11卷4期

• Link 原著 Original Article
• 巴拉刈工廠4,4'-雙吡啶原料及其廢水之分析Analysis of Components of Waste Water and Raw Materials from Three Paraquat Manufacturing Factories
• 郭憲文、王榮德
  Hsien-Wen Kuo, Jung-Der Wang
• 4,4'-雙吡啶 ； 巴拉刈工廠 ； 原料 ； 廢水
  4,4'-bipyridine ; paraquat factory ; waste water ; quinoline derivative
• 台灣地區自民國七十二年發生部份巴拉刈作業員工罹患皮膚癌前期症狀以來，此種致皮膚癌因子是否?4,4'-雙?啶及其異構物，或者范狀不純物至今尚無定論，而巴拉刈工人經常所接觸之合成原料及排放廢水之物質，是否含有這些物質，一直缺乏分析測量資料。故本研究旨在分析巴拉刈工廠所使用之原料及其排放之廢水，以作?未來研究巴拉刈工人致癌因子之參考。 本研究係利用高效率液相層析法(HPLC)，分析4,4'-雙?啶及其異構物，其適當分析條件流動相?15/85氰甲烷／30mM磷酸銨溶淤二次去離子水，以磷酸調整酸鹼值?4.6，流速1.0ml/min，管柱?Inertial ODS-2。分析廢水之結果得知含有4,4'-雙?啶?147.6μg/ml?啶?0.90μg/ml及2,3-雙?啶?14.56μg/ml，2,4-雙?啶?43.6μg/ml，另外有少量疑似皮膚致癌物的奎諾林之衍生物(Quinoline derivatives)，此物已經由氣相層析／質譜儀鑑定證實。至於國內自行合成之4,4'-雙?啶，其產品內容物與廢水大致類同，而國外進口之4,4'-雙?啶原料中，並未含有奎諾林之衍生物及2,4-雙?啶，且其純度較前者低。由於僅從事國外進口之4,4'-雙?啶相關作業者，其工人亦有輕微之皮膚黑斑症狀，類似致癌之最初期變化；故我們推測從前廢水中仍有奎諾林之衍生物，但皮膚變化卻不能單由它來解釋；可能至少也需有雙?啶之參與。
  The procedure of high performance liquid chromatography (HPLC) for the determination of bipyridyl derivatives in waste water and raw materials of paraquat manufacturing factories is described. Samples were collected from three paraquat factories in Taiwan. One of the three factories (factory A) produces self-synthesized paraquat products by the high temperature sodium process, while the others directly imported 4, 4'-bipyridine from the ICI Corp, and then formulated paraquat products with methyl chloride. Samples were extracted with methanol and then purified by passing them through a SEP-PARK(superscript R) C18 cartridge (Waters Associates). Reverse phase HPLC with an ultraviolet detector was developed to analyze the above material by comparing it with a mixture of standard solutions of six bipyridyl derivatives. All samples were further verified by a GC/MS (Gas Chromatography/Mass Spectrometry) instrument. The results indicate that the waste water taken from Factory A contained 4,4'-bipyridine, pyridine, 2, 3-, 2,4-bipyridine and a quinoline derivative. Their concentrations in the waste water were 147.6 mg/mL, 0.90 mg/mL, 14.5 mg/mL, 43.6 mg/mL and 12.4 mg/mL, respectively. The raw materials imported by the other two factories also contained 4,4'-bipyridine, pyridine, and 2,3-bipyridine, but did not contained the quinoline derivative or 2,4-bipyrid- me. Although quinoline is a known carcinogen, two workers who were only exposed to imported 4,4'-bipyridine still developed freckles, we conclude that the quinoline derivative alone may not be responsible for the development of skin lesions among workers, but rather, 4,4'-or 2,4-bipyridine, or a combination of all of them may be the cause.
