職率與制度實施前相當。服務績效方面，平均主治醫師診治人次微幅成長，整體醫院營收額持續成長，成長速率較同儕稍高，醫療本業餘絀則明顯改善，達統計學上顯著差異，惟醫療品質指標並未下降。由於主治醫師員額成長，制度實施之後，平均每位主治醫師所負擔之臨床教學學生人數下降，然而主治醫師平均SCI論文發表篇數在制度實施之後顯著增加，顯示研究績效並未遭受服務績效排擠。 獎勵金制度之實施，使得主治醫師整體薪酬增加，降低外部不公平性，提升主治醫師人事穩定因素，而獎勵金之發放依績效基準變動，不僅提供員工激勵誘因，亦提供組織策略管理依據。惟變動薪酬佔率相對較低，對主治醫師內在激勵負面影響較少。績效評估以輸入因素為主，不考慮個人輸出成果，其利弊互見。面對健保給付制度之異動，及新世代績效發展觀念之演進，原有主治醫師獎勵金制度實有定期檢視與創新變革之必要。

This retrospective study aimed to analyze how the visiting staff performance bonus system implemented since July, 1996 affect the hospital under study from various perspectives including service, teaching and research. The principles of the performance bonus system are: 1. there is no deficit in the fiscal year. 2. total bonus is calculated from 15% of monthly revenue (drugs and materials excluded). The amount of bonus depends on doctor’s individual medical service procedures, such as out patient service, inpatient service, emergency service and operation…..etc. In average, the bonus amounts to 30%-40% of a visiting staff’s total salary. The rate of resignation of the visiting staff did not differ much after the new system. However, the doctor’s productivity, the hospital revenue and financial benefit improved, at a slightly higher rate than peer hospitals. The quality of medical care kept going well. The average teaching load decreased. It could be ascribed to the fact that the number of visiting staff had increased. On the other hand, the number of publication in the Science Citation Index journals increased significantly after the implementation of the system. Research efforts were not adversely affected by the increased service. The doctor’s total salary in the studied hospital increased a lot after the bonus added, diminishing the perception of inequity of visiting staff compared with other hospitals and accordingly stabilizing their turnover rate. Performance-based bonus system provides not only motivation for the doctors, but also guidelines for the management to implement objectives from an institutional perspective. Relatively less extrinsic reward in the studied hospital is positive for the internal motivation of the employees. Inspecting and revising the bonus system periodically is necessary, particularly in the face of dramatic evolution of the national health insurance and in a new era of performance development for the employees.