| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 88 === National Health Insurance had been performed for five years since Mar,1995,which made much influence on medical care,incluing psychiatry.The present main payment systems in psychiary are fee for service〈OPD、acute ward〉and per diem〈chronic ward、community〉.Recently,the bureau of National Health Insurance has also discussed about case payment and capitation.This study tried to understand the psychiatrists' opinion towand present and future payment systems.
All research subjects are members of the society of psychiatry ,R.O.C.Taiwna.A structured questionnare,which designed by author,was mailed to psychiatrists to detect their opinion toward payment system in Apr,2000.We used DBASE-III to set up data and use SAS sofeware for further statistic analysis.
This response rate was 50.6%.Main findins showed that psychiatrists had more understaning toward present payment system ，including fee for service and per diem,than the others.Generally,psychiatrists were not satisfied with present payment systems.66.4% psychiatrists mostly favored fee for survice,but asked to adjust the level of payment.Only 7.4% psychiatrists favored case payment and 8.6% favored capitation.The influences of physician's attitude on payment system reform included,the more they thought that case payment and capitation could offer comprehensive services,make sure quality,allocate medical resource properly,monitor minimal requirement，make proper payment level,encourage medical service,the more they favored reform；the more they thought that case payment and capitation could make physicians decrease necessary services,the more they objeted payment reform；the more they thought case payment could make physicians choose mild patients to be admitted,the more they objected reform.
To sum up,we could understand that psychiatrists,as providers of mediacl care,favored fee for survice.However,we must emphasize that psychiatrists did not understand the new payment systems and had evenly negative attitudes towards them.Therefore,the bureau of Health Insurance must explain and discuss with medical providers when they try to adopt new payment system.Also,the scope of coverage and cost sharing of psychiatry must be adjusted .In the future,study subject maybe focus on the psychiatrist's knowledge、attitude and behavior toward payment system to make more detailed and comprehensive discussion.
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