• 269 - 276
• 10.6288/JNPHARC1992-11-04-01

• Link 原著 Original Article
• 台灣地區環境保護政策之正式議程與公眾議程的內容分析The Formal and Public Agenda of the Environmental Policy in Taiwan
• 李卓倫
  Jwo-Leun Lee
• 無
  Environmental policy ; policy agenda ; health policy
• 本研究以內容分析的方法，從巨視觀點描述台灣地區近四十年來的環保政策議程，議程內容包括各級政府與民意機關的環保質詢、環保法規、環保經費支出、環保事件的報紙報導，並在考慮政策延遲的情況下分析環保事件報導和環保質詢、法規、經費支出間的相關性。研究結果顯示環保公眾議程所提出的環境問題大致會適度反應在政府部門正式議程的決策中，其政策延遲時間對質詢和經費支出而言?零至一年，法規創新、修訂或廢止的政策延遲時間則不明確。
  This study describes the trends in the environmental policy of Taiwan during the period from 1951 to 1988, analyzing the relationship between public trends and the formal agenda of the governments environmental policies from a macro viewpoint. The formal agenda included the interpellation of environmental issues in the congresses of the Legislative Yuan, the Taiwan provincial Assembly, and the Taipei Municipal Assembly: the passing of environmental laws and regulations; and expenditures for environmental affairs by the central government, the Taiwan provincial government, and the Taipei and Kaohsiung municipal governments. The public agenda was represented by reports of environmental affairs in the newspapers. Considering the recognition and decision-making lags of the policy-making process, the environmental problems reported on in the public agenda were appropriately reflected in the policymaking process of the formal agenda of the government. The time lag from public recognition to government decision-making ranged from zero to one year for the interpellation of and expenditures for environmental issues, but this lag was not evident for changes in environmental laws and regulations.
• 277 - 284
• 10.6288/JNPHARC1992-11-04-02

• Link 原著 Original Article
• 嚼檳榔預防教育先驅研究(Ⅰ)-國中生嚼檳榔現況及影響因素之初探A Pilot Study of Betel Chewing Prevention (?)-The Status and Factors Related to Betel Chewing Among Adolescents
• 李蘭、晏涵文、劉潔心、關學婉、季瑋珠、林瑞雄
  Lee-Lan Yen, Han-Wen Yen, Chieh-Hsin Liu, Huseh-Wan Kuan, Wei-Chu Chie, Ruey-Hsiung Lin
• 無
  Betel chewing ; prevention ; adolescent
• 本研究?探討青少年與嚼檳鄉行?相關的因素而設計。在配合預防教育實驗計畫實施的可行性考量下，選擇臺北市的市區和市郊各兩所國民中學二年級男生?對象。每校以班級?單位隨機選取兩班，全部共抽得281名學生。利用自行發展的研究問卷收集資料和統計分析後發現：(1)有25.3%的學生表示其家人有嚼檳榔的習慣；另有11.4%的學生表示與其來往的朋友有嚼檳榔習慣；(2)有15.7%的學生曾經遇到別人勸吃檳榔；(3)有71.2%的學生表示其住家附近可見到檳榔攤；另有43.4%的學生表示其學校附近可見到檳榔攤；(4)學生們的態度傾向於不支持嚼檳榔；(5)18.5%的學生有嚼檳榔的經驗；(6)已有嚼食經驗者，分別有38.7%和61.3%的人，是在小學或國中階段時發生第一次的經驗，且有一半的人是因朋友遞送而開始嚐試：(7)可以預測學生「曾嚼過檳榔」的變項包括母親教育程度低、自我接納程度低、具外控傾向特質、對嚼檳榔的態度傾向支持、有吸菸經驗、家中有人嚼檳榔及朋友中有人嚼檳榔等七個因素。根據上述結果，?避免國中學生養成嚼檳榔的行?，達到抑制檳榔消費人。增加的目的，檳榔預防教育是必需的。針對具有自我接納度低、外控特質或有吸菸經驗的學生尤需協助其熟習拒絕技巧，使能適當的處理家人或朋友嚼檳榔及遞送檳榔的行?。
  This study was designed to examine the prevalence and characteristics of betel chewing among adolescents. Educational intervention was implemented at four junior high schools: two in the central area and two in a suburban area. We selected as subjects a sample of 281 male students in the eighth grade. A set of questionnaires was employed for data collection. Major results are as follows: (1) 25.3% of the students had family members and 11.4% had friends who chew betel-nut; (2) 15.7% of the students had never tried betel-nut; (3) 71.2% of the students had betel-nut boothes near their homes and 43.4%, near their schools; (4) Most students tended to reject betel-nut chewing; (5) 1 8.5% of the students reported that they chew betel-nut; (6) 38.7% first tried betel-nut chewing during primary school and 16.3%, during junior high school; (7) Students who chew betel-nut have mothers with a low-level of education, have low self-acceptance, exhibit the trait of external control, have a positive attitude towards betel chewing, smoke, and have family members or friends who chew betel-nut. Based on these results, it was recommended that an educational program focusing on the prevention of betel chewing be initiated. Students with a low level of self-acceptance, the trait of external control or a smoking habit need to develop the ability to say ”no” and to resist family and peer pressure to chew betel-nut.
