| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學研究所碩士在職專班 === 92 === Objective：
The study is to conduct a preliminary research on "National Health Insurance pilot project of family physician integrated healthcare program" (NHI Family Physician Program).Issues deliberated include：(1)To understand the perspectives of participant physicians on program performance indicators (2) To study on the change medical utilization of enrolled healthcare members at primary stage of the program (3)To analysis outcomes of the patient taken care of by different physicians at the primary stage.
Method：
The participants of this study include the physicians in Kao-ping area in year 2003,applicant physicians in year 2004, and 6,687 healthcare family members enrolled in the program over 6 months. Semi-open structure surveys with 37 indicators are used to evaluate physician perspectives on program performance indicators (including structure indicators, process indicators, and outcome indicators). A focus group seminar is held to collect expert opinions. In order to understand the change of medical utilization of outpatient service of enrolled healthcare family members at primary stage of the program, paired t test is implemented on the secondary data from Bureau of NHI which is collected within 6 months after the program started.
Result：
I.On program performance indicators in the aspects of structure and process, primary physicians tend to agree with the evaluations based on collaboration ability of cooperative hospital and interaction ability among primary physicians in a group. In the aspect of outcome, primary physicians tend to agree with the evaluations based on patient outcome of hypertension and asthma.
II.The appropriate performance indicators for current stage summaried in the focus group seminar include：the interaction condition among cooperative partners in community healthcare group,the continuing medical education,the enrollment rate of healthcare family members (of special age groups or with chronic diseases),the examination rate of preventive healthcare services, and the regular medical visit rate.
III.For 6,687 healthcare family members enrolled in the program over 6 months, their outpatient visit rates, outpatient medical expenditures, medical visit rates outside their community healthcare groups are all lowered to an extent of statistic significance.
Conclusion：
In examining the outpatient service utilization at primary stage of the program, the goal “to decrease waste of medical resources and to reasonably contain medical expenditures” stated in the announcement of NHI Family Physician Program in year 2003 could be achieved by the healthcare family members enrolled in the program. However the target medical visit rate outside designated community healthcare group still tend to be too high (the target rate is to decrease by 10％, but the actual rate is only 1.28％).
Suggestion:
In view of the results derived from primary stage of the program,in the current stage the policy executives should continue to encourage primary physicians to join the program.It is important for them to appreciate pragmatic physician perspectives and to increase negotiating flexibility to attract physicians with appropriate characteristics. At primary stage of the program,the performance should be evaluated based on the indicators that fall within primary physician capacity and achievable commitment. Thereupon the patient-centered healthcare climate will gradually be established.
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