請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15493
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 董鈺琪(Yu-Chi Tung) | |
dc.contributor.author | Wan-Yu Lu | en |
dc.contributor.author | 呂婉玉 | zh_TW |
dc.date.accessioned | 2021-06-07T17:41:11Z | - |
dc.date.copyright | 2020-08-27 | |
dc.date.issued | 2020 | |
dc.date.submitted | 2020-07-15 | |
dc.identifier.citation | 1. 楊志良, 健康照護體系再造的本土經驗. 台灣公共衛生雜誌, 2003. 22(2): p. 82-86. 2. 卓伊紋, et al., 健保論病例計酬對不同層級醫療機構之公平性之探討-以不同生產模式為例. 澄清醫護管理雜誌, 2017. 13(4): p. 24-34. 3. 歐進士, et al., 實施全民健康保險對醫院經營效率影響之研究. 臺大管理論叢, 2012. 22(2): p. 253-275. 4. 鍾佩樺, 黃三桂, and 錢慶文, 醫院總額浮動點值對地區醫院財務衝擊之研究. 醫務管理期刊, 2004. 5(2): p. 208-221. 5. 莊逸洲, 黃崇哲, and 鄭明智, 台灣醫院總額支付制度運作模式的初步探討. 醫務管理期刊, 2003. 4(3): p. 1-17. 6. 劉亞明, 羅德芬, and 粘毓庭, 醫院退出市場因素之分析. 台灣公共衛生雜誌, 2017. 36(3): p. 273-286. 7. 許崇賓, 全民健保法第二代財務改革之芻議. 法令月刊, 2011. 62(9): p. 61-89. 8. 徐敏鐘 and 廖珮如, Financing National Health Insurance: The Challenge of Fast Population Aging. 經濟論文叢刊, 2015. 43(2): p. 145-182. 9. 李勝祥, 全民健保影響醫院組織文化與經營績效之研究. 高雄海院學報, 2003(18): p. 289-303. 10. 蕭美淑, 私立醫療機構改制醫療社團法人之探討, in 會計研究所. 2009, 中原大學. p. 1-55. 11. 郭咏臻, 私立醫院改制醫療社團法人之效益研究-以某區域教學醫院為例, in 管理研究所. 2007, 元智大學. p. 1-101. 12. 蘇嘉瑞, et al., 論醫療社團法人對醫務管理的影響. 醫務管理期刊, 2007. 8(3): p. 195-215. 13. 簡聖哲, 地區醫院轉型策略之研究, in 醫療機構管理研究所. 2009, 臺灣大學. p. 1-152. 14. 黃啟聰, 地區醫院轉型長期照護機構經營策略之研究, in 經營管理學系碩士班. 2004, 亞洲大學. p. 1-140. 15. 李經維, 以SCP觀點分析健保制度下地區醫院競爭策略之研究, in 高階管理碩士在職專班(EMBA). 2014, 成功大學. p. 1-129. 16. 黃鴻茗 and 宋鎮照, 台灣地區醫院的消逝對社區醫療安全網絡的影響. 台灣社區工作與社區研究學刊, 2013. 3(1): p. 1-22. 15. 衛生福利部(2013)。中華民國95年版公共衛生年報。取自 https://www.mohw.gov.tw/lp-3196-1.html 16. 衛生福利部(2019)。中華民國107年版衛生福利年報。取自 https://www.mohw.gov.tw/lp-3196-1.html 17. 衛生福利部(2018)。2018-2019全民健康保險年報。取自 http://www.nhi.gov.tw/resource/Webdata/2018-19%E5%85%A8%E6%B0%91%E5%81%A5%E5%BA%B7%E4%BF%9D%E9%9A%AA%E5%B9%B4%E5%A0%B1.pdf 18. 楊志良(民108)。健康保險。台灣:文華圖書館管理。 19. 陳永興(民92)。台灣醫療發展史。台灣:新自然主義。 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15493 | - |
dc.description.abstract | 研究背景與目的: 偏遠地區的人口結構老化程度高於都會地區,年輕族群大都外移,老年人口比例偏高,但因醫療資源分布不均,以本研究個案醫院所在地南投縣為例,幅員廣大且多山區地形,境內沒有醫學中心,只有2家區域醫院及8家地區醫院。留在縣內的大多是經濟較弱勢的老人及小孩,因為交通不便,降低了民眾就醫的可近性;因人口老化及人口分布較分散,對醫院的經營也是一項挑戰;另,面對外部醫療政策的變遷及各層級醫院的相互競爭,使得位於偏遠地區的地區醫院經營更是面臨挑戰。 本研究以位於台灣中部南投縣境內一地區醫院為例,從內部與外部環境的改變,分析偏遠地區之地區醫院的經營成效,探討偏遠地區醫院經營之困境與衝擊。本研究個案醫院是由醫界、地方人士等40多人共同出資籌設合夥設立,是當時南投縣竹山鎮境內第一家具規模的綜合型醫療機構,1999年經歷921大地震的衝擊,在院長的帶領下走過最艱困的時期,因為合夥人制,也為該院的經營帶來許多的挑戰。 研究方法: 本研究採個案研究法,收集台灣健康照護體系的演進、全民健保制度、醫療社團法人等文獻,運用個案研究法,藉由半結構式深度訪談收集有效的資料,描繪個案醫院的發展、探究過往的策略,以強弱危機分析(SWOT Analysis)個案醫院做出研究。 研究結果: 傳統的醫院以急性醫療照護為主,因本研究個案醫院院長及早發現竹山當地老年人口比例偏高,甚至不少獨居的長者,故將本研究個案醫院定位以社區醫療為主,自2007年承接經濟部「銀髮族U-Care計畫」起,透過醫療服務與資訊科技的結合,成立遠距照護中心,並有專責護理人員,提供長者與醫護人員便利的雙向互動,減少舟車勞頓之苦,提升長者疾病自主管理的能力。個案醫院面對周遭大城市裡大醫院的競爭,院長嘗試將醫院轉型,從被動式等待患者到院就醫,主動走入社區推動預防醫學。 合夥人制,限制醫院永續發展,多年來對於將盈餘投入設備更新與添購新的儀器的意見多有分歧,以至於醫院發展受限,將現有制度改制為醫療社團法人,對於醫院之發展及永續經營將有所助益,也是當務之急必要的策略之一。 結論: 面對人口結構的改變,低出生率、人口老化、平均餘命延長等現實狀況,地區醫院除了提供既定的醫療服務外,應該可以轉向以預防醫學、長期照顧服務為發展重點;地區醫院在第一階段先為民眾守護健康變得相對重要,從慢性疾病的控制與防範到長期照護。地區醫院應該發揮原有的優勢,特別是在城鄉差距,愈偏遠的鄉鎮地區,地區醫院被賦予社區防護網的使命,更應該發揮其可近性與其特色。 | zh_TW |
