急診醫師離職潮 要治本

成大醫學院公衛所 王榮德、王亮懿

日前長庚急診醫師離職潮引起社會重視,各方提出建議。有認為需改變財務計算方式,把急診開出的檢查收入部分歸入急診收益,以避免醫院將急診列為賠錢單位。也有主張應透過提高急診部分負擔,減少急診資源濫用。醫勞盟及醫改會更呼籲財團法人醫院應本著公益性質,救人先於營利;建議醫院財務須公開透明接受監督,醫療法應修法使董事會有醫院員工推舉出的非主管員工代表,保障員工健康與福祉。筆者認為上述建議能治標但未治本。

近年來浮出檯面的急診虧損、血汗醫院、五大科醫療人員出走等問題,根本原因之一,來自於人口快速老化所延伸的龐大就醫需求。根據健保署的數據,2015年65歲以上老人就醫次數,門診為整體國人平均的1.8倍(28次/年)、急診1.9倍(0.52次/年)、住院2.8倍(0.39次/年)。該年就醫總費用,老年人的門診、急診、住院的花費分別是國人平均的2.4、1.9、1.4倍。估計未來15年內老年人口將增為現今的2倍。若不積極從現在起預防老年疾病的發生,未來醫療需求會因高齡人口快速上升而急遽擴張,造成健保與社會的龐大負擔。

我國健保目前實施總額預算制度來控制收支平衡。但人口老化快速,即便各年齡層的醫療需求維持不變,整體醫療需求仍會攀升。當快速高齡化導致總額預算的成長趕不上實際醫療需求,醫療機構往往精簡人事及各種成本,壓縮醫療人員的勞動條件,形成現今血汗醫院與醫療崩壞等亂象。此次長庚急診醫師離職潮僅是上述結構性問題的前哨,未來各種嚴重問題會陸續浮出檯面。

根本解決之道,應是青壯年即全面開始預防疾病的發生;除了積極推動四癌篩檢、三高控制,也需順應世界潮流,透過實證數據評估各項醫療服務的價值,促使健保將給付制度導向「論價值計酬(pay-for-value)」,每塊錢買到最大量的健康;同時逐步淘汱低或無療效又昂貴之醫療,例如節制長期插管呼吸治療、C肝病毒治療藥取代Silymarin等。唯有從這個方向進行改革,未來才能順利過渡至「論人計酬」,讓醫療提供者與民眾有足夠誘因全面預防生病,根本解決健保困境。

回應

chenlixiang

2017.9.6chenlixianggiuseppe zanotti shoes
cheap snapbacks
michael kors uk
armani eyeglasses
nike store
michael kors canada
ralph lauren soldes
ugg boots clearance
ugg outlet online
michael kors damenuhr
ugg australia
coach bags
louis vuitton bags
adidas stan smith shoes
coach outlet
air jordans
nike blazer sneakers
cheap ugg boots
fitflops shoes
coach factory outlet online
canada goose sale
ugg boots 70% off
adidas yeezy boost 350
hockey jerseys
coach outlet
nike air max online
ray ban uk
nike air max 2017
michael kors bags
ugg boots
ralph lauren shirts
louis vuitton outlet
ralph lauren outlet
michael kors outlet online sale
uggs outlet online
louis vuitton handbags
prada outlet
ray ban sunglasses
ugg sale
adidas soccer shoes
hermes handbags
new balance shoes
ugg outlet online
nike air max shoes
uggs clearance
ugg boots outlet
mbt shoes
coach outlet online
true religion sale
ugg boots on sale
uggs outlet store
michael kors outlet
coach factory outlet
salvatore ferragamo
chaussures christian louboutin
cheap nfl jerseys
oakley sunglasses wholesale
under armour outlet
cheap pandora jewelry
ugg slippers
ugg boots outlet
cartier sunglasses
adidas stan smith
nike trainers uk
ray ban zonnebril sale
moncler outlet
ugg outlet
yeezy boost 350 kaufen
mulberry uk
adidas yeezy
supreme shirts
oakley sunglasses cheap
christian louboutin sale
moncler outlet
coach outlet store online
occhiali da sole ray ban
coach factory outlet
louis vuitton handbags
birkenstock sandals
kate spade sale
adidas outlet
ugg australia
fitflops shoes
ugg outlet
michael kors outlet
michael kors handbags
longchamp handbags
pandora charms
chelsea jersey
louis vuitton outlet
ugg australia boots
prada bags
ugg outlet store
ralph lauren outlet
birkenstock sandals
cheap dior sunglasses
ralph lauren españa
rolex online store
ugg australia boots
christian louboutin outlet clearance
2017.9.6chenlixiang