• 285 - 294
• 10.6288/JNPHARC1992-11-04-03

• Link 原著 Original Article
• 嚼檳榔預防教育先驅研究(Ⅱ)-國中生嚼檳榔預防教學實驗A Pilot Study of Betel Chewing Prevention (?)-Educational Intervention to Prevent Betel Nut Chewing Among Adolescents
• 李蘭、晏涵文、劉潔心、陳麗鳳
  Lee-Lan Yen, Han-Wen Yen, Chieh-Hsin Liu, Lih-Fenq Chern
• 無
  Betel chewing ; intervention ; adolescent
• ?喚起青少年對嚼檳榔有害健康的意識，並教導他們拒絕嚼檳榔的技巧，利用立意取樣法，淤台北市選取四所國民中學二年級男生，共八班?研究對象。每所學校各有實驗組一班和對照組一班。檳榔預防教學活動共計四個單元，以每週一次，每次五十分鐘，連續四週的方式進行。各校曾接受衛生教育專業訓練的健康教育教師擔任教學者，按各校排定日程，進行各項活動。教學活動實施前後，實驗組和對照組學生同時填答問卷，實驗組學生於每次教學活動後另有教學評量。就全體學生而言，教學活動實施後：(1)實驗組學生的認知正確率顯著地高於對照組；(2)實驗組學生不支持嚼檳榔的態度得分明顯地高於對照組；(3)兩組學生自評會勸別人不嚼檳榔的比率增加；(4)實驗組學生於實驗期間主動和別人談檳榔的比率顯著地高於對照組；(5)實驗組學生普遍對教學活動中使用的教學方法覺得有趣且有幫助。根據上述結論，建議將檳榔預防教育介入活動擴大舉辦，並期望有關單位及早制定檳榔產銷及消費政策，以環境的配合強化教育的功效。
  In order to raise the awareness of adolescents to the harm of betel-nut chewing and to instruct them on the skills of rejection, we purposely chose the nineth graders from four junior high schools in Taipei City to implement a pilot study. Eight classes of male students were selected and randomly assigned to either the intervention group or the control group. A teaching protocol was designed for four weekly 50-minute educational sessions for students in the intervention group. Four school teachers with professional training in the Health Sciences were recruited as educators. In addition to a pre- and post-test for both groups, an educational evaluation following each session was implememted in the intervention group. The intervention program in-creased the students konwledeg of and negative attitude toward betel-nut chewing. Students of both groups showed increased rates of advising others not to chew betel-nut. More of the students in the intervention group discussed betel chewing with others compared with those in the control group. Students in the intervention group reported that they were interested in the strategies employed in the educational activities. They felt that this educational program focusing on betel-nut chewing was worth expanding. The educational effectiveness of this program will be enhanced when production policies are established for betel-nut.
• 295 - 303
• 10.6288/JNPHARC1992-11-04-04

• Link 原著 Original Article
• 台北縣12至23個月大幼兒預防接種之現況探討Investigation of the Current Status of Immunization Among 12-to23-month-old Children in Taipei County, Taiwan
• 黃碧花、李蘭、陳瑾瑛、金傳春
  Bi-Hua Huang, Lee-Lan Yen, Chin-Ying Chen, Chwan-Chuen King
• 無
  Immunization ; Taiwan
