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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 張睿詒(Ray-E Chang) | |
dc.contributor.author | SHIH-PI LIN | en |
dc.contributor.author | 林士弼 | zh_TW |
dc.date.accessioned | 2021-06-07T17:29:09Z | - |
dc.date.copyright | 2020-03-13 | |
dc.date.issued | 2020 | |
dc.date.submitted | 2020-02-12 | |
dc.identifier.citation | 英文:
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15268 | - |
dc.description.abstract | 背景:
健康不平等已是全球公共衛生的重要議題,致力消弭人民健康差距與改善群體健康成為各國衛生政策推動的焦點,其中又以盛行率較高的慢性疾病被視為應優先介入改善的目標。在台灣,糖尿病為高盛行率且長年名列十大死因前五位,顯見其威脅國人健康之重,有鑑於此,中央健保署參考國際趨勢導入論質計酬支付制度,以政策引導醫療提供者提供糖尿病病患完整性照護服務,進而提昇醫療品質,然而,欲達成此制度設定之品質目標,醫療提供者必須擁有且投入較多之醫療資源,此設計對醫療資源較缺乏地區之醫療提供者與病患而言,似已設下參與障礙。因此,論質計酬政策的施行是否能使需要者皆受益?抑或會在不同醫療資源差異之糖尿病病患群體間造成更大的健康差距而與促進健康公平的理念背道而馳?實值探究。 方法: 以每萬人糖尿病醫師數為地區糖尿病醫療資源多寡之區分指標,使用集群分析將台灣368個鄉鎮市區之糖尿病醫療資源分為醫療資源重度缺乏、醫療資源缺乏、醫療資源適中、醫療資源豐富四個群組,並引入Google電子地圖同時考量各鄉鎮市區間糖尿病病患取得醫療資源之交通距離與時間,將各鄉鎮市區糖尿病醫療資源多寡再做適切的調整。使用衛生福利部全民健保資料庫分析論質計酬方案介入前後四組糖尿病病患之照護品質,由於資料性質具重複測量與巢狀結構的特性,本研究將使用廣義線性混合模型(GLIMMIX)探討病患層次、機構層次與地區層次對照護品質的影響。 結果: 根據廣義線性混合模型結果顯示,台灣糖尿病論質計酬方案介入前在控制其他變項後,醫療資源缺乏組、醫療資源適中組、醫療資源豐富組之平均品質分數顯著較醫療資源重度缺乏組高出0.13、0.42、0.69分;方案介入且在控制其他變項後,醫療資源重度缺乏組平均品質分數顯著較方案介入前提升0.14分,而醫療資源缺乏組、醫療資源適中組、醫療資源豐富組之平均品質分數則又顯著較醫療資源重度缺乏組提升之0.14分再高出0.05、0.28、0.53分;獎勵卓越方案介入且在控制其他變項後,醫療資源重度缺乏組平均品質分數雖較獎勵卓越介入前提升0.02分,但已無統計上顯著差異,而醫療資源缺乏組、醫療資源適中組、醫療資源豐富組之平均品質分數則較醫療資源重度缺乏組再顯著高出0.03、0.23、0.34分。 結論: 糖尿病醫療資源較缺乏地區之糖尿病病患獲得較低的照護品質,且地區醫療資源不同之糖尿病病患在糖尿病論質計酬方案介入前已存在獲得照護品質不平等之情形;而方案介入後會拉大照護品質不平等的差距;方案之獎勵卓越措施介入後則更加大此差距。顯示台灣糖尿病論質計酬方案的推行造成地區醫療資源不同之糖尿病病患群體間更嚴重的健康不平等,值得有關單位作為調整糖尿病醫療資源分布及修正糖尿病論質計酬計畫之參考。 | zh_TW |
dc.description.provenance | Made available in DSpace on 2021-06-07T17:29:09Z (GMT). No. of bitstreams: 1 ntu-109-D98843002-1.pdf: 1779421 bytes, checksum: f52b6f4cad5238146a472bb70511808c (MD5) Previous issue date: 2020 | en |
dc.description.tableofcontents | 口試委員會審定書 ii
誌謝 iii 中文摘要 iv 英文摘要 vi 第一章 緒論 11 第一節 研究背景與動機 11 第二節 研究目的 14 第三節 研究問題 15 第二章 文獻探討 16 第一節 健康不平等 16 第二節 地區醫療資源 20 第三節 論質計酬(pay-for-performance,P4P)支付制度 28 第四節 糖尿病疾病管理 34 第三章 研究材料與方法 47 第一節 研究設計與研究架構 47 第二節 研究假說 53 第四節 資料來源及統計分析方法 60 第四章 研究結果 62 第一節 台灣368個鄉鎮市區糖尿病醫療資源多寡之區分結果 62 第二節 描述性統計 80 第三節 多層次分析 88 第五章 討論 94 第一節 台灣368個鄉鎮市區糖尿病醫療資源多寡之區分 94 第二節 糖尿病醫療給付改善方案對地區醫療資源不同之糖尿病病患照護品質的影響 96 第三節 其他研究結果的討論 99 第四節 研究限制 101 第六章 結論與建議 103 第一節 結論 103 第二節 建議 104 參考文獻……………………………………………………………………………..106 附錄一 糖尿病醫療給付改善方案照護項目表 117 附錄二 DCSI 120 附錄三 全民健康保險山地離島地區一覽表 122 附錄四 2005年西醫醫缺地區改善方案實施鄉鎮一覽表 123 附錄五 全民健康保險投保金額分級表 124 附錄六 投保身分類別一覽表 125 | |
dc.language.iso | zh-TW | |
dc.title | 醫療給付改善方案對地區醫療資源不同之糖尿病病患照護品質的影響 | zh_TW |
dc.title | The effect of Pay-for-Performance Program on Quality of Care in Diabetic Patients for Different Medical Resources | en |
dc.type | Thesis | |
dc.date.schoolyear | 108-1 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 鄭守夏(SHOU-HSIA CHENG),曾芬郁(FEN-YU TSENG),許志成(Chih-Cheng Hsu),林文德(Wender Lin) | |
dc.subject.keyword | 糖尿病,論質計酬,照護品質,醫療資源,健康不平等, | zh_TW |
dc.subject.keyword | Diabetes,Pay for performance,Care quality,Medical resources,Health inequality, | en |
dc.relation.page | 125 | |
dc.identifier.doi | 10.6342/NTU202000442 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2020-02-12 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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