บทคัดย่อ
รายงานผลการวิจัยผลกระทบของการจ่ายค่าตอบแทนบุคลากรการแพทย์ในระบบจ่ายตามปริมาณงาน และไม่ทำเวชปฏิบัติส่วนตัว การวิจัยนี้มีจุดประสงค์หลักเพื่อประเมินผลกระทบของวิธีการจ่ายเงินคือ ารศึกษา
บทคัดย่อ
The impact of paying health pesonnel by fee-for-serviceand non-private-practice allowanceThis research is to evaluate the impact of these implementations among regional/general/community hospitals. Four research methods were applied to answer different research objectives. Analysis of reported data to the Provincial Hospital and the Rural Health Divisions was to see the impact on hospital financial liquidity. Postal, self-administered questionnaire survey was carried out in 17 provinces to study attitude towards non-private-practice allowance including fee-for-service pay. Qualitative research techniques, ie focus group discussions and indepth interviews were carried out in 4 provinces to focus mainly on fee-for-service pay but also included other payment schemes. A before and after case-review was carried out to compare quality of care provided to 3 tracer conditions in 5 hospitals. The overall result suggest that financial liquidity of the hospitals was not affected by the implementation of the payment schemes, although the hospitals had to pay a higher percentage of their revenue for their personnel. In 1991, they paid 7-11 percent of the hospital revenue for their personnel and in 1995, up to 20-30 percent of the revenue. Fee-for-service pay got the highest share (more than 60 percent) of the total payment categories and increased productivity especially the number of extra-office-hour surgcical operations. Non-private-practice allowance increased job satisfaction amongst those who did not work in private sector but caused the feelings of unfair treatment among those who were ineligible. Moral hazard of providers occurred in both schemes but was more frequently observed in the fee-for-service scheme. Management system played a minimal role in safeguarding medical ethics.
