國軍醫療體系整合及組織再造之研究

Abstract

政府自大陸遷台以來，為防衛台澎金馬之安全，國軍部隊一直維持相當數量之兵力，整體預算運用於人事維持費用之比例明顯過高。為此，國防部開始着手「軍事事務革新」策略及「精實案」、「精進案」規劃，期藉民間及政、經、科技等資源及力量，在日益緊縮的預算分配限制下，帶動軍隊儘早完成轉型，使軍事戰略規劃具體支持國家政策與總體戰略目標，以降低人事預算為目標，遂研擬國軍人力精簡政策。自民國八十五年起規劃國軍重大兵力精簡方案－「精實案」，另自九十二年起執行第二次人力精簡方案－「精進案」第一階段，預劃使國軍兵力大幅減少人事費用，並達整體目標預算比例。此外，民國九十年二月一日軍人正式加入健保，國家醫療制度真正進入全民健保時代，醫療資源由中央統一調配，國軍醫療體系自不能置身事外。本研究目的為了解國軍醫療體系以組織再造精神，調整醫療結構，是否真正達到精簡人力目標？能否建構醫療後勤支援系統，確保基本醫療戰力，滿足作戰及部隊戰備整備需求？ 國軍醫療體系包括部隊基層的衛生排、衛生連、衛生營、衛生群等衛勤醫療單位，機關學校所屬醫務所及地區醫院、區域醫院及醫學中心共二十五家醫療院所。 在醫療院所方面，由於國防預算日益緊縮與近年國內經濟景氣不佳，各國軍醫院引進企管理念，改善經營體質，創造合理績效並分擔國防預算。精進案依據任務需要，以加強軍陣醫學如燒燙傷、潛醫、航醫、精神醫學為研發重點，保留國軍醫學中心、地區總醫院及軍陣醫學專業醫院，餘各地醫院檢討裁撤或以基金方式經營。依以上原則經過各項評估後作成裁撤九家醫院保留三軍總醫院醫學中心，北、中、南、東四所地區總醫院，北投精神專科、松山、岡山航醫專業以及左營潛醫專業等九家醫院。 本研究依據衛生署全國醫療資源分配資料、國軍各戰區人力參數，分析評估國軍醫院實際需求床位數及醫療院所家數、再以各醫院經營之全民健保營運狀況，檢討國軍醫療體系精進案之政策。 國軍醫療體系之精進變革，將數十年之組織體系作大幅度調整，本研究對各項資料評估分析其優缺點，並將持續監測後續國軍醫療後勤運作之能量適時提出建言，以確保國軍醫療體系在軍事事務革新之精進案後，維持支援國軍之基本戰力不墜。

To protect the islands of Taiwan, Penghu, Kinmen and Machu, a certain level of military man force has been maintained since the government was relocated to Taiwan, and a notably high budget has been necessary to maintain a military force at such scale. For which, in 1996, the Military of Defense made a major military force streamlining project - the Streamline Program, and in 2003, implementation of the first stage of the second human resource streamlining project - the Restructure Program was commenced. These two programs are expected to reduce human resource costs in a large scale and achieve the projected budget ratio. In addition, from February 1st 2001, military personnel were officially annexed into the National Health Insurance system. With annexation of military personnel, the national medical care system achieved its goal of nation-wide coverage. This research aims to project an organizational reform by readjusting the medical care structure to achieve the goal of human resource streamlining. This projected plan has structured a well-knitted medical backup system that will ensure the sufficiency and efficiency of basic military medical forces and satisfy basic military medical needs during both war and peace time. To coordinate with the Joint Logistic Command System upgrade, the backup integration operation with first annex the base troop medical care units into the Joint Command Center to establish an integrated backup command control system and enable the commanders to effectively manage the troops. As the national defense budgets are contracting and the economy has been on a slow development, military medical institutions will be guided to improve their management by implementing corporate management concepts, in aims to create reasonable profits, share the burdens of military costs, and reinforce researches in military medicine such as burns, diving medicine, aerospace medicine, and psychological medicine. National Military Medical Centers, regional Hospitals, and Specialist Military Hospitals will be preserved, but the rest, i.e. local hospitals, will be closed or managed under funds. Evaluated based on the above principles, a total of nine hospitals will be closed, and a total of nine hospitals will remain including the Tri-Service General Hospital, four regional general hospitals and four specialist hospitals. The Military Medical System Reform readjusted the organizational structure that has been in operation for a few decades in a large scale. This research will evaluate its advantages and disadvantages based on available data and information and continuously monitor the operation of military medical backup operations. Suggestions will be propped in a timely fashion to ensure that the medical backup system will be maintained at the optimal level after the national military medical system reform.