dc.description.abstract | Background and objectives: The population structure of the remote areas is aging higher than that of the metropolitan areas. Most of the young ethnic groups are moving out. The proportion of the elderly population is relatively high. However, due to the uneven distribution of medical resources, taking Nantou County, the hospital where the case of this study is located, as an example. There are no medical centers in the country, only 2 regional hospitals and 8 district hospitals. Most of the people staying in the county are economically disadvantaged elderly and children, because of inconvenient transportation, which reduces the accessibility of the public to medical treatment; due to the aging population and scattered population distribution, it is also a challenge to the operation of the hospital; in addition, facing Changes in external medical policies and the competition among hospitals at all levels make the operation of regional hospitals in remote areas even more challenging. This study takes a district hospital located in Nantou County, Central Taiwan as an example. It analyzes the operating results of regional hospitals in remote areas from the changes of internal and external environments, and explores the dilemmas and impacts of hospital operations in remote areas. The case hospital in this study was funded by more than 40 people, including the medical community and local people, to establish a partnership. It was the first furniture-scale comprehensive medical institution in Zhushan Township, Nantou County at that time. It experienced the impact of the 921 earthquake in 1999. Under the leadership of the most difficult period, the partnership system also brought many challenges to the operation of the hospital. Methods: This study adopts a case study method to collect Taiwan's health care system evolution, national health insurance system, medical association legal person and other literatures. It collects effective data through semi-structured in-depth interviews to describe the development of case hospitals and explore the past strategy through with SWOT Analysis. Results: Hospitals mainly focus on acute medical care. The hospital in this study is positioned as community-based because the director of the hospital in this study early discovered that the local elderly population in Zhushan Township is relatively high, and even many elderly people living alone. Since 2007 the hospital undertook the “Silver-haired U-Care Project” of the Ministry of Economic Affairs and a long-term care center with dedicated nursing staffs to provide convenient two-way interaction between the elders and the medical staff was established by the combination of