| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學研究所碩士在職專班 === 91 === Objective：It has made a big change on Western physician clinics after implementing the Global Budget Scheme. The aim of this research is to explore the changes on the quantity of outpatient medical service of clinics and on physicians’ practice, management strategies, satisfaction in the same one year before and after the Global Budget Scheme being inaugurated by analyzing the objective claim data and physician’s subjective questionnaire data in Kaohsiung city.
Materials and methods：Bureau of National Health Insurance Kao-Ping Branch’s File of Outpatient Medical Expense was employed among primary Western physician clinics in Kaohsiung city from July,2000 to June,2002. The other, total 906 clinic doctors registered in Kaohsiung City Medical Association at 2002 were investigated by questionnaires. All of the objective and subjective results are used to compare the changes about the claim data and physicians’ practice, management strategies, satisfaction toward the Global Budget Scheme by statistical program using the SPSS 10.0 software.
Results and discussions：In objective claim data, the average of medical expense per capital increases significantly after implementing the Global Budget Scheme，from 443 to 464 dollars，but the quantity of other medical services do not change significantly. Physicians’ practice including special case rate, chronic disease case rate, outpatient surgery rate and prescription releasing rate all increase significantly. In physicians’ prescription behavior, only the amount of drugs prescribed increases significantly from 3.9 to 4.1 days. The average of drug fee per day and per capital both decrease significantly from 30.5 to 26.4 dollars and from 118.8 to 107.5 dollars separately. In physician’s subjective questionnaire data, total 873 questionnaires were sent to clinics and 628 questionnaires were completed. The response rate is 71.9 ﹪. More than 50﹪physicians answer 「no change」to most evaluation items in the questionnaire. But there are significant correlations between evaluation items and four physician’s characteristics including age, total years of operation, professional expertise and the number of physicians in clinic after taking the questionnaire data into chi-square test.
Conclusions and suggestions：The effects of Global Budget on clinic physicians’ practice, management strategies and satisfaction are not change according to the questionnaire data, but the objective claim data reveal that there are significantly changes in the average of medical expense per capital ,physicians’ practice and prescription behavior. So it changes the medical behavior of clinic physicians by correcting the ”fee-for-service” practice progressively and elevates the appropriateness of prescription and increases the abilities of management strategies and the satisfaction also does not decrease after implementing the Global Budget Scheme. It is suggested that the authority continues to monitor the effect of decreasing medical input by clinic physicians .In addition, the authority also needs to purchase if there are any illegal problems or damage to medical quality or increasing patient’s economic burden due to lowing drug expense, increasing medical practices or non-insurance items. The authority shall promote the payment system more reasonable, the professional examination system more fair, physician’s professional autonomy and the cooperation between clinic and hospital. It also shall try to control floating values, correct physician’s practice and elevate the quality and appropriateness of medical service.
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