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研究生(外文):Jenn-jong Lee
論文名稱(外文):The system dynamics on the TW-DRG system for hospital days in Hospital Revenue, medical and behavioral study with the doctor-patient relationship
指導教授(外文):Yi-Min Tu
外文關鍵詞:System Dynamicsdiagnosing related group
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在「住院診斷關聯群」首重病例臨床路徑標準化,而影響臨床路徑標準化制定則首當住院天數,故本研究所建構之系統動力學模型,選擇第一階段實施TW-DRGSs 155項之住院天數、醫院TW-DRGSs案件數、佔床率及住院滿意度等,這些相互影響關係值的模擬均採用Table function 進行模擬。而本研究所提出的Table function 是透過個案醫院在平日常營運過程中的真實數據、觀察、經驗判斷或是相關文獻參考所得之資料,其績效衡量指標系統僅能代表國軍醫院個案,而無法證明其他規模醫院之適切性為何;且本研究僅依照個案醫院系統模式進行模擬,當系統模式不同時可能出現不同之結果。
(1) 控管住院天數,增加病床周轉率
(2) 建立各類疾病臨床指引或臨床路徑
(3) 提高醫療費用申報效益
(4) 自費項目開發之研究
Since the systems of health insurance of the whole people were run in March of the 84th year of the Republic of China, it is very near to offer medical treatment to the best patient in the whole world, the highly free right to choose of seeking medical advice, and high-quality medical care. But cause the expense expenditure of the hospital to rise continuously, is strong in protecting the office as because in conformity with the financial situation, pursue a lot of financial retrenchment policies successively, cause uncertainty and complexity of the medical industry''s environment. Especially pay the system so far the total value of the hospital, decline in the development in economy of the whole world depressedly, domestic aging of population, unemployment increase, medical resources are insufficient day by day and strong in assuaring the financial affairs are left pressingly, the central health insurance bureau is paid the system and controls the cost, adjust and pay the standard progressively, towards pay, standardize while being single, so reform pay medical the intersection of institutes and way pay system for TW-DRGSs '' diagnose related group in hospital '' stage by stage year by year from January of 1999.
Made in Singapore after setting out on a journey, future so long as medical resource more close part will be sorted out into the same class, in accordance with kinds of Diseases, operation, age, gender, amalgamate condition classification such as disease, divide into groups according to the weight grade of the condition, pay by norm, is lower than lower limit, will adopt and verify that declare the way, that is to say '' pay the system with severity and reward ''. The government implements the policy purpose of '' TW-DRGSs '', except the efficiency of serving for raising medical treatment, reduce the waste, also can improve patient, look after quality and curative effect, let the intersection of hospital and the intersection of cost and optimization, but the implementation of DRG will cause the suitable impact of the hospital, may aggravate looking after and financial responsibility and risk of the medical organization.
But hospital attribute( Set objectives, the intersection of role and localization, organization and the intersection of power and responsibility and structure,etc.) Different, the hospital faces being strong in assuaring that it and because will be different to pay the financial pressure that the system changes in conformity with ways, except army''s hospital in the country shoulders the country and looks after soldier''s healthy policy responsibility, pay attention to managing the performance even more. So because should be strong in assuaring that it will be different to pay measure and efficiency that the system''s changing takes and lowers costs to some extent, and these differences will react on the manifestation of financial performance indicators such as its medical care amount, income and interests,etc.. Satisfied how to promote the financial performance of the hospital, give consideration to operations objective, medical care quality and patient of the hospital at the same time, key factor that will be managed continuously forever for the hospital.
