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研究生:帕崔克
研究生(外文):Patrick Opiyo Owili
論文名稱:肯亞與台灣醫療資源分配機制之比較:醫療專業人員知覺與態度的結構方程式模型分析
論文名稱(外文):Comparison of National Health Care Resource Allocation Mechanisms in Kenya and Taiwan: A Structural Equation Modeling of Perceptions and Attitudes of Health Professionals
指導教授:許怡欣許怡欣引用關係
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學研究所
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:2012
畢業學年度:100
語文別:英文
論文頁數:185
中文關鍵詞:Resource allocation mechanismhealth professionalsattitudesperceptions
外文關鍵詞:資源分配機制醫療專業人員態度看法
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背景:肯亞使用一個部長級預算委員會(MBC)和資源分配標準(RAC,以需求為基礎)的公式來分配醫療資源,而台灣使用總額預算分配機制(GBAM,投入基礎)。醫療專業人員在這些不同的國家擁有不同的經驗,因為他們親自體會到醫療資源分配機制對他們工作的影響。
目的:本研究之目的為評估及比較肯亞與台灣醫療專業人員對國家醫療資源分配機制之看法和態度。
方法:本研究使用結構方程模型,比較肯亞和台灣的醫療專業人員對資源分配機制上的知覺與態度。該模型包括五個潛伏構念和九個路徑假說。在肯亞與台灣分別回收 300及299份醫療專業人員所填之問卷,並使用LISREL統計軟體針對模型進行驗證性因素分析。
結果:本研究發現分配機制利益與醫療專業人員的看法和態度密切相關。在肯亞和台灣醫療專業人員之滿意度皆與「分配機制利益」、「正向影響」、「負向影響」密切相關。然而,肯亞有負相關時,而台灣卻呈現正相關。有三個的正相關與負相關直接影響肯亞的整體滿意度,台灣的研究結果顯示,除了分配機制「正向影響」及「負向影響」之路徑假說,其他皆呈正相關,而肯亞則僅在分配機制「負向影響」與分配機制態度有統計上顯著差異。
結論:本研究發現,儘管肯亞運用MBC和RAC方式以達到醫療資源分配,但醫療專業人員認為此對於發展、公平、效率及經濟仍造成負面的影響,其認知、總體滿意度和態度呈現負面看法。而在已實現全民納保的台灣,醫療專業人士對於實施總額預算分配機制有正面的看法。

Background: Kenya uses Ministerial Budgeting Committee (MBC) and Resource Allocation Criteria (RAC) formula to allocate health care resources while Taiwan uses Global Budget Allocation Mechanism (GBAM). Health professionals in Kenya and Taiwan have different experiences as they witness the effects of resource allocation mechanism in their work.
Objective: The aim of this study was to assess and compare perceptions and attitudes of health professionals in Kenya and Taiwan on national health care resource allocation mechanism.
Methods: This study compared a structural equation model of health professionals’ perceived impacts and attitudes on resource allocation mechanisms used in Kenya and Taiwan. The model consisted of five latent constructs and nine path hypotheses. 300 and 299 questionnaires were answered by health professionals in Kenya and Taiwan respectively and Confirmatory Factor Analysis using LISREL software was employed to test the model.
Results: It was found that benefits of allocation mechanism are significantly related to perceptions and attitudes of health professionals. In both Kenya and Taiwan, satisfaction was significantly related to ‘benefits of allocation mechanism’, ‘perceived positive’ and ‘perceived negative’ impacts of allocation mechanism. However, Kenya had six significant negative and two significant positive relations while Taiwan had three significant positive and two significant negative relations. Three negative and one positive relation was directly affecting ‘overall satisfaction’ in Kenya contrary to Taiwan that had three positive and one negative relation. The hypothesized path relationships between ‘perceived positive’ and ‘perceived negative’ impacts of allocation mechanism and attitude on allocation mechanism were not significant in Taiwan while only the path relationship between ‘perceived negative’ impacts and attitude on allocation mechanism was not significant in Kenya.
Conclusion: This study found that even though Kenya uses MBC and RAC in the allocation of health care resources, health professionals observed a negative effect on development, equity, efficiency and the economy which results in a negative effect on perceptions, overall satisfaction and attitudes of health professionals while GBAM used in Taiwan has a positive effect.

