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題 名 | 回顧美國退伍軍人醫療體系改革歷程及對臺灣之啟示=A Review of the American Veterans Affairs Health Care System Reform and Its Implications for Taiwan |
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作 者 | 李偉強; | 書刊名 | 醫務管理期刊 |
卷 期 | 10:4 2009.12[民98.12] |
頁 次 | 頁221-231 |
分類號 | 419.2 |
關鍵詞 | 退伍軍人醫療體系; 榮民; 組織變革; 醫療改革; Healthcare reform; Oganization change; Strategy; Veterans affairs; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:台灣榮民醫療體系正在進行整合,而美國退伍軍人醫療體系從1995年開始進行大幅的變革。本文的目的是希望能系統性回溯並且整理美國退伍軍人醫療體系改革的歷程,做爲台灣改革的參考。 方法:系統性查閱自1990年迄今與美國退伍軍人醫療體系改革相關的研究與評論,爲兼顧學術與客觀性,引用內容以發表在國際學術期刊上的資料爲主。 結果:美國退伍軍人醫療體系在面對內部經營效率不彰、醫療品質不佳及外部輿論與國會的改革要求下,自1995年起由執行長Kizer K.W.啟動全面性的策略變革,由專科醫療照護逐步轉型爲慢性病照護爲主。爲達成此目的,退伍軍人醫療體系同時進行組織與管理模式變革,前者主要是重新劃分退伍軍人醫療機構爲廿一個整合性醫療網,減少大型醫院的病床數,增加基層醫療的數量;後者則除了授權各醫療網經理人全權負責醫療品質與財務管理,更建構可以連結全國各級退伍軍人醫院與診所的電子病歷與成效評量資訊系統,定期蒐集與分析各醫療網的醫療品質與財務狀況,做爲成效評核與改善的依據。多數評論對於美國退伍軍人醫療體系迄今的改革成效執肯定的態度,但仍有繼續進步的空間。 結論:中美兩國的退伍軍人醫療體系無論在制度設計、財務來源、醫療給付方式、及照顧對象上都明顯不同,美國的改革架構與經驗未必全部適用在台灣,但其考量病人疾病需求及財務狀況而做的策略調整及隨之而來的組織與管理變革歷程,值得本地進一步討論或學習。 |
英文摘要 | Objectives: Fundamental reform of the veterans affairs (VA) healthcare system in the United States was initiated in 1995. The purpose of this article was to review the process of reform of the American VA system and consider how it might apply to the Taiwan VA system. Methods: We reviewed research and review articles about the American VA system reform published in academic journals from 1990 to 2008. Results: K. W. Kizer, the executive director of the Department of Veterans Affairs, initiated comprehensive reform strategies in 1995 because the system faced internal quality of care and financial problems and there was pressure to reform from Congress and the public. The VA adopted organization and management transformation strategies. The healthcare delivery model was gradually changed from tertiary specialty care to primary care for chronic illnesses. The fragmented and disconnected VA hospitals were reorganized into 21 integrated systems, with more primary care clinics and fewer hospital beds. Local network managers were held accountable for the quality of care and financial performance. Quality improvement centers collected and analyzed clinical and financial information that was uploaded automatically on a regular basis through the electronic medical record system across the whole VA system. Conclusions: The framework of the American VA's reform might not be applicable to the Taiwan VA given the huge differences between the two countries in healthcare insurance systems, organizations, budgeting, and patient case mix; nevertheless, the strategies and experiences of American VA reform are worth further discussion. |
本系統中英文摘要資訊取自各篇刊載內容。