臺灣博碩士論文加值系統

本研究以國內三家不同層級的醫院分別進行全責護理照護模式試辦計畫，再分別針對不同照護模式進行分析，以推論實施全責護理所節省之人力成本及提昇護理照護品質是否有其推廣性，並由成本分析中探討不同照護模式確實有不同的推廣價值。
經分析評估結果顯示，以單一時間點由1位照顧服務員負責照顧4張病床而言，其社會總效益及社會總成本較低於1位照顧服務員負責照顧2張病床之效益及成本，高於1位照顧服務員負責照顧6張病床之效益及成本，假如全部由健保支出，則健保局每月必須支出10億8千萬元薪資費用，其每月益本差為2億9千8百萬元，益本比為1.275，是單一時間點由1位照顧服務員負責照顧2張病床或或4張病床或6張病床之三個方案中益本差最大，益本比也最高的方案，因此是三種不同照護人力之中最有效率的方案，但是，健保局必須每月支出10億8千萬元，相當於台灣地區的人民，每人每月必須多繳48.63元健保費，此一方案之所以可行，是因為台灣地區的人民，每人每月願意多繳58.97元健保費來支持這項政策。
不過由於不同照護人力之方案其益本差均為正值，或者說益本比均大於1，是屬於可行之政策，因此全責護理計畫之推動，是台灣醫療照護品質方面可以值得推動的醫療服務項目。假如醫療政策將此項計畫之支付費用納入健保&;#32473;付範圍，則民眾所願意繳交的健保費用將高於實施全責護理計畫所需之成本，推動全責護理照護活動，將是一個政府單位、保險人、民眾、醫療人員各方均共同獲益的資源配置，當資源配置能夠使得各方均獲益而無任何一方損失時，已經符合經濟學理上定義的巴雷多效率(Pareto efficiency)資源配置的涵義。因此，以完善的「全責護理」取代家屬留院制度，建構全責護理照護計畫提供全方位醫療照護品質，已成當前克不容緩的重要工作。

Research this three different hospital of level carry on the whole responsibility is it look after way run the plan as an experiment to attend to separately in Israel, and then separately to with look after way is it analyse, implement with inference the whole responsibility attend to manpower cost saved and is it is it look after quality have person who popularize their to attend to to promote to go on, and probe into different ways of looking after from cost analysis and really have different value to popularize.
Through is it assess result show, with is it look after by 1 waiter responsible for looking after 4 sick beds to order at one time only but speech to analyse, its social total benefit and social total cost are relatively lower than one and look after benefit and cost that a waiter is responsible for looking after 2 sick beds, higher than one and look after benefit and cost that a waiter is responsible for looking after 6 sick beds, is it protect expenditure to good for all, is it protect office must pay the wages expenses of 1,080 million yuan every month to good for, a difference of its benefit of every month is 298 million yuan, originally in benefit than for 1.275,whose name is order not looking after there aren''t waiter each at one time only, Ben Yi than supreme scheme too, so three different to look after the most efficient scheme among the manpower, but must good for office of protecting the expenditure of 1,080 million yuan of every month, equivalent to the people of Taiwan, must pay 48.63 yuan and strong in premium more for each person every month, this scheme is feasible, would like to pay 58.97 yuan and strong in premium to support this policy more for each person every month because of the people of Taiwan.
But because different to look after scheme their benefit copy of manpower difference to on the occasion of, Ben Yi than greater than 1, a feasible policy, so the whole responsibility attends to the push that is planned in other words, it is the medical treatment of Taiwan that looks after the medical service item that quality can be worth promoting in a more cost-effective manner. If medical policy to pay expenses is it is it protect to good for to included in the plan? One pair of ranges, people then like pay is it assuare expenses is it implement the whole responsibility attend to and plan the necessary cost to higher than to good for, promote the whole responsibility to attend to the activity of looking after, it will be the resource distribution that a government unit, insurer, people, medical personnel''s each side benefitted together, when resource distribution can make each side benefit and not have either party''s loss, much efficiency of Palestinian thunder defined on already according with economy and studying the science Pareto efficiency Meaning of resource distribution.
So '' the whole responsibility attend to '' replace relative leave institute system, is it construct the whole responsibility attend to and look after planning to offer omni-directional medical treatment to look after quality to build with a perfect one, have become gram at present and has not allowed slow important work.

