王俊文Jiunn-Wen Wang林宜穎yi-ying Lin醫學研究所2026-10-282008-06-122003https://handle.ncl.edu.tw/11296/wnzt23https://scholars.csmu.edu.tw/handle/123456789/35000前言：隨著時代的變遷、科技的發達及全民健保的推行，台灣地區的醫療產業不斷的蓬勃發展。近年來許多大型醫院紛紛增、擴建；但相對地，基層醫療院所由於醫師個人投資成本負擔較高，加上保險給付之設計對基層醫療院所相對不利，反而鼓勵病人往大醫院跑，使得基層醫療的生存受到極大的威脅，造成其日漸萎縮。隨著世界潮流的趨勢，醫師執業型態也將隨之轉變，基層開業醫師單打獨鬥的方式已逐漸被聯合執業的模式取代。從國外實際經驗中，也證明聯合執業不但提升了基層醫療的品質、增加民眾就醫可近性、還可降低醫療成本、改善醫師生活品質等……。因此，對基層開業醫師而言，「聯合執業」不啻是目前改變現狀較可行的方法之一。 　　本研究的目的旨在探討：1.醫師參與聯合執業之可行性及其相關影響因素。2.醫師對聯合執業的看法及其認為之最適經營模式。3.中區醫療區域之基層開業醫師對於聯合執業經營模式之參與或實施意願。 　　研究結果發現：（一）絕大多數的醫師皆表示願意參與聯合執業（二）基層開業醫師認為最適的聯合執業模式為：1.在組織型態方面：大多數醫師認為應採用合夥的方式來經營；2.在支援醫師方面：近一半醫師認為應該由其他診所相互支援；3.在服務內容方面：絕大多數的醫師認為應朝向多重專科發展。4.在合作的醫師人數方面：大多數希望由2-3位醫師組成。5.在執業地點方面：醫師偏好選擇在醫療資源缺乏的地區開業；6.在經營管理方面：醫師主張由合夥人自行管理的佔了將近四成；7.在收入分配方面：多數醫師主張依固定薪加獎勵金的方式給予。 　　建議：為提高基層開業醫師對聯合執業的認識及參與意願，本研究對於衛生主管機關的建議為：1.衛生主管單位應提供更多的誘因，以鼓勵基層醫師參與聯合執業，例如貸款利息的補貼。2.若衛生主管機關仍要推行聯合門診，則相關誘因的配套措施必須再加強。3.健保給付項目必須以人力設備為評估依據，而非醫院評鑑等級，如此可鼓勵更多的醫師於基層從事高水準的醫療服務。Healthcare industry has been prosperous and well developed in Taiwan after time passing and national health insurance implementation. Primary care clinics are facing survival pressure when large hospitals are processing expansion these years due to the insurance reimbursement concern. Therefore, the pattern of clinic operation is transformed from sole practice to group practice according to worldwide trend and experience. 　　The purposes of this study are to explore: 1.the feasibility study of group practice and related factors for primary care physicians. 2.the optimal model of group practice for primary care physicians. 3.the willingness of primary care physicians to participate the group practice in central Taiwan. Results: Most physicians would like to participate group practice. The optimal model for group practice includes: (1) organization: physicians preferring to work with partners; (2) supportive physicians: most physicians considering the sources of supportive physicians should come from other clinics; (3) specialty: most physicians preferring the multi-specialty practice model; (4) number of cooperative physicians: physicians favoring two to three physicians working in a group practice; (5) working place: physicians preferring to work in rural area; (6) management: physicians considering that a group practice had better be managed by co-owners; (7) revenue: most physicians preferring a fixed salary system plus performance-based compensation. 　　Suggestions: In order to encourage primary care physicians participate group practice, the study has proposed the following suggestions that may be helpful to the successful operation of primary clinic: 1. The health authority should provide more incentive to encourage the model of group practice in the market. 2. Other regulations related to the group practice should be added and enhanced if health authority likes to promote this approach. 3. National health insurance bureau should readjust the payment criteria based on the actually quality of services provided by the clinics rather than the accredited level of organization.基層開業醫師聯合執業執業模式primary care physiciansgroup practicepractice modelthesis