目標：績效研究大都以單一層次(個人或組織)分析，本文以多層次理論探索醫院總額支出目標制下報償方式對醫師生產力和服務品質之影響。方法：於2008年便利抽樣33家參加自主管理區域醫院並調查高階主管和醫師，共計獲得24家210份有效樣本，採層級線性模式分析，以個體層次服務績效為依變項，納入組織層次(報償方式和機構特性)以及個體層次(人口特徵和專科別)預測因子。結果：醫院變動薪水準對醫師服務品質和門住診生產力正向效果未達顯著(0.250, 0.171, 0.253, p>.05)；病床醫師比對醫師品質、住診生產力有負向、正向影響(-0.044,p<.01; 0.040, p<.05)；隸屬公立、財團法人醫院的醫師其門診服務量高於私立醫院43.7%,79.1%；北部醫院其醫師品質、住診服務量高於南部18.3%, 45.1%；年資與門診、住診生產力有正向關係(0.846, p<.001; 0.523, p<.05)；內科醫師門診生產力高於外科醫師27.0%。整體而言，
醫師服務績效之變異19.96%, 20.74%, 18.86%存在醫院內，54.13%, 56.93%, 36.26%來自醫院間。結論：醫院採變動薪報償並未降低醫師品質和醫療服務量，但組織特性與醫師服務表現有交互關係，因而減弱財務報償的系絡效果。(台灣衛誌 2011；30(4)：337-346)

Objectives: Previous studies of performance have focused on either organizational or individual-level analysis. Multilevel theory has been used to explore the effect of the method of compensation on the quality and quantity of individual physician services after hospital global budgeting (HGB) was implemented in Taiwan. Methods: We used a sample of convenience of 33 regional hospitals that participated in HGB and surveyed managers and physicians with structured questionnaires in 2008. A total of 210 valid questionnaires from 24 hospitals were returned. We
conducted hierarchical linear modeling analyses and demonstrated that both individual-level and organizational-level factors were associated with physician performance. Results: The effect of the variable compensation level on quality of physicians’ service, productivity in the outpatient department (OPD) and in the inpatient department (IPD) was not significant (0.250, 0.171, 0.253, all p>.05). The ratio of beds to physicians negatively affected individual quality (-0.044, p<.01) while positively influencing productivity in and IPD (0.040, p<.05). The OPD production of physicians in public or non-profit hospitals was higher than those in private ones (43.7%, 79.1%). Physician quality and IPD production in northern hospitals was higher than that in the southern area
(18.3%, 45.1%). Tenure was positively related to physicians’ productivity (0.846, p<.001; 0.523, p<.05). The OPD of internists was higher than that of 27.0% of surgeons. Overall, the individuallevel factors explained 19.96%, 20.74%, 18.86% of within-hospital variance on performance and hospital-level factors explained 54.13%, 56.93%, 36.26% of between-hospital variance. Conclusions: Variable compensation did not stimulate physicians to reduce quality or productivity. Hospital features and physician performance were co-determinant, thus weakening the contextual
effect of financial compensation. (Taiwan J Public Health. 2011;30(4):337-346)