• 臺灣地區於1982年發生小兒麻痺大流行後（1,043名報告病例），幼兒預防接種問題又成?眾所矚目的焦點。 本研究之目的在淤估計預防接種完成率，並瞭解影響延遲及未完成預防接種之因素。以等機率分層分段抽樣方法，自臺北縣內選取12至23個月大之幼兒?樣本，於民國七十八年一月至七月間，針對幼兒母親以家庭訪視和電話訪問方式，共收得2,367位個案資料，完訪率達74%。 研究結果顯示：(1)完成全部預防接種者（包括一劑卡介苗，三劑白喉、百日咳、破傷風混合疫苗，三劑小兒麻痺疫苗，一劑麻疹疫苗，及四劑B型肝炎疫苗）佔77.9%；(2)各項預防接種之按時完成率均不高，上述疫苗的完成率分別?45.1%，43.1%，43.1%，49.1%及53.9%；(3)延遲預防接種之主因?小孩身體不適(24.2-42.3%)；(4)卡介苗及第一劑B型肝炎疫苗的預防注射地點，以前往醫院、診所接種者較多（分別?46.8%和56.6%），其餘各項預防接種地點約以衛生所居高(62.5~71.4%)，但對衛生所的服務感到滿意的人僅佔(39.8%)；以及(5)幼兒母親有關預防接種之資訊來源雖以醫護人員?主(61.5%)，仍顯不足，且知道卡介苗可預防結核病者僅佔45.4%，有45.9%的父母認?「小孩出麻疹?自然現像，不必打預防針」。 根據本研究結果，可知台灣地區的預防接種完成率仍有待提高。本研究因此對政府有關單位在未來要有效控制「疫苗可預防的傳染病」，提出下列幾點誠摯建議：(1)加強衛生所的服務品質；(2)鼓勵醫院和診所更主動積極地參與預防接種工作；(3)各項預防接種時間之安排宜考慮民眾的遵循行?、疾病流行的可能性及該病原的傳染力，再做考量；(4)提高一歲幼兒第四劑B型肝炎疫苗及麻疹疫苗的完成率；以及(5)加強有關預防接種之衛生教育（包括預防接種原因、接種後可能反應及何種情況不宜接種等）。
  Since the poliomyelitis epidemic of 1982 in Taiwan, which resulted in 1,043 cases, the problems of immunization have attracted public attention. The objectives of this survey were: (1) to investigate the coverage rate of immunization among 12-to 23-month-old children; and (2) to identify the factors associated with vaccine failure and delay in receiving the recommended vaccinations (one dose of BCG, three doses of DPT, three doses of oral ploio vaccine, one dose of measles, and four doses of hepatitis B vaccine). The subjects were selected by the ”probability proportional to size” sampling method from Taipei County from February to July 1988. A total of 2,367 mothers of children were questioned in personal and/or telephone interviews. The response rate was 74%. Our study found that: (1) 77.9% of the children had completed their immunizations for the above vaccines; (2) the coverage rate for on-time completion for BCG was 45.1%, for DPT was 43.1%, for polio was 43.1%, for measles was 49.1%, and for hepatitis B was 53.9%; (3) the major reason for a delay in immunization was sickness of child; (4) most BCG (46.82%) and hepatitis B (56.57%) vaccinees were received at hospitals or in private clinics, while most other vacccines (62.48-71.43%) were received at health stations. Only 39.8% of these mothers were dissatisfied with the quality of service given at health stations, and (5) the majority (61.5%) of mothers acquired their information on immunizations from their medical staff; information at the public level was considered inadequate. This study demonstrates that the completeness of immunizations in Taiwan needs further improvement. We recommend that effective vaccination in the future should focus on: (1) upgrading the quality of services at local health stations; (2) encouraging hospitals or private clinics to participate in immunization programs; (3) reevaluate immunization schedules to eliminate delays in immunization; (4) reinforce the need to complete the fourth dose of the hepatitis B vaccine and the measles vaccine; and (5) strengthen health education emphasizing the purpose of immunization, post-immunization reactions, and conditions for refusing or postponing immunization.
