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題 名 | 全民健保實施後醫院面臨經營困境之影響因素分析=The Effecting Factors Analysis of Facing Difficulties among Hospitals After Implementation of NHI |
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作 者 | 楊錦洲; 蔡淑鈴; | 書刊名 | 中原學報 |
卷 期 | 30:2 2002.06[民91.06] |
頁 次 | 頁161-171 |
分類號 | 419.45 |
關鍵詞 | 全民健保; 醫院; 經營困境; National Health Insurance; Hospital; Impacts on hospital; |
語 文 | 中文(Chinese) |
中文摘要 | 近年來我國的醫療環境產生了很大的改變,尤其是自從1995年開始實施全民健保之後,更是對醫院帶來非常大的衝擊。為了能深入的了解,並分析醫療院所之經營困境的影響因素,本研究是以專家訪談及問卷調查之方式來進行。在問卷方面,全台總共寄了692份,有效問卷有99份,比例為14.3%。由分析結果可知,對醫院之經營影響較大的因素依序為:健保局為唯一買主,醫院處於受牽制的一方;轉診制度未落實,使得地區醫院的經營更困難;高核減率對醫院造成收入的縮減,對小型醫院來說,由於欠缺相關人才,影響會更大;健保局在某些科別之給付常有不敷成本之情事,尤以外科較嚴重;由於保費調升不易,因而給付價格被凍結,但另方面,經營成本又不斷上升,更增加經營上的困難;住院醫師、醫事人員、護理人員的不足,聘請不易,不但會增加營運成本,也會影響到醫療品質等等。此外,還有多項外部環境的影響因素及內部的經營管理因素,也會造成不可忽視的影響。 基本上,這些影響因素對地區醫院及區域醫院造成的衝擊較大,如全民健保之實施,轉診制度未落實,高核減率,醫療專業人才的不足等等均對地區醫院與區域醫院之營運較為不利。然而,在給付的不敷成本,高比例之保險病床要求及慢性病人、惡性腫瘤等病人之佔床率高則對醫學中心之營運較有不利之影響。 在此情況下,許多醫院紛紛採取對策,如導入ISO9000 '推行TQM'進行流程改造,醫院之間的策略聯盟等之策略,其目的無非是要提升醫療品質,降低經營成本,提升競爭力。經過醫療界的努力與突破,已逐步的產生顯著的功效。 |
英文摘要 | After this year, there are several change in the medical environment and great impact on hospitals after implementation of NHI. The most affecting factors are (1)Theho pitals feel restrained owing to the NHI is an only buyer of medical services.(2)The regional hospita1s feel more difficulties because of the refer system doesn't work.(3)The high cut rate after examination of NHI enhance the decrease of revenue of hospitals especially for regional hospitals.(4) The amount of payment can't meet the cost of hospitals especiallyin the surgical service.(5)The fixed budget of medical service can't meet the inflating of operating cost of hospitals, the quality of medica1 services will be worried. (6)The shortage of medical and related personnel affect the cost and quality of hospitals. There are different impacts from regional hospitals to medical centers. The implementation of NHI, the refer system doesn't work, the high cut rate of NHI, and the shortage of medial and related personnel has most impacton the district and regional hospitals. The amount of payment can't meet the cost of hospital, the high rate of insurance beds and the high occupancy rate of chronic patients has great impact on the medical centers. The hospitals must take strategies to enhance the quality of medical service to decrease the operation cost, 10 raisè the competitive power, and to meet the impact from the NHI. The strategies inc1uded the IS09000, TQM, process redesign and strategic alliance with other hospitals. There have several effects based on this kind of efforts. |
本系統中英文摘要資訊取自各篇刊載內容。