臺灣博碩士論文加值系統

摘要

結核病是影響人類非常深遠的疾病，它與愛滋病(AIDS)同為本世紀目前最重要的兩個傳染病，所以世界衛生組織將結核病防疫列為非常重要的工作項目。目前全球每年仍有約八百萬個新發病的病例，而且估計有一百六十萬人死於結核病。而我國近十年來雖然結核病的死亡率下降很多，但每年的新增個案數仍大於一萬五千例，未有明顯的下降趨勢，顯示國內結核病防疫工作仍有很大的努力空間。因此，無論在醫療或公共衛生的領域，結核病防治工作都是重要的課題。
在使用正確劑量及完整療程的藥物化學治療下，絕大部份的結核病是可以被治癒的。因此，如何設計並推動有效的管理方案來發現病人及完治病人是結核病防疫工作的重點。我國現行的結核病防疫體系是由衛生署疾病管制局所主導，採用醫療與公衛雙軌並行制，並運用疾病管理及個案管理的精神，推動健保論質計酬試辦方案及都治計劃等策略，成效值得觀察與期待。在此體制下，各級醫院的角色相對重要，而醫院能否確實治療結核病並執行公共衛生政策是防疫工作成敗的關鍵。
本研究在國內某醫學中心，以國外cohort review的成功經驗及強化資訊管理的理念為基礎，發展了包含管理小組、衛教單位、資訊系統、結核病委員會及院內相關單位的醫院結核病管理系統，運用在日常實際的結核病防治工作上，並檢討歸納出品質管理指標，藉以改善管理流程，再追蹤執行成果。
本研究的結果期待能成為各醫院在這方面工作的參考，也希望主管機關能給予指導並訂定統一的規格，如此則能加強縱向及橫向的溝通聯繫和合作，結核病防疫才能真正落實，『十年減半』的目標才能早日完成。

Abstract
Background：After the carryout of Global Budget Payment System by Bureau of National Health Insurance since July 2002，contentions between hospitals become more fierce，the management and operation method must beyond any of business models. Since the conscience of consumers flying high，requests were called frequently by Funds of Medical Reform to have government hygiene organizations disclose financial reports of hospitals of juridical person and let the information of Health Insurance transparent.
Except convey achievements of management and deployments of medical resources, basically financial reports can provide critical information, let staffs of hospital management level, government organizations and outside users consult, and furthermore cited as data resources of research and investigation and basis for allocation of medical resources, all of which have great influence and cannot be disregarded.
Objectives：1. Investigate the origins of the editing criteria for financial reports of the medical juridical person and analyze and compare the editing criteria and framework norms for financial reports of the hospitals of juridical person (proclaimed by the Department of Health—DOH ) and generally acknowledged accounting norms for American nonprofit organizations.2.Understand current situations of financial accounting of domestic medical juridical person and their influential effects.
Results：1. According to the editing criteria of financial reports for medical juridical person from DOH, we know if medical juridical person disclose their financial reports, they can let their management condition transparent, and after 2006, all of them must completely follow the criteria to editing their balance sheet, revenue and expenditure balance sheet, net value variation sheet, and cash flow sheet. 2. There are little differences of financial reports editing criteria between medical juridical person and American nonprofit organization, but the accounting item definitions of American

目 錄
第一章 緒論1
第一節 研究背景與動機-1
第二節 研究目的-6
第二章 文獻探討-7
第一節 結核病的流行病學-7
第二節 結核病的照護-9
第三節 我國結核病防疫體系的歷史和變革-12
第四節 疾病管理、個案管理及資訊管理-13
第三章 研究方法-16
第一節 研究設計與架構-16
第二節 研究材料-17
第三節 研究變項操作型定義-19
第四節 研究方法-22
第四章 研究結果-24
第一節 結核病管理系統的建構及病人資料收集-24
第二節 2006年TIMS資料分析-26
第三節 結核病管理流程的改造-30
第四節 2007年1到4月TIMS資料的追蹤分析-32
第五章 討論、建議與結論-33
第一節 討論-33
第二節 研究限制-40
第三節 建議-41
第四節 結論-45
參考資料 中文部份-47
英文部份-49
附錄一-53

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