• 304 - 315
• 10.6288/JNPHARC1992-11-04-05

• Link 原著 Original Article
• 台北地區女學生的身體形象和飲食行為Body Image and Eating Behavior in Young Females at Taipei
• 洪建德、鄭淑慧
  Chien-Te Hung, Shu-Huei Cheng
• 無
  Anorexia nervosa ; bulimia ; body image ; eating behavior
• 本調查研究的目的在瞭解台北區青少年女學生的身體形象和飲食行?，這份飲食行?問卷是向精神科醫師、內科醫師、心理學家，根據DSM-Ⅲ-R編製而成。我們抽取了國中11所、高中13所、專科學校5所、大學8所，每年級約100人（兩班），共計12,813人，得有效樣本12,597人。經統計分析得知，大部分受試者對她們的體重(56.2%)和體形(67.2%)並不滿意；超過一半的學生認?她們的大腿(56.2%)、小腿(53.2%)太粗，近一半的人認?她們的臀部(42.35)、腰(39.6%)、手臂(22.7%)太胖。有69%的學生報告她們會常節食或禁食，0.7%的學生吃減肥藥、利尿劑、瀉劑，7.1%的學生做激烈的運動，2.1%的學生催吐以達到減肥的目的。調查結果顯示女學生們普遍害怕發胖，而一些學生不當的減肥方式值得我們關注。
  The investigation was conducted to describe the body image and eating behavior in young females at Taipei. The Eating Behavior Questionnaire was designed by a psychologist, a psychiatrist, and an internist based on DSM-IH-R. About one hundred female students in each grade from 11 junior high schools, 13 high schools, 5 technical colleges, and 8 universities in Taipei were invited to participate this survey. The total number of students contacted was 12,813. As a result of the analysis of the valid data of 12,597 students, most of the students were not satisfied with their body weight (68.6%) and body shape (67.2%). Over half of the students felt their thigh (56.2%) and legs (53.2%) were too fat, and nearly half of the students were not satisfied with their hips (42.3%), waist (39.6%), and arms (22.7%). The rate of the students who engaged in dieting or fasting was 6.9%, use of laxatives or diuretics or diet pills was 0.7%, vigorous exercise was 7.1%, and self-induced vomiting was 2.1%. The data suggest that fear of obesity are pervasive among young females, and some students' inappropriate strategies for reducing weight need to be concrened.
• 316 - 327
• 10.6288/JNPHARC1992-11-04-06

• Link 原著 Original Article
• 社區民眾從事體能活動之研究A Study on Participation of Physical Activities of Community Residents
• 季瑋珠、符春美
  Wei-Chu Chie, Chun-Mei Fu
• 社區 ； 體能活動
  Physical activities ; community
• 本研究之目的在於探討社區民眾自發性體能活動進行的情況，民眾如何組織、如何參與，藉以發掘蘊藏於社區中的健康資源，並比較社區間之不同，以作?衛生政策與計畫之參考。同時採用問卷調查法及對各活動團體之田野調查法，透過量化與質化資料分析，對此問題作一深入而廣泛的了解。研究之社區採立意取樣，分別?台北市康莊社區（松山區敦厚、六藝二里）、台北縣新莊市頭前社區（頭前、化成二里），與台北縣貢寮鄉龍門、貢寮二村，代表大都市、衛星城市與鄉村地區。結果發現只有39.1%的受訪者，從事固定體能活動，且?高度個人化的行?，唯家庭仍有相當的影響力，有57.1%的因定運動者有家人陪同。從事因定運動?男性、都市居民、高教育程度及社經地位者的特質。社區正式組織影響力及號召力甚微，硬體設施亦不足。但較少運動的鄉村居民卻極熱心從事與其切身利益相關的活動。本研究建議社區保健工作者參考吸引民眾高度熱心的社區活動的實例，充實軟硬體設備，利用工作場所及家庭等資源，提倡有益身心社會的體能活動，藉著社區參與、有組織的社區努力達到全民健康的目的。
  The purposes of this study are to investigate the spontaneous physical activities in the community, to study their organization, the participation of community people, in order to find out the hidden health resources in the community. The author also compared the differences among different communities, and give suggestions to health policy and planning. In this study both questionnaire interview and field method, and both quantitative and qualitative data analysis were used to obtain the result. The study samples were drawn through purposeful systematic sampling, which are: Kang-chuang community in Taipei City, Tou-chien community in Shin-chuang city, and Lung-men and Kung-liao community in Kungliao rural township, standing for urban, satellite city, and rural areas. The results showed that only 39.1% of the subjects had regular exercise, and these actitives were highly individualized, while the family still had its influence, 57.1% of the regular exerciser had at least one family member taking exercise with them. Male, urban residents, people of high education and SES tended to exercise regularly. The formal organizations in the community had little influences. The handware for exercise was also inadequate. However, those rural people exercising seldomly showed great enthusism in those activities related to their own interest. The authors hoped the health workers in the community borrow the experiences from those activities highly related to the residents’ interests, strengthen the hardware and software in the community, mobilize the existing resources such as family and worksite, initiate physical activities which are good for people's physical, mental and social well-being, and finally reach the goal of ”health for all” through community involvement, and organized community efforts.