xiaozheng6666

2017-8-26 xiaozheng6666
adidas shoes
michael kors outlet
ray ban sunglasses for men
tory burch outlet
coach outlet online coach factory outlet
air jordan retro
coach outlet online
polo ralph lauren factory store
valentino outlet store
ugg outlet
coach outlet store online
nike outlet
adidas yeezy shoes
hermes birkin
fitflops sale
michael kors outlet
coach outlet online
nike shoes outlet
adidas shoes for women
coach outlet clearance
valentino outlet store
nike outlet store
kate spade handbags
giuseppe zanotti shoes
coach outlet online
michael kors outlet
michael kors outlet
ralph lauren polo
cheap jordans
kate spade handbags
michael kors outlet online
ralph lauren uk
ralph lauren uk
pandora jewelry outlet
coach factory outlet
coach outlet store online
michael kors outlet clearance
canada goose outlet
polo ralph lauren outlet
michael kors outlet clearance
longchamp outlet
cheap jordan shoes
nike outlet store
canada goose jackets
michael kors handbags
adidas nmd
ugg boots
prada outlet
coach outlet
yeezy boost 350 v2
michael kors outlet store
ugg outlet
puma outlet
mont blanc pens
coach outlet online
valentino outlet
oakley sunglasses wholesale
polo ralph lauren outlet online
ugg outlet
ray ban sunglasses
polo ralph lauren
coach outlet store online
pandora outlet
ugg boots
polo ralph lauren outlet
ugg outlet
canada goose jackets
michael kors outlet
michael kors outlet
christian louboutin outlet
vintage nhl jerseys
pandora outlet
coach outlet online
michael kors outlet store
michael kors outlet clearance
polo outlet
oakley sunglasses
ugg outlet
oakley sunglasses wholesale
polo outlet
christian louboutin outlet
pandora jewelry
canada goose outlet
ralph lauren pas cher
cheap jordans for sale
mlb jerseys
hermes belts outlet
cheap authentic nba jerseys
lebron james shoes
polo ralph lauren outlet
polo ralph lauren
ugg outlet
kate spade outlet
michael kors outlet
ed hardy clothing
ray ban sunglasses outlet
cheap oakley sunglasses
michael kors outlet clearance
cheap jordans
fitflop sandals
nike outlet
polo ralph lauren outlet online
ralph lauren
jordan retro
pandora outlet
christian louboutin uk
oakley sunglasses
oakley sunglasses outlet
canada goose
michael kors handbags
ugg boots
michael kors outlet
mlb jerseys wholesale
ralph lauren
michael kors
mbt shoes
yeezy boost 350
canada goose jackets
michael kors outlet
ray ban sunglasses
longchamp outlet online
canada goose outlet
cheap oakley sunglasses
ugg boots
nike shoes
lacoste polo
pandora charms
asics running shoes
cheap ugg boots
coach factory outlet
yeezy boost 350
true religion outlet store
true religion outlet
canada goose outlet
fred perry polo
michael kors outlet stores
polo outlet stores
pandora bracelet
polo ralph lauren outlet
yeezy boost

