臺灣博碩士論文加值系統

Background: In 2002 Hospital global budget had been implemented in Taiwan. The switch from retrospective to prospective reimbursement was intended to give hospitals the incentive to be more efficient and effective. Hospitals will adapt strategically in ways and cause physician job dissatisfaction and intention to leave.
Method: Total number of 180 hospital-based physicians and are from 1 medical center and 4 regional hospitals in Tainan City. Applied 36-items survey questionnaire with 5-point Likert Scale to investigate physicians’ job satisfaction and intention to leave. Six research hypotheses derived from the proposed model were empirically validated by Structure Equation Model.
Results: The results depicted that indicates that (1) if hospital adopted more acts, physicians are more likely to perceive less job satisfaction (β = 0.770, t value = 6.192, p＜0.01). (2) Hospital strategies have a positive association with physicians’ intention to leave (β = 0.45, t value = 3.446, p＜0.01). (3) Hospital strategies are positively related to physicians’ intention to leave through job dissatisfaction (β= 0.363, t value = 4.575, p＜0.01). (4) Physician job satisfaction is negatively related to physicians’ intention to leave (β= 0.52, t value = 3.958, p＜0.01).(5) Hospital strategies, job satisfaction, and intention to leave only differ from physician’s gender and martial statuses. (6) Hospital strategies, job satisfaction, and intention to leave are no different from hospital characteristics.
Discussion: Hospital strategies such as limited prescription days and medications, and control inpatient days effect on physicians’ autonomy. These strategies have strong impact on physician job satisfaction and intention to leave their hospitals. As physician was dissatisfied, it is the most important issue for physicians’ intention to leave. Physician manpower is a quite important human resource. Thus, hospital should more focus on physicians’ job satisfaction. The limitations of this study (1) the result could not be generalized to all hospital-based physicians. (2) Only retaining physicians answered the questionnaires during the survey period so self-selection bias might exist. (3)The longitudinal studies are recommended to explore how hospital-based physicians and the relationships among research variables change over time.

TABLE OF CONTENTS

CHAPTER ONE INTRODUCTION 1
1.1 Background and Motivations 1
1.2 Research Objectives 2
1.3 Research Project 3
1.4 Research Procedure 4
1.5 The Structure of this Study 5
CHAPTER TWO LITERATURE REVIEW 7
2.1 Current Health Care System 7
2.2 Hospital Strategies 10
2.3 Job Satisfaction 14
2.4 Intention to Leave 16
2.6 Hospital Strategies versus Job Satisfaction 16
2.7 Hospital Strategies versus Intention to Leave 17
2.8 Job Satisfaction versus Intention to Leave 18
CHAPTER THREE RESEARCH DESIGN AND METHODOLOGY 20
3.1 The Conceptual Model 20
3.2 Interrelationship among Research Constructs 21
3.3 Questionnaire Design 24
3.4 Pretest of the Survey Instrument 28
3.5 Sample Plan 31
3.6 Data Analysis Procedure 32
CHAPTER FOUR DESCRIPTIVE ANALYSIS AND RESULTS 37
4.1 Introduction 37
4.2 Descriptive Analysis 37
4.3 Reliability Tests 43
4.4 Confirmatory Factor Analysis (CFA) 47
4.5 Analyze Individual Difference 55
4.6 Structural Equation Model (SEM) 65
CHAPTER FIVE CONCLUSIONS AND SUGGESTIONS 74
5.1 Research Results 74
5.2 Research Contributions 78
5.3 Limitations of this Research 79
Reference 80