• 328 - 340
• 10.6288/JNPHARC1992-11-04-07

• Link 原著 Original Article
• 大學生部份負擔意願及能力Willingness for Copayment of National Health Insurance-An Opinion Survey of Undergraduates
• 林芸芸
  Yun-Yun Lin
• 道德危險 ； 部份負擔 ； 付費意願 ； 部份負擔能力
  moral hazard ; copayment ; willingness to pay ; ability to copay
• 本研究以全?公、私立大學（院）一、四年級學生為研究對象。採複式隨機抽樣法抽取2733名醫學院、非醫學院、及師範學院的學生，完成有效樣本數為1215名；回收率為44%。本研究的主要目的在於瞭解大學生對全民健康保險各醫療項目部份負擔的意願及相關因素；同時分析大學生願意部份負擔門診、住院、生育的金額及其負擔能力。大學生對各醫療項目願意部份負擔的百分比分別為：門診52%、住院51%、居家護理50%、健康檢查41%、復健36%、生育28%、衛生教育22%。全體樣本學生願意部份負擔的平均金額，及佔基準醫療費用的百分比為，門診109元(36%)、住院5438元(27%)、生育7727元(31%)。 部份負擔意願的相關特性：健康自覺較差者，部份負擔門診的意願較高。西醫門診使用頻率較多者，部份負擔住院的意願較高。部份負擔意願的隱性結構，79.9%為「無意願型」、20.1%為「有意願型」。且醫學院學生「有意願型」的百分比，顯著高於非醫學院學生。願意參加全民健康保險且有部份負擔意願者中，以女生較男生，一年級較四年級學生願意部份負擔住院費用的金額較高。且以女生、或每月可支配花費愈少、門診使用頻率愈多者，願意負擔住院的金額佔每月可支配的比率愈高。但門診及生育的部份負擔金額及負擔能力則未發現顯著的相關因素。
  none
• 341 - 355
• 10.6288/JNPHARC1992-11-04-08

• Link 原著 Original Article
• 美國RB-RVS（醫療資源基準相對價值表）在長庚醫院之應用Application of Resource Based-Relative Value Scale (RB-RVS) in Chang Gung Memorial Hospital
• 莊逸洲
  Yih-Jou Juang
• 無
  RBRVS resource-based relative value scale ; RPC relative practice cost ; AST amortization for special training ; CPT-4 current procedure terminology-4
• 根據美國HCFA(Health Care Financing Administration)的統計資料顯示在1990年美國全國醫療費用總支出已高達6,613億美元，佔同年度國民總生產毛額(GNP)的12.2%；其中單就『醫師費』部份即已支出1,375億美元，佔總醫療費用的20.8%且『醫師費』在過去十幾年來幾平均以兩倍於GNP成長的速度在增加。面對如此龐大而快速成長的支出，如何訂定『醫師費』的計算基準，以合理的分配醫療資源及反應醫師的付出，在美國近些年來一直是一個非常重要而迫切的研究課題，RB-RVS（醫療資源基準相對價值表）即是在此背景下因應而生並於1992年1月率先於老人健康保險(Medicare)實施。長慶醫院係國內首先實施『醫師費』制度的醫院，近十年來對『醫師費』的計算基準雖亦不斷地檢討改善，惟仍感未盡完善，故美國在研究RB-RVS之初長庚即予引入並陸續實施。本文僅就對RBRVS之瞭解及在長慶應用初期之經驗作一概述，未來是否能全面適用於國內的醫療體系，仍須作更進一步的探討。
  According to the statistical data released by HCFA (Health Care Financing Administration) of the United States, the total health care expenditure reached 661.3 billions, or 12.2% of GNP, in 1990. The total expenditure on physician services in 1990 was 137.5 billions, or 20.8 % of the total health care expenditure. In addition, the growth rate of physician fees is almost twice as high as that of GNP in the past of more than 10 years. How to calculate physician fees, based on the reasonable allocation of health resource & the reflection of physicians’ time & workload, is becoming a very important & urgent issue in the United States recently while facing a rapid growth expenditure of physician services. The resource based-relative value scale (RB-RVS) was developed and applied to Medicare in January, 1992 because of those reasons. Chang Gung Memorial Hospital is still not satisfied with its continuous improvement on physician fees system although it implemented physician fees earliest in Taiwan. Chang Gung Memorial Hospital implemented the RB-RVS gradually when the research of RB-RVS was completed. This article will make an introduction to RBRVS's results & preliminary imple-mentation results of Chang Gung Memorial Hospital. It is still not clear whether the health care in Taiwan can implement RB-RVS or not.
• 357 - 365
• 10.6288/JNPHARC1992-11-04-09