jianbin0816

JIANBIN0816
oakley sunglasses
oakley sunglasses
christian louboutin outlet
adidas wings
kate spade handbags
mbt shoes
michael kors outlet
mbt shoes outlet
coach outlet online
kevin durant shoes
michael kors outlet online
michael kors outlet
kobe 9
canada goose outlet
tory burch outlet
fitflops shoes
ugg outlet
soccer jerseys
swarovski outlet
michael kors outlet
michael kors outlet clearance
fitflops sale clearance
ugg outlet
oakley sunglasses
mulberry handbags
nike outlet store
los angeles lakers jerseys
ugg boots,ugg boots outlet,ugg boots for women,ugg boots on sale,ugg boots clearance,ugg boots for men,ugg boots for kids,ugg boots clearance sale women,ugg boots clearance outlet
canada goose jackets
mulberry sale
hermes belt
ray ban sunglasses
true religion jeans
birkenstock sandals
mulberry outlet store
ugg outlet
cazal sunglasses
ferragamo outlet
canada goose outlet
ralph lauren polo
coach outlet online
air max 1
cheap jordans
Basketball Shoes
polo outlet
longchamp outlet
ray ban sunglasses
michael kors handbags
christian louboutin online
ralph lauren polo
marc jacobs outlet
burberry outlet
ray ban sunglasses
michael kors wallets
pandora charms
oakley sunglasses
christian louboutin shoes
ray ban sunglasses
ugg boots,ugg boots outlet,cheap uggs boots,ugg boots for women,ugg boots on sale,ugg boots clearance,ugg boots clearance sale women,ugg boots clearance outlet,ugg boots for men,ugg boots for kids
cheap oakley sunglasses
ralph lauren outlet
coach outlet online
ugg boots for women,ugg boots,ugg boots outlet,ugg boots on sale,ugg boots clearance,ugg boots for men,ugg boots for kids,ugg boots clearance sale women,ugg boots clearance outlet
ferragamo shoes
ferragamo shoes
ugg outlet,ugg outlet clearance,uggs outlet,ugg outlet online clearance,ugg outlet store,ugg outlet online store,ugg outlet sale,ugg outlet coupons,ugg outlet boots
coach factory outlet
mulberry handbags
bottega veneta outlet
coach outlet
cheap uggs outlet,cheap uggs for sale,cheap ugg boots,cheap uggs for kids,cheap uggs for women,cheap uggs bailey bow,cheap uggs china,cheap uggs for men,cheap uggs for girls,cheap uggs boots for women
fitflops sale
true religion outlet
mac cosmetics
nike blazer pas cher
ugg outlet
cheap nfl jerseys
christian louboutin outlet
michael kors
lacoste soldes
chrome hearts outlet
air max uk
michael kors outlet
oakley sunglasses
true religion jeans
polo shirts
polo outlet
canada goose jackets
ed hardy clothing
ecco shoes

jianbin0816

JIANBIN0816
oakley sunglasses
oakley sunglasses
christian louboutin outlet
adidas wings
kate spade handbags
mbt shoes
michael kors outlet
mbt shoes outlet
coach outlet online
kevin durant shoes
michael kors outlet online
michael kors outlet
kobe 9
canada goose outlet
tory burch outlet
fitflops shoes
ugg outlet
soccer jerseys
swarovski outlet
michael kors outlet
michael kors outlet clearance
fitflops sale clearance
ugg outlet
oakley sunglasses
mulberry handbags
nike outlet store
los angeles lakers jerseys
ugg boots,ugg boots outlet,ugg boots for women,ugg boots on sale,ugg boots clearance,ugg boots for men,ugg boots for kids,ugg boots clearance sale women,ugg boots clearance outlet
canada goose jackets
mulberry sale
hermes belt
ray ban sunglasses
true religion jeans
birkenstock sandals
mulberry outlet store
ugg outlet
cazal sunglasses
ferragamo outlet
canada goose outlet
ralph lauren polo
coach outlet online
air max 1
cheap jordans
Basketball Shoes
polo outlet
longchamp outlet
ray ban sunglasses
michael kors handbags
christian louboutin online
ralph lauren polo
marc jacobs outlet
burberry outlet
ray ban sunglasses
michael kors wallets
pandora charms
oakley sunglasses
christian louboutin shoes
ray ban sunglasses
ugg boots,ugg boots outlet,cheap uggs boots,ugg boots for women,ugg boots on sale,ugg boots clearance,ugg boots clearance sale women,ugg boots clearance outlet,ugg boots for men,ugg boots for kids
cheap oakley sunglasses
ralph lauren outlet
coach outlet online
ugg boots for women,ugg boots,ugg boots outlet,ugg boots on sale,ugg boots clearance,ugg boots for men,ugg boots for kids,ugg boots clearance sale women,ugg boots clearance outlet
ferragamo shoes
ferragamo shoes
ugg outlet,ugg outlet clearance,uggs outlet,ugg outlet online clearance,ugg outlet store,ugg outlet online store,ugg outlet sale,ugg outlet coupons,ugg outlet boots
coach factory outlet
mulberry handbags
bottega veneta outlet
coach outlet
cheap uggs outlet,cheap uggs for sale,cheap ugg boots,cheap uggs for kids,cheap uggs for women,cheap uggs bailey bow,cheap uggs china,cheap uggs for men,cheap uggs for girls,cheap uggs boots for women
fitflops sale
true religion outlet
mac cosmetics
nike blazer pas cher
ugg outlet
cheap nfl jerseys
christian louboutin outlet
michael kors
lacoste soldes
chrome hearts outlet
air max uk
michael kors outlet
oakley sunglasses
true religion jeans
polo shirts
polo outlet
canada goose jackets
ed hardy clothing
ecco shoes

