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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 郭年真 | |
dc.contributor.author | Yu-Ting Lin | en |
dc.contributor.author | 林雨亭 | zh_TW |
dc.date.accessioned | 2021-06-17T03:49:45Z | - |
dc.date.available | 2019-02-22 | |
dc.date.copyright | 2018-02-22 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-01-20 | |
dc.identifier.citation | 英文部分
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Scandinavian Journal of Public Health, 30(2), 125-132. doi:10.1080/14034940210133744 Tai, W. T., Porell, F. W., & Adams, E. K. (2004). Hospital choice of rural Medicare beneficiaries: patient, hospital attributes, and the patient-physician relationship. Health Serv Res, 39(6 Pt 1), 1903-1922. doi:10.1111/j.1475-6773.2004.00324.x Thompson, W. T., Cupples, M. E., Sibbett, C. H., Skan, D. I., & Bradley, T. (2001). Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study. BMJ, 323(7315), 728-731. Ubel, P. A., Angott, A. M., & Zikmund-Fisher, B. J. (2011). Physicians recommend different treatments for patients than they would choose for themselves. Arch Intern Med, 171(7), 630-634. doi:10.1001/archinternmed.2011.91 中文部分 王乃弘. (1999). 民眾就醫選擇之研究-分析層級程序法之應用. [The Aplication of Analytic Hierarchy Process in the Selection of Hospital]. 中華公共衛生雜誌, 18(2), 138-151. doi:10.6288/cjph1999-18-02-07 王冠懿, & 鄭守夏. (2006). 民眾就醫層級與醫療利用分析:SARS疫情前後的觀察. [The Analysis of Level of Outpatient Visits and Healthcare Utilization: A before and after Observation of the SARS Outbreak]. 臺灣公共衛生雜誌, 25(1), 75-82. doi:10.6288/tjph2006-25-01-08 田維哲. (2007). 初次全人工髖與膝關節置換術的盛行率與病人的醫療費用分析─從1996年~2004年. 高雄醫學大學. Available from Airiti AiritiLibrary database. (2007年) 余承萍. (1987). 醫學中心一般內、外科病患利用門診服務及其相關因素的研究. 國防醫學院公共衛生研究所, 台北. 吳肖琪、李玉春. (2004). 總額支付制度下建立基層與醫院門診分級醫療指標之研究. 台北. 吳建和, 張財源, & 王淑蕙. (2011). 白內障術後眼內炎預測模型之研究. [A Study on a Logistic Model for Predicting the Incidence of Endophthalmitis after Cataract Surgery]. 長榮大學學報, 15(2), 99-115. 呂碧鴻、王英偉、謝維玲. (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. 台北. 李宗晉. (2011). 資訊不對稱與就醫選擇──以醫事人員暨親屬就三種手術之選擇為例. 臺灣大學. Available from Airiti AiritiLibrary database. (2011年) 李柏杰. (2002). 衡量健保論病例計酬制度實施前後特定疾病之相對診療效率與生產力變動. (碩士), 國立中央大學. 周英香. (2012). 女性護理人員與其他醫事人員下背痛之就醫行為與用藥型態分析. (碩士), 中山醫學大學, 台中市. 周鴻儒, 高森永, & 陳育忠. (1997). 國軍醫院門診病患就醫選擇因素調查研究. 國防醫學, 25(5), 423-430 洪乙禎, & 林錦鴻. (2008). 從患者就醫場所的選擇看轉診制度之落實. [Patient Choice and Practitioner Referral]. 社會科學論叢, 2(1), 61-89. 高毓翔. (2008). 醫師之住院醫療利用是否較具成本效果? (碩士), 國立台北護理學院, 台北市. 高毓翔, & 楊長興. (2009). 醫師之住院醫療利用是否較具成本效果?. [Do Hospitalized Physicians Consume Medical Resources More cost-effectively?]. 臺灣公共衛生雜誌, 28(3), 194-204. doi:10.6288/tjph2009-28-03-04 張苙雲, & 謝幸燕. (1994). 就醫流向的長期變遷. [Changing Patterns of Patient Flow: A Case of Taiwan's Health Care Delivery System]. 中華公共衛生雜誌, 13(1), 54-76. doi:10.6288/cjph1994-13-01-06 連怡甄, & 楊長興. (2012). 醫師臨終之醫療資源耗用:醫師病人是否不同?. [Physicians' Medical Resource Consumption at the End of Life: Do Physician-Patients Behave Differently?]. 臺灣公共衛生雜誌, 31(3), 236-250. doi:10.6288/tjph2012-31-03-04 陳拱北預防醫學基金會 (Ed.) (2007). 公共衛生學. 臺北市: 陳拱北預防醫學基金會. 陳淑惠, 管連胡, 蔡麗伶, 李素真, & 柯昭英. (2005). 尿路結石疾病管理效果之評價. [An Evaluation Study on the Disease Management of Urolithiasis]. 醫保研究雜誌, 1(1), 63-73. 陳欽賢, 劉彩卿, & 陳美吟. (2005). 全民健康保險制度下之民眾就醫:感冒及慢性病. 保險專刊, 21(2), 113-143. 黃俊哲, 黃光華, 鍾信成, 蘇燕雲, & 楊長興. (2008). 知情消費者與機構所在地區對剖腹生產醫療利用之探討. [The Relationship between Informed Consumers and the Geographic Area of the Providing Institutions with Respect to Utilization of Caesarean Section]. 