Until '' diagnose related group in hospital '', first serious the intersection of case and clinical route standardize, influence clinical the intersection of route and standardization make, act as, in hospital number for the first time, so this research institute builds the systematic dynamics model constructed, the ones that chose the first stage to implement 155 items of TW-DRGSs were in hospital in days, the hospital TW-DRGSs case number, take bed rate and satisfaction in hospital etc., these influence each other the simulation of the relation value adopts Table function to imitate. And Table function which this research institute puts forward passes the true data in often operation course on ordinary days of case hospital, observe and experience judgement or relevant literature consult materials of income, performance its weigh the intersection of indicator and system can represent the intersection of country and the intersection of army and the intersection of hospital and case only, can''t prove why the other scale hospitals are appropriate; And this research is paid and imitated according to the systematic way of case hospital alone, as system way may present different results not simultaneously.
Expect to give the case hospital some suggestions in managing, managing and is made with the clinical route through this research, the colleagues of staff of different levels work satisfiedly in safeguarding patient''s whole rights and interests, courtyard, promote the quality of medical care, the purpose of this research:
(1)Make use of system of macroscopic think way, canvass the intersection of case and hospital, implement, good for, protect TW-DRGSs at the system, the influence that the management in hospital stays runs to the case hospital for a long time, and can assist the case hospital to find the optimum management effect.
(2)Set up systematic dynamics way, imitate the intersection of case and hospital, divide into annual to implement, good for, protect TW-DRGSs, in hospital management of day to the intersection of hospital and revenue and expenditure, medical behavior and influence to cure the desease relation at the system stage by stage.
The concrete suggestion of this research is as follows:
(1) Control and manage number in hospital, increase the turnover rate of the sick bed
(2) Set up all kinds of disease clinical guiding or clinical routes
(3) Improve the hospitalization cost and declare benefit
(4) Research of project development at one''s own expense
誌謝 II
中文摘要 III
表目錄 XI
圖目錄 XII

第1章 緒論 1
1.1研究背景 1
1.2研究動機 1
1.3研究目的 2
1.4研究流程 2
1.5研究架構 4
第2章 文獻探討 5
2.1 前言 6
2.2健保支付制度簡介 6
2.2.1論服務量計酬 6
2.2.2論病例計酬 6
2.2.3總額預算支付制度 6
2.2.4 DRG診斷關聯群支付制度 8
2.2.5 DRG名詞解釋 13
2.3住院日數與醫療費用之研究 16
2.4住院日數、疾病嚴重度與醫療費用之相關研究整理 16
2.5個案醫院簡介 18
2.5.1個案醫院之沿革 18
2.5.2經營理念與願景 18
2.5.3營運現況 19
2.5.4個案醫院 TW-DRGs導入後占全部住院費用之影響 19
第3章 研究方法 23
3.1系統思考 23
3.2系統動力學 25
3.2.1資訊回饋環路 26
3.2.2時間滯延 26
3.2.3動態性複雜 26
3.2.4處理非線性問題 27
3.3因果回饋圖 27
3.4繪製因果關係圖應注意的事項 30
3.5 系統動力學基礎模型 31
3.5.1線流圖 31
3.5.2積量 31
