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研究生:張雪芬
研究生(外文):CHANG, SHUEH-FEN
論文名稱:論質計酬試辦計畫成效初探-以肺結核疾病為例
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:蔡文正蔡文正引用關係
指導教授(外文):TSAI, WEN-CHEN
學位類別:碩士
校院名稱:中國醫藥學院
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:113
中文關鍵詞:肺結核論質計酬完治率醫療品質滿意度
外文關鍵詞:TuberculosisPay-by-qualityMedical qualityComplete treatment rateSatisfaction
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為了平衡全民健康保險財務及增加就醫可近性,以達到提高醫療品質等目的,健保局自民國九十年十月起開始推動「醫療給付改善方案試辦計畫」,以肺結核等五大疾病為主,試將醫療保險給付與醫療品質結合,此「論質計酬」給付方式成效建立於「疾病管理」之基礎上。有鑑於此,本研究以「肺結核醫療改善方案試辦計畫」為例,探討其「疾病管理」效果。
本研究針對中部四縣市罹患肺結核病患為研究對象,目的為分析是否加入論質計酬肺結核患者之完治情形、對肺結核疾病的認知、醫療服務過程及治療結果之整體滿意度。此外,探討影響肺結核疾病完治情形、醫療服務過程及結果之整體滿意度及醫療費用之因素。本研究採用面對面訪談問卷調查方式收集資料,共回收有效問卷270份。本研究除進行一般描述性分析外,並應用複迴歸及羅吉斯迴歸分析方法加以探討。
本研究結果顯示加入試辦計畫之病患其完治率並未提高,相對於未加入試辦計畫病患其對醫療服務的滿意度亦較低,總醫療費用亦較高,初期看來健保局所推動的「肺結核醫療給付改善方案試辦計畫」成效不彰。而加入試辦計畫完治病患之完成治療時間,較離開試辦計畫後完治者或未加入試辦計畫完治者的治療時間短,達統計上顯著意義,此部份說明試辦計畫的治療時間確實較短。
依據結果本研究提出如下建議:一、對中央健康保險局之建議:應加強對試辦計畫之宣導及加入對醫療品質指標相關之評估;二、對衛生主管機關之建議:對民眾加強社區衛生教育,結合疾病管制局與健康保險局之通報系統,以利管理。
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
附錄一、全民健康保險肺結核醫療給付改善方案試辦計畫 96
附錄二、研究問卷 102
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