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題名 | 組織理論與醫院DRGs因應準備作業=Organization Theories and Hospital Preparation for the Forthcoming DRG Payment Scheme |
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作者 | 陳建立; 黃瑞典; Chen, Chien-li; Huang, Ruey-dean; |
期刊 | 健康保險雜誌 |
出版日期 | 20060300 |
卷期 | 2:2 民95.03 |
頁次 | 頁1-13 |
分類號 | 419.44 |
語文 | chi |
關鍵詞 | 診斷關聯群; 支付制度; 代理理論; 正當性; 同形化; Diagnosis related groups; Payment system; Agent theory; Legitimacy; Isomorphism; |
中文摘要 | 93年11月健保局公告第二版診斷關聯群(DRGs; Diagnosis Related Groups)的分類架構,總共區分為9676組,供醫界模擬使用並提出修訂意見,準備導入作為支付制度之一,預期將會對醫界造成重大影響。支付制度的修訂在於提供不同的誘因機制,藉由移轉風險,課以醫療服務提供者之財務責任,改變醫療行為,減少過當的醫療服務。誘因的設計除了提供酬償之外,也隱含著控制機制,從論量計酬改變為論病例計酬,試圖從結果導向調整為行為導向,其中的機制是本文探討的課題之一。再者,強制的保險體制,使得保險人具有獨斷的權力,可以輕易的將不同的制度遂其所願的實行。醫療服務提供者必須配合醫療環境的改變,調整其組織結構與組織實務,這是情境觀點的組織與環境配適;此外,醫療服務提供者為獲取所需資源以求生存,須先取得正當性,也就是獲得制度環境的認同,經由同形化使得組織實務越來越相像,以適應不同的環境壓力。最後,本文提出某醫院準備DRGs/PPS之相關實務,以供醫界參考。 |
英文摘要 | Bureau of National Health Insurance announced the second edition of the framework for categorizing Diagnosis Related Groups in Nov. 2004 which is expected to have great impact on the medical industry. With 976 categories, this framework is to invite opinions from the medical industry before its official inclusion in the payment system. The purpose to amend the payment system is to provide different incentive mechanism which shifts the risk from the insurance company to the medical service providers by making the latter be responsible for financial duties, changing medical practices and reducing inadequate medical services. In addition to reimbursement, the design of the incentive mechanism implicitly includes measures for control, i.e. a direction towards behavior-based rather than outcome-based payment system. We intend to explore how this mechanism operates. Furthermore, the insurance company is empowered with direction to do what is most beneficial for them since it is obligatory to join the insurance system. Based on the contingency perspective, medical service providers should adapt to the changing medical environment and adjust their organizational structure and practices for the fitness between organization and environment. Furthermore, medical service providers should gain the institutional legitimacy to acquire the resources for survival. By mimicking the organizational practices with each other, the medical service providers would be able to adapt to different environmental pressure. At the end, we present the related practices for preparing DRGs/PPS of a hospital for your reference. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。