目的：在健保總額預算後，醫療人員的工作量、負面感受及壓力增加，導致工作倦 怠。本研究探討健保總額預算期間，西醫師的負向感受、工作壓力源、工作倦怠，並分析 上述項目的影響因子。 方法：採用問卷調查，對桃園縣西醫師以分層比例隨機取樣，邀請各個科別的西醫師 填寫問卷。以工作感受量表(WPGB)、壓力源感受量表(QMWS)、因應方式量表、工作倦怠- 醫療行業調查(MBI-HSS)(含三個向度：情緒耗竭、去人性化、個人成就)來測量工作負向感 受、工作壓力源、工作倦怠。 結果：2006年7-12月得有效問卷230份。工作負向感受的平均數為28.0、工作壓力源感 受的平均數為33.1、因應方式的平均數為40.3、情緒耗竭的平均數為20.9、去人性化的平均 數為6.9、個人成就的平均數為36.3。多變量分析結果顯示，薪資滿意度對WPGB、QMWS 皆有統計顯著差異(p=.0169, p=.0117)。控制性因應是情緒耗竭(p=.0270)，去人性化(p=.0008) 及個人成就(p<.0001)的重要影響因子。年齡及工作年資分別是情緒耗竭及去人性化的顯著 影響因子(p=.0005, p=.0001)。 結論：總額預算後，西醫師對於面對醫療糾紛及應付醫院評鑑制度有較多壓力，隨著 工作年資及年齡的增長容易導致工作倦怠。

Background and purpose: After the global budget, job stress was increased among medical workers to reduce the hospital’s high rising expenditure, burnout is resulted from increased workload and job stress among medical staff. In this study, we investigated stress at work, the magnitude of job burnout among western medical doctors, and analyzed factors during the implementation of the global budget payment system of the National Health Insurance. Methods: A questionnaire survey with a stratified and proportional random sampling in Taoyuan was used to obtain the sample. Questionnaires with acceptable reliability and validity, work perception of global budget (WPGB), questionnaire on medical workers’ stress (QMWS) and Maslach burnout inventory-human service survey (MBI-HSS) were used. Results: From July to December 2006, 230 valid questionnaires were obtained. The mean score of the WPGB was 28.0 and QMWS was 33.1. The mean score of coping was 40.3. The mean score of emotional exhaustion was 20.9, depersonalization was 6.8, and personal accomplishment was 36.3, respectively. Multivariate analysis reveals that salary satisfaction was significantly associated with WPGB, medical worker’s stress (QMWS) (p=.0169, p=.0117). Control coping was the significant factor for emotional exhaustion (p=.0270), depersonalization (p=.0008) and personal accomplishment (p<.0001). Age and job year was the significant factor of emotional exhaustion and depersonalization (p=.0005, p=.0001), respectively. Conclusion: During the global budget payment system, western medical doctors had higher occupational stress, especially facing medical disputes, and preparing hospital accreditation work. With the increase in the number of years of work and age, job burnout can easily occur.