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研究生:蘇訓正
研究生(外文):Shiung-cheng Su
論文名稱:臺灣基層醫療網絡組織建立及運作之研究–「全民健康保險家庭醫師整合性照護制度試辦計畫」之個案探討
論文名稱(外文):The Establishment and Practiceof Medical Network of Primary Medical Care in Taiwan:A Case Study in DOH’s “The Experimental Planfor the System of Integrated Care of Family Physicianin National Health Insurance”
指導教授:楊仁壽楊仁壽引用關係
指導教授(外文):Jenshou Yang
學位類別:碩士
校院名稱:國立雲林科技大學
系所名稱:企業管理系碩士班
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:2004
畢業學年度:92
語文別:中文
論文頁數:94
中文關鍵詞:醫療整合家庭醫師制度醫療網絡
外文關鍵詞:System of family physicianMedical integrationMedical network
相關次數:
  • 被引用被引用:6
  • 點閱點閱:228
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:5
中 文 摘 要
台灣社會因為人口快速老化,使得慢性病和長期照護逐漸成為醫療照護的主角,但目前台灣的醫療體系是以治療急性病為主,並不適於照顧慢性病患者。過去台灣醫療體系一直未建立家庭醫師制度和分級轉診的制度,醫療體制間長期缺乏整合的機制,基層醫療院所與醫院間是競爭多於合作。□解決上述問題,衛生署在健保實施總額支付制度控制醫療費用的成長後,於92年3月推動「全民健康保險家庭醫師整合性照護制度試辦計畫」,希望建立一個社區醫療群組織,以促進基層醫療院所和醫院間垂直和水平方向整合,並提升醫療品質,控制健保費用的上漲。本研究想要了解影響醫療網絡(社區醫療群)的組成、運作因素及其與組織績效間的關係。
本研究由醫療網絡關係中的廣度和深度兩個構面切入,採用質性研究中的個案研究法。由研究結果得知醫療網絡各種構面的相關性中,建立組織成員間的信任和承諾是網絡組織最重要的工作。這將影響成員間的協調溝通與向心力,亦即網絡組織凝聚力的高低。有凝聚緊密的組織,才能整合組織內的各種資源提供更多元、更有價值的醫療服務,如此才能增進網絡的績效。
關鍵詞:醫療網絡、家庭醫師制度、醫療整合
Abstract
As the population structure of Taiwan is getting aged rapidly, the medical system should allocate more resources on the treatment of chronic disease and long-term care. Nevertheless, the current medical system in Taiwan has long been designed mainly to treat acute disease, rather than chronic disease. Obviously, it is not fit for the need nowadays. Because the system of family physician and the level of referral system have not been well established, the medical system has serious lack of linkage mechanism among different levels of medical institutions. In order to solve these problems, Department of Health (DOH) has implemented a global budget control of the national health insurance to restrain the growth of medical expenditure. In March 2003, DOH also started to carry out “The Experimental Plan for the System of Integrated Care of Family Physicians in National Health Insurance.” Based on the establishment of “social medical network” embedded in the local community, the plan aims to promote the vertical and horizontal integration of primary medical care and hospital, advance the quality of medical service, and control the growth of medical expenditure in the whole society. This study attempts to investigate different factors which affect the organization, practice, and performance of the medical network (social medical group) constructed.
In the case study with qualitative approach, this study explores the medical network relation via its two dimensions of width and depth. Among variety of the relation structures of the medical network, the establishment of trust and commitment between the members of network is the most important. The effort in this factor will strengthen the cohesiveness of the social network, which will in turn enhance the coordination, communication and centripetal force between the members of network. Intensive cohesiveness of network can also integrate all resources of organization to provide more multiple dimensional and more valuable medical services, and improve the network’s total performance.
Key words:Medical network、System of family physician、Medical integration.
目 錄
中文摘要---------------------------------------------------------------i
英文摘要---------------------------------------------------------------ii
目錄---------------------------------------------------------------iii
表目錄---------------------------------------------------------------iv
圖目錄---------------------------------------------------------------v
第一章緒 論----------------------------------------------------------1
第一節研究背景與動機------------------------------------------------1
第二節研究重要性和研究目的------------------------------------------2
第二章 文獻探討-------------------------------------------------------4
第一節臺灣健康保險制度的演變與總額支付制度實施現況--------------------4
第二節醫療網絡-------------------------------------------------------13
第三節全民健康保險家庭醫師整合性照護制度試辦計畫----------------------29
第三章研究設計與方法-------------------------------------------------37
第一節研究流程-------------------------------------------------------37
第二節研究方法-------------------------------------------------------38
第三節研究設計研究對象與資料收集-----------------------------------40
第四章研究結果與討論-------------------------------------------------42
第一節案例背景-------------------------------------------------------43
第二節研究結果-------------------------------------------------------43
第五章結論與建議-----------------------------------------------------75
第一節結論-----------------------------------------------------------75
第二節建議-----------------------------------------------------------83
第三節研究限制 ------------------------------------------------------85
參考文獻---------------------------------------------------------------87
中文---------------------------------------------------------------87
英文---------------------------------------------------------------89
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1. 臺灣基層醫療網絡組織建立及運作之研究–「全民健康保險家庭醫師整合性照護制度試辦計畫」之個案探討
2. 評估「全民健康保險家庭醫師整合性照護計畫」的實施對民眾醫療資源利用之影響
3. 某區域教學醫院推動全民健康保險家庭醫師整合性照護試辦計畫之成效探討
4. 『全民健康保險家庭醫師整合性照護計畫』經營模式之探討
5. 「全民健保家庭醫師整合性照護試辦計畫」對照護持續性之影響
6. 台灣全民健康保險家庭醫師整合性照護試辦計畫社區醫療群之基層診所與合作醫院退出或更換夥伴之影響因素探討
7. 家庭醫師整合試辦計畫之成效評估
8. 參與家庭醫師整合性照護試辦計畫民眾對醫療服務品質之觀感
9. 以質性研究探討基層醫師對家庭醫師整合性照護試辦計畫之看法及執行現況
10. 牙醫及中醫實施全民健康保險家庭醫師整合性照護制度之可行性研究-以高屏地區為例
11. 參與家庭醫師整合性照護計畫之民眾與醫療機構之成效評估
12. 家庭醫師整合性照護計畫成效探討-以病患滿意度評量-
13. 全民健保下的家庭醫師整合照護制度---竹東榮民醫院個案研究
14. 民眾對「家庭醫師整合性照護計畫」知識、態度及行為之探討--以社區醫療群糖尿病人為例
15. 總額預算與家庭醫師整合性照護計劃下醫院與診所之競合關係研究--以台南市社區醫療群為例