澄清醫護管理雜誌, 4(1), 24-33. 齊燕斌, & 魏華儀. (1995). 成人腹股溝疝氣無張力修手術. [Tension-Free Hernioplasty of Adult Groin Hernia]. Journal of Medical Sciences, 16(2), 138-143. 蔡文正, & 龔佩珍. (2003). 民眾對基層診所評價與就醫選擇影響因素. [Consumers' Assessment of Clinic Services and its Affecting Factors]. 臺灣公共衛生雜誌, 22(3), 181-193. doi:10.6288/tjph2003-22-03-04 衛生福利部中央健康保險署. (2017). 衛生福利部中央健康保險署全球資訊網. 鄭守夏. (1997). 1996年民眾選擇就醫地點的考量因素. Retrieved from 盧瑞芬, & 謝啟瑞. (2000). 醫療經濟學. 臺北市: 學富文化. 賴煌仁, 蕭正文, 糠榮誠, 趙培傑, 萬青青, & 饒樹文. (2006). Emergency Hemorrhoidectomy for Treating Acute Hemorrhoidal Crisis: A Single Institute Experience. [以緊急痔瘡切除術治療痔危症]. 中華民國大腸直腸外科醫學會雜誌, 17(3), 87-94. doi:10.6312/scrstw.2006.17(3).09513 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/70213 | - |
dc.description.abstract | 研究背景:醫療機構必須根據專業分工,才能讓整體的醫療資源利用更有效率。臺灣目前將醫療體系分為醫學中心、區域醫院、地區(社區)醫院及基層院所等四個層級,但在全民健保制度下並未限制患者的就醫地點,故病患可能前往各個不同層級的院所接受醫療照護,導致分級醫療難以落實。過去文獻指出醫療供給面及需求面特性皆會影響民眾的就醫選擇,而醫事人員身為健康照護體系中的知情消費者 (informed consumer) ,其醫療利用及就醫選擇亦與一般民眾的型態不同。但是,究竟醫療專業知識背景的差異是否會影響接受一般手術之患者在就醫院所層級別的選擇與背後的原因為何?目前尚未有學者以國家級資料針對此類議題做探討,故本研究希望能藉此了解臺灣目前不同病患族群的醫療選擇現況以及探討可能之醫療品質因素。
研究目的:本研究以七項臨床上常見之手術處置為例,探討不同身分別患者與一般民眾在接受手術處置之院所層級別,以及醫療選擇與照護品質結果的關係,最後是執業地點與就醫選擇院所層級別的關係。 研究方法:本研究採回溯型研究法,以全民健保資料庫中的承保檔、醫事人員檔與健保門、住診申報資料,分析並比較醫護人員及其眷屬在生產 (labor) 、闌尾炎切除術 (Appendectomy) 、痔瘡手術 (Hemorrhoids surgery) 、疝氣手術 (Hernia surgery) 、白內障手術 (Cataract surgery) 、(股)膝關節置換術 (THR,TKR) 及尿路結石體外震波碎石術 (Extracorporeal shock wave lithotripsy, ESWL) 等七項門、住診常見手術處置就醫選擇的差異,以及探討不同就醫院所層級與離院後3日、14日內發生再急診或再住院之情形是否相關。 研究結果:本研究共納入217,514筆案件進行分析,結果發現病患本身或其眷屬為醫療專業人員的個案,擇醫學中心就醫的比例最高 (33.3% ~72.0%) ,約為一般民眾的1.78~5.66倍。出院後發生3日、14日內再急診或再住院的機率則無顯著差異。最後,本研究也發現病患本身或眷屬為醫療專業人員,多選擇與自己執業之機構層級相同或更高之醫事機構就醫。 結論與建議:綜上而言,病患本身為或眷屬為醫療專業人員,對高層級別的醫事機構選擇有較大的偏好,且在不同的手術處置類別有些許的差異,而瞭解醫療專業人員與一般民眾偏好至大型醫療機構的原因,有助於改善分級醫療推動的困難。 | zh_TW |
dc.description.abstract | Background: The medical care institution depends on a hierarchical division of labor to allow for an efficient utilization of medical resources. Taiwan’s medical care institutions are currently categorized and ranked into four levels: medical centers, regional hospitals, community hospitals, and physician clinics. However, the current National Health Insurance system does not restrict patients to any one type of medical institution for the care they seek. Patients are thus able to go to any one of these four types of medical institutions to receive medical care. This has inhibited the hierarchical structure of the medical care institution from realizing its intended purpose. Research literature has pointed out that both the supply for and demand of medical treatment affect how patients choose where they receive medical treatment. Medical professionals are considered to be “informed consumers” in the medical care system and approach medical care differently from members of the general public. This study investigates whether being more “informed” about medical care affects how patients, specifically general surgery patients, choose medical care institutions, and looks into the reasons driving that choice. Currently, no scholars in Taiwan have utilized national registry data to investigate this issue. Thus, this study aims to use such data to better understand how patients in Taiwan decide where to receive medical care, and also delve into the quality of care as a possible factor affecting such a decision.
