全民健保總額預算制度對於基層醫療院所經營之影響 —以牙醫診所為例

Abstract

全民健保總額預算制度影響國內各大醫療院所的經營與發展模式，對於依賴全民健保點數申請的基層診所，更是左右其營運的方式與成效。本研究利用質化訪談的方式，針對牙醫診所的負責醫師（院長）與受僱醫師進行詢問，以探討總額預算制度對於基層醫療院所之影響。 研究結果顯示，全民健保總額預算制度對於基層醫療院所的影響可以就顧客價值主張（顧客服務的建立、完整服務的提供與口碑推薦的產生）；利潤模式（健保門診治療申報總量的控制、營收模式的建立）；關鍵資源（服務品質的訓練、醫療聯盟的發展、醫療品牌的建立）；特殊流程（營運模式的轉型、目標客群的建立、自費診所的發展、專科經營的趨勢）等4個項目、12個影響方向。期待本研究的結果能提供後續想經營醫療院所的醫師參考，並能夠提高其經營的績效。

The Global Budgeting of national health insurance affects medical units in Taiwan, especially primary special clinics. We had interviewed 13 dentists (both employers and employees included) with quality research method to clarify the influence of the Global Budgeting to dental clinics. The result reveals the Global Budgeting affects the operation of dental clinics by 4 items (Customer value proposition, Profit model, Critical resources and Special processes) and 12 aspects (Customer servicing established, complete services provided, oral spreading; Control of total revenue from health insurance, New revenue model established; improvement of service quality, Medical alliance developed, Medical brand specified; Change of business model, Target customers marketing, Self-pay clinics developed, Business model of dental subspecialty treatment). We expect the result of this study could give advisement to those who want to open new clinics.