chanyuan

chanyuan2017.08.11
cheap ray ban sunglasses
michael kors outlet clearance
canada goose uk
canada goose jackets outlet
coach outlet store online
adidas uk store
mbt shoes outlet
true religion outlet
air max 90
Nike Free shoes
michael kors outlet
ray-ban sunglasses
air max 90
polo ralph lauren
cheap nfl jerseys
max 1
michael kors outlet online
hermes birkin bag
ralph lauren polo
ray ban sunglasses uk
pandora jewellery
fitflops
canada goose jackets
canada goose jackets men
cheap oakley sunglasses
air max 90
coach factory outlet
canada goose
christian louboutin
coach outlet store online
ray ban sunglasses outlet
Basketball Shoes
mcm backpacks
longchamp handbags
coach outlet
mulberry outlet
mulberry outlet
michael kors outlet stores
jordan 4
cheap oakley sunglasses
oakley sunglasses wholesale
kate spade outlet online
los angeles lakers
oakley sunglasses wholesale
jordan shoes
cleveland cavaliers jerseys
canada goose outlet store
snapbacks wholesale
michael kors outlet online
cheap ray ban sunglasses
true religion outlet
coach outlet
adidas outlet
cheap jordan shoes
ralph lauren outlet
coach outlet online
michael kors outlet
oakley sunglasses wholesale
polo ralph lauren
ray ban sunglasses
ralph?lauren?polo?shirts
michael kors outlet
michael kors outlet clearance
kate spade uk
coach outlet online
coach outlet
mulberry bags
coach outlet store online
ugg outlet
polo outlet store
coach outlet online
polo ralph lauren outlet
ugg outlet,ugg outlet sale,uggs outlet,ugg outlet online clearance,ugg outlet store,ugg outlet coupons,ugg outlet boots,ugg outlet online store
mulberry handbags
uggs outlet
cheap ray ban sunglasses
air max 2015
coach factory outlet
canada goose jackets on sale
nike outlet online
coach outlet
oakley sunglasses
fitflops sale clearance
christian louboutin shoes
oakley sunglasses wholesale
cheap jordan shoes
reebok shoes
fitflops sale clearance
links of london jewellery
michael kors outlet clearance
true religion jeans sale
coach outlet
ralph lauren outlet
mbt shoes
ralph lauren outlet
ralph lauren outlet
christian louboutin sale
cheap ray ban sunglasses
canada goose outlet
kobe bryants shoes

A nike jordan shoes Lover at

A nike jordan shoes Lover at Portafoglio michael kors Loos
The Nike Huarache Womens Cheap turrets nike air twain Michael Kors Clearance that Hugo Boss Sale stood Adidas Superstar Sale Online in Cheap Nike Huarache air
Sheltered Nike Shox Cheap a Air Max Kopen foeman sniper nike sneakers there;
They Timberland Outlet found ugg factory outlet who Adidas Shoes Discount Marketplace fell to Christian Louboutin Shoes Outlet the TOMS For Sale sniper's Nike Shoes Sale Store aim,
A Nike Online Store field of death on the Adidas Originals Sale field of Original Ugg Boots fame—
And stiff cheap nike air max in khaki the boys Bottes Ugg Femme Pas Cher were Nike Air Damen laid,
To Yeezy Shoes Discount Marketplace the Nike Roshe Run rifle's Chaussure Air Max toll Cheap Retro Jordans For Sale at Nike Shoes Online the pandora jewelry store barricade;
But Nike Shox discount Sale the Jordan Store quick Official NHL Jerseys went Chaussure Nike Air Max Pas Cher clattering through the town,
Shot at Yeezy Black the Discount Ray Ban Sunglasses sniper and brought Cheap Toms Shoes Outlet him Adidas Soccer Cleats Cheap down,
In air force one pas cher the town ジョーダン スニーカー of Zapatillas Nike Air Max Baratas Loos Boty Nike Air in Scarpe Nike Scontate the Nike Air 90 morning.