3.5.3 率量 31
3.5.4輔助變數 32
3.5.5 關係 32
3.6系統動力學模擬軟體 33
3.6.1 DYNAMO 33
3.6.2 Vensim 33
3.6.3 Powersim 34
3.6.4 STELLA 34
3.7系統建模程序 34
3.8模型測試及效度檢驗 39
第4章 系統動力學模型建構與政策模擬分析 41
4.1系統動力學基礎模型 41
4.1.1個案醫院之問題描述與系統邊界 41
4.1.2因果回饋分析 41
4.1.3系統動力學架構 45
4.1.4信度與效度檢定 51
4.2情境模擬 54
4.3情境分析 57
4.4政策分析 57
第5章 結論與後續研究建議 60
5.1研究發現與結論 60
5.2研究貢獻 60
第6章 參考文獻

(3)Hornbrook, MC., “Techniques of Accessing Hospital Case Mix,” Ann Rev Public Health, vol6, 1985, 295-324
(8)郭進隆譯,1994,第五項修練 – 學習型組織的藝術與實務(原著:Senge, Peter M., 1990, The Fifth Disciple),台北:天下文化出版社。
(9)吳重慶、葉淑娟,2001a,醫療管理的省思(一)--全民健保現況與回顧,台灣醫界第44 卷第5 期,55-57 頁。
(10)吳重慶、葉淑娟,2001b,醫療管理的省思(二)-- 總額預算的多元化支付制度,台灣醫界第44 卷第6 期,55-57 頁。
(11)吳運東,2000,健保支付制度下醫療品質之檢討與改革之芻議,台灣醫界第第43 卷第2 期,10-11 頁。
(17)杜強國,2004,以系統動力學探討平衡計分卡策略動態搭配原則, 中山大學企業管理研究所博士論文。
(18)周麗芳、陳曾基,1999,探究健康保險總額預算制度,台灣醫界,第 42 卷第2 期, 57-64 頁。
(20)邱永仁,1999,總額預算制對醫界的影響,台灣醫界第42 卷第9 期, 38-40頁。
(21)邱永仁,2000,健保危機總體檢,台灣醫界第 43 卷第11 期,38-40 頁。
(23)徐慧娟、薛亞聖,2001,醫院管理指標的性質與應用,醫院,第1 卷第34 期,29-41 頁。
(27)陳加屏,2003,支援平衡計分卡從策略目標展開至執行目標的方法之發展:以系統動力學為基礎的方法,2003 提昇臺灣執行力學術研討會論文。
(28)陳信榮,2007,系統動力學導向之策略管理研究-以C 咖啡連鎖店為例, 中山大學資訊管理研究所碩士論文。
(30)黃麗蓮,2002,以系統動力學研究保險人、 被保險人、及醫療機構之決策互動 對健保財務與品質的影響, 國立中山大學企業管理研究所博士論文。
(1)Forrester, J. W., Industry Dynamics, Cambridge: MIT press, 1961.
(2)Flood, A. B., S. M. Shortell, and & W. R. Scott,1994, Health Care Management:Organization Design and Behavior,3th New York:Delman Publishers Inc.
(3)Lyneis, J., Corporate Planning and Policy Design, Waltham, MA, Pegasus Communication, 1980.
(4)Li, L. (1997),Relationships Between Determinants of Hospital QualityManagement and Service Quality Performance—a Path AnalyticModel . Omega(Vol.,25,No.5):531145
(5)Lewy, C. and Du Mee. (1998). The Ten Commandments of Balanced Scorecard Implementation, Management Control and Accounting, April, translated into English by Paul McCunn and reprinted by KPMG Management Consulting
(6)Lyneis, James M. (1980). Corporate Planning and Policy Design: A System Dynamics Approach, Cambridge, MA, The MIT Press.
(7)John, D. S., Business Dynamics: Systems Thinking and Modeling for a Complex World, McGraw-Hill/Irwin, 2000.
(8)Kaplan, R. S. and Norton, D. P. (1996). The Balanced Scorecard : Translating Strategy into Action. Boston, Massachusetts. Harvard Business School Pres
(9)Senge, Peter M. and J. D. Sterman, 1992,“System Thinking and Organizational Learning:Acting Locally and Thinking Globally in the Organization of Future, ” In T.Kochan and M. Useem (Eds.),Transforming Organizations, Oxford University Press, Oxford, pp.353-371.
(10)Senge, Peter M., et al., 1994, The Fifth Discipline Fieldbook:Strategies and Tools for Building a Learning Organization, New York:Doubleday.
(11)Senge, Peter M., 1990, The Fifth Discipline:The Art and Practice of the Learning Organization, New York:Doubleday.
(2)行政院衛生署,2005,「總額基本概念」 Q&A,網址:http://www.doh.gov.tw。
(4)衛生署中央健康保險局住院診斷關聯群支付制度主題專區 網址:http://www.nhi.gov.tw/webdata/webdata.asp?menu=5&menu_id=463&webdata_id=937&WD_ID=463

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