我國自2002年起，於醫院部門全面實施總額支付制度，並採分區分配總額，目的在解決資源分配不均之問題，促使醫療提供者與保險人共同分擔醫療費用的財務風險。該制度係採分區上限制，形成「浮動點值」，使得各區點值不同，造成各分區出現同工不同酬的效果，對醫療院所收入造成相當嚴重的衝擊，並直接影響醫師所得，進而影響醫師執業地點之選擇。為檢視該政策之有效性，為本研究之目的。 本研究係採用國家衛生研究院發行之全民健保研究資料庫、戶政司人口統計及政府公開資訊。研究期間為2004年至2011年，再控制醫學中心數、醫師特性等變項後，以邏輯斯迴歸模型探討浮動點值高低對醫師選擇區位之影響。研究結果顯示，當浮動點值越高，越不易轉換執業地點。如該醫師係於總額支付制度實施前執業，其中以南區及高屏區最為明顯。如該醫師係於總額支付制度實施後方執業，則以南區最為明顯。不論於制度實施前後執業的醫師，在南區分局都符合預期。推論應為地區特性之差異，因該地區點值相較其他地區偏高，且其他條件與其他地區差異不大的情況下，醫師欲改變執業地區的誘因較低，故當浮動點值越高，醫師越不易轉換執業地點。 Since 2002 , full implementation of the global budget system in the hospital sector, and use the partition. The goal is to solve uneven distribution of resources problem, encourage healthcare providers and insurer share the financial risk of medical expenses. The system base-on expenditure cap. The system generates a "floating point value", cause different point value in different department. The effect of causing the department appear unequal wages, caused very serious impact on hospital revenue, and a direct impact on physician income. The purpose of the present study is to review the effectiveness of this policy. In this study we use National Health Insurance Research Database, Department of Household Registration, M.O.I., and Open Data of Government. The study period is during 2003 to 2011. In this case we use Logistic regression to test the hypothesis. Research result, if the area point value higher than others, the physicians more hardly converted location. When the physicians in practice before the implementation of the global budget system. The physicians more hardly converted location, if the area point value higher than others, particularly in the Southern Division, Kao Ping Division. If the physicians in practice after the implementation of the global budget system. The physicians more hardly converted location particularly in the Southern Division.
