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研究生:丁福成
論文名稱:總額支付制度下各級醫療院所財務風險分擔及合作機制之研究
論文名稱(外文):Financial risk & collaboration mode of all healthcare organizations in global budget system
指導教授:丘駿飛丘駿飛引用關係
學位類別:碩士
校院名稱:元智大學
系所名稱:管理研究所
學門:商業及管理學門
學類:企業管理學類
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:86
中文關鍵詞:總額支付財務風險合作機制
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全民健康照護之普及為政府照顧國民積極推展之目標,民國八十四年三月一日起,我國政府開辦全民健康保險,在支付制度方面,首先採「論量計酬」模式,各級醫療院所為獲取較大之資源回饋,無不盡其所能提供大量醫療服務。因此,衍生速食醫療之惡性競爭,院所間醫療資源重複耗用,嚴重影響服務品質,致使健保財務年年虧損,面臨破產危機。
為遏止健保財務危機所面臨之困境,政府參酌先進國家研擬出「總額支付制度」。然在該制度下,由於各級醫療院所間仍存在甚多重疊性之服務。為避免「總額支付制度」實施後,因利益掛帥引致醫師人數及病人就醫量之大幅變動,對預算造成太大之衝擊。因此,本研究乃針對總額支付制度下,各級醫療院所財務風險分擔及合作機制做探討,結果顯示:在此一給付制度的衝擊下,各級醫療院所醫師人數及病人就醫量均有大幅變動,健保給付更從每點一元降至0.94元,明顯造成院所行為模式的改變。惟有在互信互賴的基礎之下,提供優質醫療服務,落實財務責任制度,藉以建立整合性醫療照護網絡,方能降低醫療資源重複耗用導致點值持續下降而造成之財務風險。
第一章 緒論……………………………………………………………… 1
第一節 研究背景…………………………………………………… 1
第二節 研究限制…………………………………………………… 4
第三節 研究架構…………………………………………………… 5
第二章 文獻探討………………………………………………………… 6
第一節 醫院垂直整合……………………………………………… 6
第二節 醫院策略聯盟………………………………………………14
第三節 總額支付制度………………………………………………22
第三章 研究方法…………………………………………………………42
第一節 研究對象……………………………………………………42
第二節 資料收集……………………………………………………45
第三節 分析方法……………………………………………………47
第四章 研究結果…………………………………………………………48
第一節 各級醫療院所財務風險分擔之機制………………………48
第二節 各級醫療院所之預算分配及合作機制建立………………53
第三節 各級醫療院所合作目標及相關配套措施…………………56
第四節 促成各級醫療院所之整合,以減少醫療資源之重複耗用62
第五節 監控指標之設立……………………………………………64
第五章 結論與建議………………………………………………………75
第一節 研究結論……………………………………………………75
第二節 政策建議……………………………………………………78
第三節 未來研究建議………………………………………………80
參考文獻(中文部分)………………………………………………81
參考文獻(英文部分)………………………………………………83
表2-1…………………………………………………………………12
表2-2…………………………………………………………………20
表2-3…………………………………………………………………39
表4-1…………………………………………………………………66
表4-2…………………………………………………………………67
表4-3…………………………………………………………………68
表4-4…………………………………………………………………69
一、中文部分:
1.中央健康保險局 2001全民健康保險統計。
2.王炳龍 2000醫院採用垂直整合策略隻影響因素與績效評估。
3.李丞華 1998全民健康保險統計圖表及跨國性比較研究。
4.張沅嬪 2001醫院總額支付制度之探討。
5.羅芳怡 2002醫療產業策略聯盟以及管理的相關概念。
6.陳孝平 1998影響全民健康保險醫療費用因素之探討。
7.江東亮 1999醫療保險政策:台灣經驗。
8.楊志良 1998醫療費用支付制度之理論探討與台灣經驗。
9.劉興寬 2002醫院策略管理。
10.國家衛生研究院 2001全民健康保險深度訪談彙編。
11.國家衛生研究院 2001全民健康保險年度邀稿彙編。
12.行政院衛生署 2002全民健康保險-醫院總額支付制度研討會資料。
13.韓 揆 1990全民健康保險對醫院經營管理之影響評估:台灣地區綜
合醫院之分布、利用、管理與全民健保之關係。
14.劉嘉祺 1999健保多元體制下風險調整機制之探討-全民健保資料
的實証分析。
15.李玉春 1997全民健康保險住院論病例計酬制對醫院醫療行為之影
響。
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17.全民健康保險雙月刊。
18.醫院雙月刊第33卷第3期;第35卷第1期;第35卷第3期。
19.醫務管理期刊創刊號;第2卷第4期;第3卷第2期。
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7.Brown, M., & Mc Cool, B. (1986), Vertical integration: Exploration of a popular strategic concept. Health Care Mana-gement Review, 11(4), 7-19.
8.Brown, M.(1996). Mergers, networking, and vertical integration: Managed care and investorowned hospitals. Health Care Management Review, 21(1), 29-37.
9.Burns, L.R., Bazzoli, G.J., Dynan, L., & Wholey, D.R.(1997). Managed care, market stages, and integrated delivery systems: Is there a relationship? Health Affairs, 16(6), 204-218.
10.Burns, L.R., Shortell, S.M., & Andersen, R.M.(1996). The effect of physicianhospital integration of physician productivity, loyalty and work relationships, Association for Health Services Brsearch Annual Meeting Abstract Book, 13, 121.
11.Cave, D.G. (1995). Vertical integration models to prepare health systems for capitation. Health Care Management Review, 20(1), 26-39.
12.Chan, B., S.M. Shortell, T.D” Aunno, G.J. Bazzoli, “The financial performance of hospitals belonging to health networks and systems” Inquiry- Blue Cross and Blue Shield Association, Vol,37, Iss. 3, 234-52, Fall 2000.
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18.Conrad, D.A., & Dowling, W.(1990(. Vertical integration in health services: theory and managerial implications. Health Care management Review, 15(4), 9-22.
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