Objectives: This study looks at seven clinical common surgeries to investigate the surgery patient’s identity and the type of medical care institution in the hierarchy that is chosen for the surgical procedure to be done. The study also investigates the relationship between the type of medical care institution chosen by the patient and the resulting quality of care. Lastly, the study investigates the relationship between the surgery patient’s place of work and the type of medical care institution chosen by the patient. Methods: This is a retrospective study that utilizes the registry of NHI beneficiaries, the registry of medical professionals, and data from medical insurance claims filed by patients to analyze and compare the type of medical care institution chosen by medical professionals, who are patients themselves, or their relatives to receive care for the following seven procedures: labor, appendectomy, hemorrhoids surgery, hernia surgery, cataract surgery, THR, TKR and extracorporeal shock wave lithotripsy (ESWL). The researcher has also tracked emergency department revisits and hospital readmissions that have occurred in 3 or 14 days after the patient has been discharged from the hospital, and investigated whether these revisits and readmissions are related to the type of hospital chosen. Results: This researcher collected and analyzed a total of 217,514 files. The results of the analysis showed that patients who chose medical centers are highest among medical professionals or their relatives (33.3% to 72.0%). This percentage is 1.78 to 5.66 times higher than patients who are not themselves nor relatives of medical professionals. Instances of revisits to the emergency department occurring in 3 days and hospital readmissions after being discharged in 14 days showed no significance differences between these two groups. Lastly, the analysis showed that medical professionals or their relatives tended to choose medical care institutions that were equal to or above the level of the medical care institution at which they worked. Conclusion and recommendations: The results of the study showed a preference for higher level medical care institutions among medical professionals as patients or their relatives. Depending on the type of surgical procedure being performed, the type of medical care institution chosen may also have differed. All in all, understanding the reasons behind why patients who are medical professionals and general patients have a preferential bias for larger medical institutions will contribute to improving the effectiveness of a hierarchical division of hospitals. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T03:49:45Z (GMT). No. of bitstreams: 1 ntu-107-R03848035-1.pdf: 3147887 bytes, checksum: 46962bf61a168f1f26ae1e4700ba6957 (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii ABSTRACT v 目次 viii 圖目錄 x 表目錄 xi 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 第二章 文獻回顧 4 第一節 求醫行為及研究模式 4 第二節 影響求醫行為之因素 5 第三節 醫療專業人員之醫療利用特殊性 11 第四節 小結 24 第三章 材料與方法 25 第一節 資料來源與研究對象 25 第二節 研究設計與架構 29 第三節 研究假說 32 第四節 研究資料選取流程 33 第五節 研究變項與操作型定義 35 第六節 統計分析方法 41 第四章 研究結果 42 第一節 研究樣本描述性及雙變量分析 42 第二節 多變量分析 70 第三節 執業地點別與就醫選擇別分析 113 第四節 小結 129 第五章 討論 138 第一節 研究結果討論 138 第二節 假說驗證 145 第三節 研究限制 147 第六章 結論與建議 150 第一節 結論 150 第二節 建議 151 參考文獻 153 論文口試委員建議回覆表 157 | |
dc.language.iso | zh-TW | |
dc.title | 醫療專業人員與一般民眾在就醫機構層級選擇上的差異
─以七種手術處置為例 | zh_TW |
dc.title | The type of medical care institution selection of the case of seven surgeries among medical staffs and general adults | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 楊銘欽,李純馥 | |
dc.subject.keyword | 知情消費者,影響就醫選擇因素,醫事機構特約類別,醫療品質,執業地點, | zh_TW |
dc.subject.keyword | informed consumer,factors affecting choice of medical care,contracted medical care,quality of medical treatment,place of work, | en |
dc.relation.page | 164 | |
dc.identifier.doi | 10.6342/NTU201800109 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-01-22 | |
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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