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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏(Shou-Hsia Cheng) | |
dc.contributor.author | Wei-Han Chen | en |
dc.contributor.author | 陳威翰 | zh_TW |
dc.date.accessioned | 2021-05-19T17:42:46Z | - |
dc.date.available | 2028-08-01 | |
dc.date.available | 2021-05-19T17:42:46Z | - |
dc.date.copyright | 2019-03-05 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-02-01 | |
dc.identifier.citation | 江東亮、文羽苹、謝嘉容. (2014). 全民健康保險制度的發展與問題. 台灣醫學, 18(1), 33-42.
吳肖琪、李玉春. (2004). 總額支付制度下建立基層與醫院總額支付制度下建立門診分級醫療指標之研究. 全民健康保險醫療費用協定委員會委託研究計畫,計畫編號DOH92-CA-1002。衛生福利部。. 呂碧鴻、王英偉、謝維銓. (1990). 家庭醫師在全民健康保險醫療網中的角色-現在與未來之探討. 全國法規資料庫. (2017). 全民健保法.(修正日期2017年11月29日)。擷取自:https://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0060001 李龍騰, 陳慶餘, 賴美淑, & 謝維銓. (1990). 實際基層醫療保健指數於不同門診之比較. [A Comparison of the Empirical Primary Care Index among Different Out-Patient Clinics]. 中華民國公共衛生學會雜誌, 10(2), 98-103. doi:10.6288/jnpharc1990-10-02-03 林依瑩. (2005). 我國轉診與分級醫療相關政策之制訂、實施與成效. 臺灣大學, Available from Airiti AiritiLibrary database. (2005年) 林詠蓉, 周天給, & 林恆慶. (2006). 參與“家庭醫師整合性照護試辦計畫”民眾對計畫實施成效之觀感. [The Viewpoints of Consumers Joining the 'Family Physician Integration Trial Plan (FPITP)' Toward the Effectiveness of the Plan]. 台灣家庭醫學雜誌, 16(4), 260-273. doi:10.7023/tjfm.200612.0260 張必正, 郭斐然, 李汝禮, 王三郎, 陳慶餘, & 邱泰源. (2011). 台灣家庭醫師整合照護計畫的執行成效與未來展望. 臺灣醫界, 54(8), 56-60. doi:10.30044/tmj.201108.0010 許佑任, 徐富坑, 李顯章, 陳端容, & 林恆慶. (2006). 基層醫師對“家庭醫師整合性照護試辦計畫”成效評估. [The Evaluation of the Efficacy of 'The Trial Plan for the National Public Health Insurance Family Doctor Comprehensive Care System' from Primary Care Physicians]. 台灣家庭醫學雜誌, 16(1), 13-26. doi:10.7023/tjfm.200603.0013 陳啟禎, 陳麗光, & 鄭守夏. (2017). 照護連續性議題的省思與未來發展方向. [Re-thinking continuity of care and future directions]. 台灣公共衛生雜誌, 36(4), 324-336. doi:10.6288/tjph201736106052 陳慶餘. (2001). 家庭醫學與社區健康營造. Formosan J Med, 5(2), 188-193. 監察院. (2017). 調查報告-106內調0033. 劉文良. (2016). 顧客關係管理應用與認證(第二版). 台灣: 碁峰. 劉文俊、吳晉祥、邱泰源. (2008). 基層醫療與健康照護成效. 臺灣家庭醫學研究,, 6(3&4), 105-111. doi:10.29475/TFMR.200810.0001 潘芷昕. (2014). 家庭醫師整合性照護計畫對醫療照護利用與結果之影響. 臺灣大學, Available from Airiti AiritiLibrary database. (2014年) 衛生福利部中央健康保險署. (2017). 全民健康保險家庭醫師整合性照護計畫. 鄭守夏. (2011). 全民健保向論人支付邁進. 台灣公共衛生雜誌, 30(1), 1-4. doi:10.6288/tjph2011-30-01-01 鄭守夏, & 陳啓禎. (2014). 健保制度下的醫療體系. [Health Care System under National Health Insurance Scheme]. 台灣醫學, 18(1), 74-84. doi:10.6320/fjm.2014.18(1).09 鄭雅文、江東亮. (2015). 公共衛生學 上冊(修訂五版). 盧瑞芬, & 謝啟瑞. (2003). 台灣醫院產業的市場結構與發展趨勢分析. [An Analysis of the Market Structure and Development of Taiwan's Hospital Industry]. 經濟論文叢刊, 31(1), 107-153. doi:10.6277/ter.2003.311.5 藍忠孚、李玉春. (1983). 區域醫療計劃之概念與架構. 中華民國公共衛生學會雜誌, 2, 34-41. doi:10.6288/JNPHARC1983-02-01-05 顔似綾, 詹其峰, 梁繼權, 邱泰源, 劉文俊, & 陳慶餘. (2008). 社區醫療群家庭醫師對全民健保家庭醫師整合性照護試辦計畫政策滿意度調查. [Survey of Primary Care Physicians Opinions of the National Health Insurance Family Doctors Integrated Health Delivery System]. 台灣家庭醫學雜誌, 18(1), 11-21. doi:10.7023/tjfm.200803.0011 Alpert, J. J. C., Evan. (1973). The Education of Physicians for Primary Care. Health Resources Administration (DHEW/PHS), Bethesda, MD. Bureau of Health Services Research. Anderson, D. C. (1982). The satisfied consumer: service return behavior in the hospital obstetrics market. J Health Care Mark, 2(4), 25-33. Cheng, S. H., & Chiang, T. L. (1997). The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment. JAMA, 278(2), 89-93. Christensen, D. E., & Giese, T. D. (1988). Assessment and application of patient satisfaction variables in marketing a psychiatric practice. J Health Care Mark, 8(3), 47-49. Cooper, R. A., Getzen, T. E., McKee, H. J., & Laud, P. (2002). Economic and demographic trends signal an impending physician shortage. Health Aff (Millwood), 21(1), 140-154. doi:10.1377/hlthaff.21.1.140 De Maeseneer, J. M., De Prins, L., Gosset, C., & Heyerick, J. (2003). Provider continuity in family medicine: does it make a difference for total health care costs? Ann Fam Med, 1(3), 144-148. Eisenberg, H. (1990). Patient loyalty. You're doing something right. Med Econ, 67(8), 50-55. Fisk, T. A., Brown, C. J., Cannizzaro, K. G., & Naftal, B. (1990). Creating patient satisfaction and loyalty. J Health Care Mark, 10(2), 5-15. Franks, P., & Fiscella, K. (1998). Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience. J Fam Pract, 47(2), 105-109. Griffin, S., & Kinmonth, A. L. (2000). Diabetes care: the effectiveness of systems for routine surveillance for people with diabetes. Cochrane Database Syst Rev(2), CD000541. doi:10.1002/14651858.CD000541 Hirth, R. A., Fendrick, A. M., & Chernew, M. E. (1996). Specialist and generalist physicians' adoption of antibiotic therapy to eradicate Helicobacter pylori infection. Medical Care, 34(12), 1199-1204. Hoffman, C., Rice, D., & Sung, H. Y. (1996). Persons with chronic conditions. Their prevalence and costs. JAMA, 276(18), 1473-1479. International Conference on Primary Health, C. (1978). Declaration of Alma-Ata. WHO Chron, 32(11), 428-430. IOM. (1996). Primary Care: America's Health in a New Era. In M. S. Donaldson, K. D. Yordy, K. N. Lohr, & N. A. Vanselow (Eds.), Primary Care: America's Health in a New Era. Washington (DC). James F. Engel & Blackwell, R. D., joint author & Kollat, David T., joint author. (1978). Consumer behavior (3d ed). Hinsdale, Ill Dryden Press. Jee, S. H., & Cabana, M. D. (2006). Indices for continuity of care: a systematic review of the literature. Med Care Res Rev, 63(2), 158-188. doi:10.1177/1077558705285294 Kingstrom, P. O. (1983). Patient ties to ambulatory care providers: the concept of provider loyalty. J Health Care Mark, 3(2), 27-34. Macinko, J., Starfield, B., & Shi, L. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Serv Res, 38(3), 831-865. MacStravic, R. S. (1987). Loyalty of hospital patients: a vital marketing objective. Health Care Manage Rev, 12(2), 23-30. MacStravic, S. (1994). Patient loyalty to physicians. J Health Care Mark, 14(4), 53-56. McWhinney, I. R. (1975). Continuity of care in family practice. Part 2: implications of continuity. J Fam Pract, 2(5), 373-374. McWhinney, I. R. (1975). Continuity of care in family practice. Part 2: implications of continuity. J Fam Pract, 2(5), 373-374. Medicine, I. o. (1993). Access to Health Care in America. In M. Millman (Ed.), Access to Health Care in America. Washington (DC). Mendenhall, R. C., Girard, R. A., & Abrahamson, S. (1978). A national study of medical and surgical specialties. I. Background purpose, and methodology. JAMA, 240(9), 848-852. Mendenhall, R. C., Lewis, C. E., DeFlorio, G. P., & Girard, R. A. (1979). A national study of medical and surgical specialties. III. An empirical approach to the classification of patient care. JAMA, 241(20), 2180-2185. Mendenhall, R. C., Lloyd, J. S., Repicky, P. A., Monson, J. R., Girard, R. A., & Abrahamson, S. (1978). A national study of medical and surgical specialties. II. Description of the survey instrument. JAMA, 240(11), 1160-1168. Penchansky, R. (1986). Patient-Provider Concordance: A Review and Conceptualization. Medical Care Review, 43(2), 293-350. doi:10.1177/107755878604300204 Penn, L. D. o. (1920). Interim report on the future provision on medical and allied services. Ministry of Health Consultative Council on Medical and Allied Services. London. Petterson, S. M., Rabin, D., Phillips, R. L., Jr., Bazemore, A. W., & Dodoo, M. S. (2009). Having a usual source of care reduces ED visits. American Family Physician, 79(2), 94. Rakel, D., & Rakel, R. E. (2016). Textbook of family medicine. Place of publication