中文摘要……………………………………………………………i
英文摘要…………………………………………………………iv
誌 謝………………………………………………………………vii
目 錄………………………………………………………………ix
表 目 錄………………………………………………………………xii
圖 目 錄……………………………………………………………iv
第一章 緒論………………………………………………………1
一、研究背景………………………………………………1
二、研究問題…………………………………………………4
三、研究目的…………………………………………………5
第二章 文獻探討…………………………………………………7
一、 Primary Nursing and Total Nursing……………………7
二、 護理照護模式的分類………………………………8
三、 學者對於照護模式之看法…………………………13
四、 護理費之現況………………………………………15
五、 照護服務員之興起…………………………………19
六、 照顧服務員名稱與定義……………………………21
七、 護理人員與照顧服務員之關係……………………23
八、 經濟評估……………………………………………29
第三章 研究設計與方法………………………………………32
一、 效果(effectiveness)評估……………………………32
二、 效率(efficiency)評估………………………………33
(一) 成本效果(cost-effectiveness)分析………………33
(二) 成本效益(cost-benefit)分析………………………34
三、 研究流程……………………………………………38
四、 研究架構……………………………………………40
五、 研究對象與執行模式………………………………41
(一) 研究對象………………………………………41
(二) 執行模式………………………………………42
六、 資料分析……………………………………………46
第四章 結果……………………………………………………48
一、 試辦單位執行內容分析…………………………48
二、 試辦單位執行成效…………………………………54
三、 民眾付費意願分析…………………………………59
(一) 基本資料描述性統計………………………………61
(二) 付費意願與個人特質相關性……………………64
四、 成本效益分析…………………………………………69
(一) 成本效益分析(CBA)與成本效果分析(CEA)本研究的適用性……………………………………………………69
(二) 付費意願(WTP)在本研究的測量效度………………69
(三) 總體付費意願試算：付費意願卡…………………70
五、 總體社會成本試算……………………………………73
六、 總體社會成本效與政策建議……………………74
第五章 討論……………………………………………………78
一、 三家試辦醫院執行成效討論………………………….78
二、 台北巿立聯合醫院全責照顧制度內容………………80
三、 研究限制…………………………………………………93
第六章 結論與建議………………………………………………94
一、 計畫目標資料蒐集……………………………………96
二、 計畫評估依據…………………………………………97
第七章 參考文獻…………………………………………………98
附錄一 研究問卷………………………………………………112
附錄二 全責護理試辦計畫評價研究成本資料表……………113
附錄三 全責護理試辦計畫評價研究成本資料表彙整……115


表目錄
表1. 醫學中心健保急性病床護理費支付點數試算…………16
表2. 醫學中心與區域醫院健保急性病床護理費支付點數差距試算表…………………………………………………………17
表3. 衛生署95年度計畫內容摘要………………………………48
表4. 三家試辦醫院全責護理計畫目標…………………………52
表5. 三家試辦醫院全責護理計畫目標成效……………………53
表6. 受訪者縣巿分析情形………………………………………61
表7. 受訪者個人特質……………………………………………63
表8. 受訪者個人特質……………………………………………63
表9. 一位照顧員對二位病患之付費意願與受訪者個人特質之關係……………………………………………………………66
表10. 一位照顧員對四位病患之付費意願與受訪者個人特質之關係………………………………………………………67
表11. 一位照顧員對六位病患之付費意願與受訪者個人特質之關係………………………………………………………68
表12. 付費意願複迴歸分析…………………………………70
表13. 每月總體付費意願試算：付費意願卡………………71
表14. 單一付費金額願付比率分布…………………………72
表15. 每月總體成本試算……………………………………74
表16. 全責護理計畫每月成本效益分析……………………75
表17. 臺北巿立聯合醫院全責照護制度照護內容……………81
表18. 修訂陪病定義後94年1-5月全責照顧推動後陪病情形83
表19. 臺北巿每月總體付費意願試算：付費意願卡…………87
表20. 臺北巿每月總體社會成本試算(一)……………………87
表21. 臺北巿每月總體社會成本試算(二)……………………88
表22. 臺北巿每月總體社會成本試算(三)……………………89
表23. 臺北巿全責護理計畫每月成本效益分析………………90

圖目錄
圖1 研究流程圖……….………………………………………..39
圖2 研究架構圖…………………………………………………41
圖3 全責照顧推動前後陪病率情形……………………………83
圖4 全責照顧推動前後陪病類別的變化(家屬、看護工)……85
圖5 住院病患及家屬對全責護理滿意度調查…………………85
圖6 病房助理對全責護理照護滿意度…………………………86

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