Anderson, G. F., & Kohn, L. T. (1996). Hospital Employment Trends in California, 1982-1994. Health Affairs, 15(1), 152-158.
Arbuckle, J. L., & Wothke, W. (1999). Amos 4.0 user's guide: IL: SmallWaters Corporation.
Bagozzi, R. P., & Yi, Y. (1988). On the evaluation of structural equation models. Journal of the Academy of Marketing Science, 16(1), 74-94.
Baker, L. C., & Cantor, J. C. (1993). Physician Satisfaction Under Managed Care. Health Affairs,12 (1), 258-270.
Bovier, P. A., & Perneger, T. V. (2003). Predictors of Work Satisfaction among Physicians. European Journal of Public Health, 13, 299-305.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp.136-162). New-bury Park: CA: Sage.
Burdi, M. D., & Baker, L. C. (1999). Physicians' Perceptions of Autonomy and Satisfaction in California. Health Affairs, 18(4), 134-145.
Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81-105.
Chuang, N.-T., Huang, K.-C., Hsu, Y.-H. E., Kuo, N.-W., & Wei, Z.-R. (2004). Factors associated with strategic choices of hospitals in response to the global budget payment system. Chinese Journal of public health, 23(2), 150-158.
Chuang, Y.-C., Hwang, C.-J., & Cheng, M.-C. (2003). Exploring the Operating Model of Hospital Global Budget in Taiwan. Journal of healthcare management / American College of Healthcare Executives, 4(3), 1-17.
Demmy, T. L., Kivlahan, C., Stone, T. T., Teague, L., & Sapienza, P. (2002). Physicians' Perceptions of Institutional and Leadership Factors Influencing Their Job Satisfaction at One Acadeic Medical Center. Academic Medicine, 77(12), 1235-1240.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18, 39-50.
Fruen, M., Hadley, J., & Koper, S. (1980). Effects of financial incentives on physician’s specialty and location decisions. Health Policy Education, 1(2), 143-159.
Gefen, D., Straub, D., & Boudreau, M. C. (2000). Structural equation modeling and regression: Guidelines for research practice. Communications of AIS, 4(7), 1-78.
Ginn, G. (1990). Strategic change in hospitals: an examination of the response of the acute care hospital to the turbulent environment of the 1980s. Health Serv. Res., 25(4), 565-591.
Ginn, G., & Young, G. (1992). Organizational and Environmental Determinants of Hospital Strategy. Hospital & health services administration, 37(3), 291-302.
Hair, J. F., Anderson, R. E., Tatham, R. L., & Black, W. C. (1998). Multivariate data analysis (5th ed.). NJ: Prentice Hall.
Huang, K. C., Chen, Y. H., Chang, H. C., Chang, W. J., Wen, H. C., & Chiu, C. H. (2007). Adaption Strategies of Hospitals under the Global Budget System. Taiwan Journal of Public Health, 26(4), 283-293.
Hsueh, Y.-S., Lee, S.-Y., & Hiang, Y.-T. A. (2004). Effects of Global Budgeting on the Distribution of Dentists and Use of Dental Care in Taiwan. Health Services Research, 39(6), 2135-2153.
Konrad, T., Williams, E. S., Linzer, M., McMurray, J., Donald, P., Gerrity, M., (1999). Measure Physician Job Satisfaction in a Changing Workplace and a Challanging Environment. Med Care, 37(11), 1174-1182.
Jovis, E., Wallace, J., & Lemaire, J. (2006). The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians. Health Serv. Res., 6, 55-71.
Landon, B. E., James, R. D., Hoangmai, P. H., & Blumenthal, D. (2006). Leaving Medicine: The consequences of Physician Dissatisfaction. Med. Care, 44(3), 234-242.
Lawton R. Burns, Ronald M. Andersen, & Shortell, S. M. (1990). The Effect of Hospital Control Strategies on Physician Satisfaction and Physician-Hospital Conflict. Health Services Research, 25(3), 527-556.
Leigh, J. P., Kravitz, R. L., Schembri, M., Samuels, S. J., & Mobley, S. (2002). Physician Career Satisfaction Across Specialties. Archives Internal Medicine, 162, 1577-1584.
Linzer, M., Konrad, T. R., Douglas, J., McMurray, J. E., Pathman, D. E., Williams, E. S., et al. (2000). Managed Care, Time Pressure, and Physician Job Satisfaction: Results from the Physician Worklife Study. Journal of General Internal Medicine, 15, 441-450.
Lo, H., & Yaung, C.-L. (1998). The Association of the Satisfaction with Compensation, Propensity to Leave, and Their Related Factors of Fulltime Visiting Staff in a Medical Center-Application of Linear Structural Equation Model. Chinese Journal of Public Health, 17(2), 125-138.
Maarase, H. A. M. (1996). Fixing Budgets in the inpatient sector: the case of the Netherland. In: F.W. Schwartz, H.Glennerster , R.B.Saltman . Fixing Health Budget: Experience from Europe and North America. New York: John Wiley & Sons Ltd.
Misra-Hebert, A. D., Kay, R., & Stoller, J. K. (2004). A Review of Physician Turnover: Rate, Causes, and Consequences. American Journal of Medical Quality, 19(2), 56-66.
Nestman, L. J. (1996). Federal and Provincial Roles in Canadian Health Care Budgets. In: F.W. Schwartz, H.Glennerster , R.B.Saltman . Fixing Health Budget: Experience from Europe and North America. New York: John Wiley & Sons Ltd.
Pathman, D. E., Konrad, T. R., William, E. S., Scheckler, W. E., Linzer, M., & Douglas, J. (2002). Physician Job Satisfaction, Dissatisfaction, and Turnover. Journal of Family Practice, 51(7), 593-602.
Rittenhouse, D. R., Mertz, E., Keane, D., & Grumbach, K. (2004). No Exit: An Evaluation of Measures of Physician Attrition Health Services Research, 39(5), 1571-1588.
Sturm R. (2002). Effect of Managed Care and Financing on Practice Constraints and Career Satisfaction in Primary Care. Journal of the American Board of Family Practice, 15(5), 367-377.
Tseng, C.-H. (2002). Dentists’ Strategy Adoption vs. Global Budgeting Payment System. National Cheng Kung University, Tainan, thesis.
Wang, S. C. (2004). A Study on the Satisfaction of a District Teaching Hospital Doctors to the Global Budget Payment System in the Southern Taiwan. I-Shou University, Kaohsiung Country, thesis.
Williams, E. S., Konrad, T., Linzer, M., McMurray, J., Pathman, D. E., Gerrity, M., (1999). Refining the Measurement of Physician Job Satisfaction: Results From the Physician Worklife Survey. Med. Care, 37(11), 1140-1154.
Wiliams, E. S., & Skinner, A. C. (2003). Outcomes of Physician Job Satisfaction: A Narrative Review, Implications, and Directions for Future Research. Health Care Management Res., 28(2), 119-140.
Yang, C.-M., ang Lin, W.-C., Chung, C.-H., & Chon, C.-Y. (2001). The Impact of Dental Global Behavior of Dentists in Taipei City. Journal of Health Science, 3(3), 255-266.