not identified: Elsevier Inc. Reichheld, F. F., & Sasser, W. E., Jr. (1990). Zero defections: quality comes to services. Harv Bus Rev, 68(5), 105-111. Rogers, J., & Curtis, P. (1980). The concept and measurement of continuity in primary care. Am J Public Health, 70(2), 122-127. Saultz, J. W. (2003). Defining and measuring interpersonal continuity of care. Ann Fam Med, 1(3), 134-143. Shi, L. (1992). The relationship between primary care and life chances. Journal of Health Care for the Poor & Underserved, 3(2), 321-335. Shi, L. (1994). Primary care, specialty care, and life chances. International Journal of Health Services, 24(3), 431-458. Shortell, S. M. (1976). Continuity of medical care: conceptualization and measurement. Medical Care, 14(5), 377-391. Smetana, G. W., Landon, B. E., Bindman, A. B., Burstin, H., Davis, R. B., Tjia, J., & Rich, E. C. (2007). A comparison of outcomes resulting from generalist vs specialist care for a single discrete medical condition: a systematic review and methodologic critique. Archives of Internal Medicine, 167(1), 10-20. Spiegel, J. S., Rubenstein, L. V., Scott, B., & Brook, R. H. (1983). Who is the primary physician? New England Journal of Medicine, 308(20), 1208-1212. Starfield, B. (1980). Continuous confusion? Am J Public Health, 70(2), 117-119. Starfield, B. (1998). Primary Care: Balancing Health Needs, Services, and Technology. 19-21. Starfield, B., & Shi, L. (2004). The medical home, access to care, and insurance: a review of evidence. Pediatrics, 113(5 Suppl), 1493-1498. Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank Q, 83(3), 457-502. doi:10.1111/j.1468-0009.2005.00409.x Tsai, J., Shi, L., Yu, W. L., & Lebrun, L. A. (2010). Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese community. Medical Care, 48(7), 628-634. doi:10.1097/MLR.0b013e3181dbdf76 Weiss, L. J., & Blustein, J. (1996). Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans. Am J Public Health, 86(12), 1742-1747. White, K. L. (1973). Life and death and medicine. Sci Am, 229(3), 22-33. Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162(20), 2269-2276. World Organization of National Colleges, A. a. A. A. o. G. P. F. P. (2013). The Contribution of Family Medicine to Improving Health Systems: A guidebook from the World Organization of Family Doctors, Second Edition. Xu, K. T. (2002). Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res, 37(6), 1509-1529. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7393 | - |
dc.description.abstract | 研究背景:由於臺灣缺乏全面性家庭醫師制度或守門人的角色,加上民眾擁有高度的就醫自由,不須轉診便可至各層級的醫事機構就醫,致使分級醫療無法落實。在家醫計畫成效不如預期、醫療體系朝專科化發展的情況之下,民眾經常選擇專科醫師作為自己的主要基層醫療服務提供者。2016年健保署提出分級醫療政策,欲用實際行動改善無實質分級醫療,鼓勵民眾建立家庭醫師或經常就診醫師之觀念,由固定基層醫師為其健康負起責任。然而臺灣是否存有基層醫療的身影,哪些專科醫師可能受病人選擇為經常就診醫師以擔當基層醫療提供者,值得深入探討。
研究目的:利用基層醫療之概念,發展病人經常就診醫師指標測量目前臺灣健康照護體系,哪些醫師較可能受病人選擇為經常就診醫師。 研究方法:使用全民健康保險資料庫2007~2011年承保抽樣百萬歸人檔進行研究分析。研究設計分為三部分,第一部分為研究者發展之病人經常就診醫師指標,如:病人之就醫忠誠、病人就診頻率、舊病人占率等指標。第二部分由醫師過去看診初級照護疾病,作為探索病人經常就診醫師指標之效標,以效標關聯效度作為檢定效度的方法。第三部分利用接受者操作特徵曲線(ROC curve)找出指標最佳臨界值作為病人經常就診醫師指標判定依據,並對三項指標進行比較。 研究結果:基層診所醫師看診初級照護疾病占率越高,與病人之就醫忠誠指標與舊病人占率指標有正相關性,在排除相關係數無統計顯著相關的專科別後,可以推論民眾可能將基層診所家醫科、內科、小兒科、婦產科醫師作為經常就診醫師;區域醫院層級以上的醫師,其看診初級照護疾病占率越低,在三項指標中一致地呈負相關的結果,表示區域醫院以上就醫的疾病類型可能偏向重症或難症,需要經常回診進行診療。 結論:雖然三項指標效度尚可接受,但足以正確區別出病人經常就診醫師為哪些專科別,以及在區域醫院以上層級可一致地發現,非初級照護疾病之病人可成功自我轉診至三級醫療層級就醫。 | zh_TW |