Table of Contents
Dedication i
Acknowledgment ii
Abstract in English iii
Abstract in Chinese iv
Table of Contents v
List of Tables ix
List of Figures x
List of Equations xi
List of Acronyms and Abbreviation xii
CHAPTER 1 : INTRODUCTION 1
1.1 Introduction 1
1.2 Background 1
1.3 Political and Socioeconomic Environment 2
1.4 Research Motivation 4
1.5 Problem Statement 5
1.6 Significance of the Study 7
1.7 Research Questions 8
1.7.1 Broad Research Question 8
1.7.2 Specific Research Question 8
1.8 Objectives of the Study 9
1.8.1 Broad Objective 9
1.8.2 Specific Objectives 9
CHAPTER 2 : LITERATURE REVIEW 10
2.1 Introduction to Literature Review 10
2.2 Health Care Systems 10
2.3 Health Care System in Kenya 21
2.4 Health Care System in Taiwan 24
2.5 Health Care Resources 25
2.6 Health Care Resource Allocation Mechanism 31
2.7 Evaluation of Health Care Resource Allocation Mechanisms 41
2.8 Characteristics of Resource Allocation Mechanism 46
2.9 Health Care Resource Allocation Mechanism Used in Kenya 53
2.10 Health Care Resource Allocation Mechanism Used in Taiwan 58
2.11 Health Professionals’ Perceptions and Attitudes 61
2.12 Summary of the Literature Review 64
CHAPTER 3 : METHODOLOGY 65
3.1 Overview of the Approach 65
3.2 Conceptual Model 65
3.2.1 Research Hypotheses 67
3.2.2 Operational Framework 68
3.2.3 Definition of Operational Variables 69
3.3 Study Sites 74
3.4 Study Population 75
3.5 Sampling Method 75
3.5.1 Sample Frame 75
3.5.2 Sample Size Determination 75
3.6 Data Collection Method 76
3.6.1 Questionnaire Development 76
3.6.2 Data Collection Process 77
3.7 Time Period 77
3.8 Quality Control 77
3.9 Data Processing and Analysis Decisions 78
3.10 Ethical Consideration 79
3.11 Data Dissemination and Utilization 80
3.12 Summary 80
CHAPTER 4 : RESULTS 81
4.1 Introduction to Presentation of Results 81
4.2 Reliability Analysis and Mean Responses 81
4.2.1 Perceived Positive Impacts of Allocation Mechanism 82
4.2.2 Perceived Negative Impacts of Allocation Mechanism 83
4.2.3 Overall Health Professionals’ Satisfaction 84
4.2.4 Attitude on Resource Allocation Mechanism 85
4.2.5 Benefits of National Health Care Resource Allocation Mechanism 86
4.3 Result of 2 Samples T-test of the Latent Mean Differences 87
4.4 Respondent Characteristics 88
4.5 Analysis of Proposed Structural Model 90
4.5.1 Model Fit Evaluation 93
4.5.2 Analysis of Measurement Model (Observed variables) 95
4.5.3 Analysis of Structural Model 103
4.6 Summary of Results 110
4.6.1 Summary of Significant Structural Model 111
4.6.2 Summary of Hypotheses Tested 112
CHAPTER 5 : DISCUSION 113
5.1 Introduction to Discussion 113
5.2 Discussion per Hypothesis 113
5.2.1 Hypothesis 1 113
5.2.2 Hypothesis 2 115
5.2.3 Hypothesis 3 116
5.2.4 Hypothesis 4 117
5.2.5 Hypothesis 5 118
5.2.6 Hypothesis 6 119
5.2.7 Hypothesis 7 120
5.2.8 Hypothesis 8 120
5.2.9 Hypothesis 9 121
CHAPTER 6 : CONCLUSION AND RECOMMENDATIONS 122
6.1 Conclusion 122
6.2 Limitations and Future Research 123
6.3 Recommendations 124
6.3.1 Recommendations to Governments 124
6.3.2 Recommendations to Institutions 125
6.3.3 Recommendations to Service Providers 125
6.3.4 Recommendations to Researchers 126
REFERENCES 127
APPENDICES 151
Appendix 1: Revenue and Expenditure of Taiwan’s NHI 151
Appendix 2: Roles and Functions of Ministry of Health, Kenya 152
Appendix 3: Taiwan’s Organization of Health Administration 153
Appendix 4: Conceptual Model for Need-Based Resource Allocation 154
Appendix 5: Sources of Health Care Financing in Kenya, 2001/2002 and 2005/2006 155
Appendix 6: Actual Expenditure (Gross) Recurrent and Development by Sub-vote (%) 156
Appendix 7: English/Chinese Survey Questionnaire 157
Appendix 8: Ethical Committees’ Approval Letters 162
Appendix 9: Frequency Charts of Kenya and Taiwan 164
Appendix 10: LISREL Output for Kenya 166
Appendix 11: LISREL Output for Taiwan 175

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