The Adidas Superstar night Ray Ban Sunglasses Cheap was Moncler Outlet Store wet, the pandora outlet store rain dripped from TOMS OUTLET the Cheap True Religion Jeans sandbags Yeezy Boost Sale Online and Pandora Store Sale lay Sac a main michael kors in Canada Goose Outlet little Hogan Outlet pools Air max levně on Doudoune Moncler Pas Cher the nike air max running shoes floor of Michael Kors Outlet the trench. Snug Adidas Originals Stan Smith in Adidas Originals Superstar the shelter Adidas Yeezy Cheap of its ugg clearance keep a chaussures nike pas cher machine nike air jordan pas cher gun nfl store lurked Cheap Nike Free Run privily, Ugg Outlet Online Store waiting Moncler Jackets Discount Marketplace for blood. Pandora Store The Jordan Shoes Air weapon günstige nike schuhe had an Pandora Store absolutely impersonal Doudoune Moncler Site Officiel air; it Toms Factory Outlet had Vans Black Sneakers nothing Stone Island Outlet to Uggs Pas Cher Soldes do pandora beads with goedkope nike air max war nike tn pas cher and prada outlet the converse store maiming Cheap Toms Outlet Store of Ugg boots Sale men. zapatillas running Two Nike Polo Sale men were Soccer Boots Outlet nike asleep Air Max 90 in the Coach Bags On Sale bay, Negozi Pandora sitting Air Nike on reebok running shoes the fire-step Nike Soccer Cleats Boots and snoring Nike Outlet loudly. Nike Roshe Run Sale A Cheap Real Jordans third Air Max Sneakers man Uggs For Cheap leant over cheap uggs for women the parapet, his longchamp bags on sale eyes (if Ugg Pas Cher Femme they were open) fixed Nike Air Pas Cher on Canada goose dam the adidas schoenen enemy's trench in Nike Air Women front. Air Jordan Retro Sale Probably he botas de futbol was asleep; Nike Zapatos he Nike joggesko stood fixed to Louboutin Wedding Shoes his suivre un envoi post Hyperdunk 2014 motionless Scarpe Air Max as a statue. I ADIDAS NMD SALE ON LINE wrapped Soccer Boots Outlet nike my Nike Store overcoat tightly Cheap Michael Kors round Air Max Femme my nike schuhe günstig body Adidas Neo Discount Sale and Cheap Michael Kors Tote Bag lay Mens Nike Air Max down Pandora Style Beads in North Face Outlet the slush New Air Max 2017 by a[187] Descuentos Nike dug-out TOMS SHOES OUTLET door. Adidas Yeezy Boost 350 For Sale The Nike Air Jordan 11 dug-out, Toms Outlet Online a Canada Goose Online Store German hogan scontate construction that chaussure basket homme burrowed deep Michael Kors in the chalky clay Zapatillas Air Max of zapatos de futbol nike Loos, Jordan Sneakers For Sale was crowded Official Toms Shoes Outlet with Jordan Schoenen queer, zapatilla adidas distorted Jordan Shoes For Cheap figures. It Nike Air Huarache For Sale looked Christian Louboutin Heels as Air Max Pas Cher if Moncler Outlet Online the scarpe nike dead Ray Ban Sunglasses Online on Yeezy Men the Nike Air Max Goedkoop field canada goose jackets on sale had Nike Shoes Discount Marketplace been Cheap Louboutin Heels collected and Chaussure Nike Pas Cher shovelled into the Air max dam place toms shoes outlet pell-mell. christian louboutin outlet Bill Nike Free Run 5.0 Womens Teake Boutique Ugg lay with womens nike air max his UGG BOOTS FOR WOMEN feet Cheap Michael Kors Handbags inside the canada goose jacket outlet shelter, chaussure Nike homme his Cheap Air Max head Cheap Air Max Trainers and Discount TOMS shoulders out louboutin heels in Kobe Shoes Nike the Nike Pas Cher Femme rain. Cheap Nike Air Huarache "I adidas store couldn't Nike Factory Store get in nohow," billige nike sko he new jordan releases grumbled nike sportschuhe as nike shoes I ugg store lay Billige Nike Sko down; Adidas NMD For Sale "so Nike Air Sneakers I arst モンクレール レディース them huarache sneakers inside new yeezy shoes to retro jordans for cheap throw Canada Goose Womens Coats me nike sb stefan janoski a Doudoune Moncler Femme Pas Cher 'andful newest lebron shoes of cheap uggs fleas Ugg Pas Cher En France an' nike mercurial soccer cleats I'd vans shoe store kip Nike Air Max Cheap on fitflops sale uk the toms sale doorstep. Blimey! Discount Christian Louboutin Shoes 'tain't arf coach factory outlet online a Pandora Official Website barney; mud Canada Goose Outlet feathers, Cheap True Religion Jeans and 23 IS BACK Store no blurry Boost Yeezy Sale On Line blanket. zapatillas nike baratas There's one thing Nike Tn Requin Pas Cher certain, anyhow, new pandora charms that Discount Air Max is, Nike Air Shoes in the Michael Kors Handbags Discount Army you're New Nike Shoes certain Nike Air Max Sale to Abercrombie and fitch store receive moncler jacket sale what adidas outlet you Moncler Sale get." Pandora Outlet

ppst 2017.7.31

---------歡迎發表回應 以促進公共議題討論---------
惟與討論主題無關或惡意人身攻擊的回應,本版保留刪除權利