dc.description.abstract | Background: Taiwan not only lacks a comprehensive family physician system or a role of “gatekeeper”, but also allows people accessing to any medical care provider without being referred. Therefore, the situation leads to the hierarchization of services cannot be implemented. Along with the effectiveness of Family Physician Integrated Care Program is not as good as expected, and the medical system is developing towards the specialization, people usually chooses specialist as their primary care provider. In 2006, the National Health Insurance Administration strengthen the promotion of the Hierarchically Integrated Healthcare System that encourage people to first seek care at primary-level hospitals or clinics. In addition, it expects that people can have a regular source of care or a family physician to take the responsibility for their health. However, is it still presence of primary care in Taiwan? Which types of specialist could be choosing to be a regular source of care provided primary care practice?
Objective: The aims of study are applying the concept of primary care to develop patients’ regular source of care indicators. Methods: The study used National Health Insurance Research Database from 2007 to 2011 for statistics analysis. The study design is divided into three parts. The first part is developing patients’ regular source of care indicators, including: patient loyalty, the frequency of visit and the proportion of old patient. In the second part, tracking the percentages of primary care diseases in outpatient visits, and used Criterion-related validity to validate the validity. The final part used the receiver operating characteristic curve (ROC curve) to find the optimal threshold of the indicator as the basis for the patients’ regular source of care indicator, and compared the indicators. Result: The higher percentages of primary care diseases in clinic outpatient visits, with positive correlation in patient loyalty and the proportion of old patient indicators. After excluding the specialists with non-significant correlation coefficient, it can be inferred that people choose Family Medicine, General Internal, Pediatrics, Obstetricians and Gynecologists as their regular source of care. And the lower percentages of primary care diseases in regional hospital and medical center outpatient visits, with negative correlation in three indicators. It can be inferred that types of diseases sought by the regional hospitals and medical center may be severe or difficult. That result in patients needed to revisit frequently. Conclusion: Although the validity of the three indicators is acceptable, it is enough to correctly distinguish which types of specialist could be choosing to be a regular source of care provided primary care practice. And people would “self-referred” to the tertiary care, when they thought it wasn’t primary care practitioner could help. | en |
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dc.description.tableofcontents | 中文摘要 ii
Abstract iv 目錄 vi 圖目錄 viii 表目錄 ix 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 3 第三節 研究重要性 4 第二章 文獻回顧 5 第一節 基層醫療 5 第二節 臺灣健康照護體系發展 10 第三節 病人經常就診醫師 13 第四節 病人經常就診醫師指標發展 15 第五節 文獻探討小結 20 第三章 研究方法 21 第一節 研究設計 21 第二節 研究架構 25 第三節 研究材料與對象 26 第四節 研究變項與操作型定義 30 第五節 統計分析方法 36 第四章 研究結果 37 第一節 研究樣本描述性統計 37 第二節 病患經常就診醫師指標描述性統計 48 第三節 病患經常就診醫師指標測量結果與效度分析 62 第四節 研究指標準確度分析 85 第五章 討論 94 第一節 研究方法討論 94 第二節 研究結果討論 96 第三節 研究限制 100 第六章 結論與建議 102 第一節 結論 102 第二節 建議 103 參考文獻 104 | |
dc.language.iso | zh-TW | |
dc.title | 臺灣健康照護體系病人經常就診醫師指標探索 | zh_TW |
dc.title | Exploring Patients’ Regular Source of Care Indicators in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 李玉春(Yue-Chune Lee),李龍騰(Long-Teng Lee) | |
dc.subject.keyword | 基層醫療,經常就診醫師,分級醫療,專科化照護,效標關聯效度, | zh_TW |
dc.subject.keyword | Primary care,Regular source of care,Hierarchization of services,Specialty care,Criterion-related validity, | en |
dc.relation.page | 111 | |
dc.identifier.doi | 10.6342/NTU201900246 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2019-02-01 | |
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 |
dc.date.embargo-lift | 2028-08-01 | - |
顯示於系所單位: | 健康政策與管理研究所 |
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