全方位新生兒整合照顧：以一所公立醫學中心為例

Abstract

少子化使台灣在2016年邁入超高齡社會，同時台灣人口在2018年出現死亡交叉，人口紅利的快速消失讓經濟成長的果實可能被快速侵蝕。但台灣的兒童醫療網，長年來因全民健保給付規劃的不當，而殘破不全。這導致台灣的嬰兒死亡率及新生兒死亡率在已開發國家中偏高。生的少又照顧不好形成台灣人口的雙重負擔。本研究希望以一個台灣中部的醫學中心為例，在整合不競爭的原則下建立長期良好的醫療網合作關係，提供伙伴醫療院所雙向轉診，為策略聯盟醫療院所培育醫護人員，改善外接流程，維持良好的生態系經營環境。並檢討內部流程與資源耗用，希望達到最妥善的新生兒照護模式。 本研究採個案研究法，選擇本個案的原因是在充滿制約的全民健保環境下，又面對大型財團醫院的劇烈競爭，但本個案所仍能在照護品質、研究創新、人材培育、健全分級醫療以及員工幸福感等指標上成為台灣中部的翹楚。 本個案在有限的資源下，在新生兒的照護做到產前、週產期、重症加護及出院後的垂直整合，同時也在醫療網內以合作取代競爭的方式達到水平整合的綜效。同時多年來專注於內部流程改善及醫療創新，於新生兒慢性肺疾病、早產兒死亡率及感染率三個重要指標達到全國領先的水準。此外，也進行長期有計畫的人材培育，有多位醫師及護理師在職進修學位，近年來的論文發表質與量均有提升。同時在研究方面藉由平台化的策略，引進國內各大專院校的研究資源，共同進行生技及醫療照護方面的研究。經由醫療網的營照，使醫學中心專注於醫學中心工作後，服務量下降，但盈餘及人員薪資提升，使員工樂在工作，營造幸福職場。 未來，持續垂直與水平整合全方位的新生兒照護，與學界、業界廣泛合作，成為醫藥科技研究發展平台。共榮不競爭，創造醫療網良好生態系並持續長期培育高端專業人才為本個案未來之展望。

The declining birthrate brought Taiwan into an ultra-old society in 2016. At the same time, the population of Taiwan showed a death cross in 2018. The rapid disappearance of the demographic dividend may cause the fruits of economic growth to be quickly eroded. However, Taiwan’s children’s medical network has been broken for years due to improper planning of the National Health Insurance payment. This has led to higher infant mortality and neonatal mortality rates in developed countries. The low birthrate and poor care have created a double burden for the Taiwanese population. This study hopes to take a medical center in central Taiwan as an example to maintain a good ecosystem operating environment by establishing a long-term good medical network cooperation relationship under the principle of integration and non-competition, providing two-way referrals from partner hospitals, cultivating medical staff for strategic alliance hospitals, improving transferal process. Moreover, to review internal processes and resource consumption, hoping to achieve the most appropriate neonatal care model. This study adopts a case study method. The reason for choosing this case is that it is under the restrictive National Health Insurance environment and faced with fierce competition from large consortium hospitals. However, this case institute can still become leaders in central Taiwan on indexes, such as quality of care, research and innovation, talent cultivation, graded medical care system and employee happiness. In this case, with limited resources, vertical integration of prenatal care, perinatal care, intensive care, and post-discharge care was achieved. At the same time, the integration of horizontal integration succeeded through cooperation instead of competition within the medical network. Meanwhile, by focusing on internal process improvement and medical innovation for many years, it has reached the national leading level in three important indicators of neonatal care including chronic lung disease, premature infant mortality and infection rate. In addition, long-term planned talent cultivation is also underway. There are many doctors and nurses who are pursuing in-service degrees. The quality and quantity of papers published in recent years have been improved. At the same time, through a platform strategy, the research resources of domestic universities and colleges are introduced to jointly conduct research in biotechnology and medical care. After establishing the medical network, the medical center could focus on the medical center's work, and the service volume has decreased, but the surplus and the salary of the staff have increased, so that the employees are happy to work and create a happy workplace. In summary, we will continue to vertically and horizontally integrate all-round neonatal care, cooperate extensively with academia and industry, and become a platform for pharmaceutical technology research and development. Co-prosperity does not compete, creating a good ecosystem of the medical network and continuing to cultivate high-end professionals for a long time is the future prospect of this case.