medical services and information technology to reduce the suffering of boating and enhance the ability of the elderly to manage their own diseases. The superintendent of the hospital in this study tries to transform waiting passively for patients to go to the hospital into actively entered the community to promote preventive medicine. The partnership system restricts the sustainable development of the hospital. Over the years, there have been many differences of opinion on surplus investment in equipment updates and the purchase of new equipment, so that the development of the hospital is limited. For the development of the hospital and sustainable operation, it is one of the most urgent and necessary strategies to restructure into a medical corporation. Conclusion: Faced with changes in the population structure, low birth rate, aging population, and longer life expectancy, district hospitals should be able to shift to focusing on preventive medicine and long-term care services. it becomes relatively important to protect the health of the people, from the control and prevention of chronic diseases to long-term care. District hospitals should take advantage of their original advantages, especially in the rural and urban areas, and the more remote rural areas, regional hospitals are given the mission of community protection nets, and they should also play their accessibility and characteristics. | en |
dc.description.provenance | Made available in DSpace on 2021-06-07T17:41:11Z (GMT). No. of bitstreams: 1 U0001-1507202010312300.pdf: 4002124 bytes, checksum: 7764706e8f4150a1156e48bd4dee8263 (MD5) Previous issue date: 2020 | en |
dc.description.tableofcontents | 口試委員審定書 i 誌謝 ii 目錄 iii 表目錄 v 圖目錄 vi 中文摘要 vii Abstract ix 第一章 緒論 1 第一節 研究背景 1 第二節 研究目的 3 第二章 文獻探討 4 第一節 健康照護體系之介紹 4 第二節 全民健保制度之演進 7 第三節 醫療社團法人之介紹 12 第四節 地區醫院經營之策略 18 第三章 研究方法 21 第一節 研究方法 21 第二節 研究對象 22 第三節 資料收集 22 第四節 研究架構和流程 23 第四章 結果 24 第一節 個案醫院所屬醫療體系發展史 24 第二節 個案醫院概況分析 27 第三節 竹山鎮概況分析 38 第四節 內外部分析 43 第五章 討論 54 第一節 策略選擇與評估 54 第二節 研究限制 60 第三節 結論 60 第四節 建議 64 參考文獻 66 | |
dc.language.iso | zh-TW | |
dc.title | 偏遠地區醫院經營之策略-以中部某地區醫院為例 | zh_TW |
dc.title | Strategic Management in a Remote Hospital: A Case Study of a District Hospital of Central Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 108-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 黃靖媛(Ching-Yuan Huang),鍾國標(Kuo-Piao Chung) | |
dc.subject.keyword | 偏遠地區,地區醫院,遠距照護,醫療社團法人, | zh_TW |
dc.subject.keyword | Remote areas,district hospitals,telehealth care,Medical Corporation, | en |
dc.relation.page | 67 | |
dc.identifier.doi | 10.6342/NTU202001530 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2020-07-15 | |
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 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
U0001-1507202010312300.pdf 目前未授權公開取用 | 3.91 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。