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論文名稱(外文):Preliminary Study for Evaluation of the Effectiveness of the Pay-by-Qualify program in Tuberculosis Patient
指導教授(外文):TSAI, WEN-CHEN
外文關鍵詞:TuberculosisPay-by-qualityMedical qualityComplete treatment rateSatisfaction
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In order to balance the finances of the National Health Insurance and to increase its accessibility to hospitals, Bureau of National Health Insurance started to execute a medical payment program to achieve a better healthcare quality on October 2001. This program tried to combine payments and medical quality in five major diseases such as tuberculosis. The pay-by-quality payment method was established based on disease management. Therefore, this research used the tuberculosis medical payment program to study the effectiveness of disease management.
The tuberculosis patients residing in four cities located in the middle part of Taiwan were enrolled in this study. The purpose of this study was to analyze their complete treatment rate, their knowledge about tuberculosis, and satisfaction to the whole medical service and treatment consequences between patients who participated in the program and those who didn’t participate in the program. In addition, the factors of the effect of complete treatment rate to tuberculosis for patients, the satisfaction of medical service, and medical expenditures were explored in this study. Interview questionnaires were used to collect data. There were 270 questionnaires collected in this study. The descriptive analysis, multiple regression and logistic regression were used for data analysis.
The results showed that there were no significant increases in complete treatment rate when patients enrolled in the tuberculosis medical payment program. The satisfaction rate of medical service was relatively low and the total medical expenditures were much higher compared to those patients who didn’t participate in the program. It also showed that the tuberculosis medical payment program didn’t work out well at the beginning. The treatment time for complete treatment patients participating in program was significantly shorter than that for complete treatment patients who interrupted the program or didn’t join the program.
According to our results, the suggestions are proposed as follows: 1. Suggestions to Bureau of National Health Insurance: Enhance the advertisement to educate and deliver the concepts of the tuberculosis medical payment program, and evaluate their healthcare quality; 2. Suggestions to Office of Public Health: Strengthen people’s education to community health, and combine a case reporting system between the Center for Disease Control and the Bureau of National Health Insurance.
第一章 緒 論 1
第一節 研究背景及動機 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 結核病與現況探討 5
第二節 治療方式 12
第三節 國內的防治工作與衛生政策 16
第四節 疾病管理 18
第五節 計畫評估方法 31
第三章 研究方法 33
第一節 研究架構與研究假設 33
第二節 研究變項及定義 35
第三節 資料來源 38
第四節 資料處理與分析 41
第四章 研究結果 43
第一節 描述性分析 43
第二節 雙變項分析 47
第三節 迴歸分析結果 53
第五章 討論 81
第六章 結論與建議 86
第一節 結論 86
第二節 建議 88
第三節 研究限制 91
參考文獻 92
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