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題名 台灣全民健康保險制度下癌症照護轉型為價值醫療的策略:以S醫院乳癌照護為例
A Strategy for Transforming Cancer Care into Value-based Medicine under Taiwan`s National Health Insurance System: Breast Cancer Care at Hospital S
作者 邱倫瑋
Chiou, Lun-Wei
貢獻者 宋皇志
Sung, Huang-Chih
邱倫瑋
Chiou, Lun-Wei
關鍵詞 價值醫療
論質計酬制
包裹式支付制
乳癌照護
時間導向作業基礎成本制
策略矩陣分析法
Value-based health care
Pay for performance
Bundled payment
Breast cancer care
Time-driven activity-based costing
Strategic Matrix Analysis
日期 2022
上傳時間 9-Mar-2023 18:20:05 (UTC+8)
摘要 健康照護體系面臨費用快速高漲與品質差距過大的問題,究其原因主要是醫療體系內所有的人在錯誤的層級上競爭。麥可・波特與伊莉莎白・泰絲柏格提出以價值為基礎的醫療照護,定義價值是每花一塊錢可以得到的健康結果,鼓勵醫療照護體系追求卓越的結果,降低系統的成本,協助病人創造最大的價值,達成健康照護的改革。

台灣全民健康保險因為全民納保的設計,除了保障全民的基本健康,也減少了民眾因病而貧的困境。然而單一保險人制度的設計,在面臨費用高漲與品質不一的問題時,並未讓醫療改革比其他國家容易。本研究參考波特與湯瑪斯・李提出邁向價值醫療的六項策略任務,藉由文獻回顧與資料收集,根據六項策略任務的核心概念設計問卷,以S醫院乳癌照護團隊核心成員為對象,收集意見,釐清個案團隊的照護模式與波特六項策略任務的異同,同時採用司徒達賢的事業策略六項構面與策略矩陣分析法,分析S醫院乳癌團隊的優劣之處,提出改善劣勢的競爭策略,作為台灣癌症照護轉型為價值醫療的參考。

台灣健保的乳癌試辦計畫證明癌症照護採用完整醫療週期的包裹式支付制,可以兼顧醫療品質與費用支出;而成本計算必須精確,可以採用時間導向作業基礎成本制;強制公布醫療結果,幫助民眾做出價值選擇,是尚未開始的重要步驟;癌症照護團隊應該屏棄傳統職能分科,邁向整合醫療單位的組織架構,結合病人與醫療團隊的目標,達到最大的價值;醫療資訊系統需要以病人為單位,收集完整資訊,方便被團隊成員與病人所用,同時促進病人成果回報與即時照護改善的功能;最後醫療機構根據資源與成本訂定最適當服務目標,推展卓越服務、擴大服務地區,將整個醫療體系的價值最大化。

台灣健保制度具有朝向價值醫療的基礎,乳癌試辦計畫值得成為醫療改革的參考模式,進而推進醫療全領域的價值。
The health care system faces problems with rapidly rising costs and disparities in quality, largely because stakeholders in the system are competing at the wrong level. Michael Porter and Elizabeth Teisberg propose value-based health care and defines value as the health outcomes achieved per dollar spent. He encourages all medical professionals to pursue excellent outcome and reduce the cost, further, to create value for patients and facilitate the health care reform.

Under National Health Insurance’s compulsory enrollment system, it not only provides the citizen’s basic health, but also ensures patients not being driven into poverty by medical bills. In the face of high costs and inconsistent quality, the design of the single insurer system does not make health care reform easier than in other countries. Porter and Thomas Lee proposed six strategic agenda to move towards value-based health care. This study conducted a literature review, data collection and questionnaire designed with reference to the six strategic agenda. The core members of the breast cancer multidisciplinary team at Hospital S were targeted to collect opinions. Based on the opinions and breast cancer care’s advantages and disadvantages at Hospital S by Seetoo’s 6-dimention strategy analysis and Strategic Metrix Analysis, a strategic planning is proposed to gain competition for the team and, taking it as a model, for transforming current cancer care into value-based health care in Taiwan.

National Health Insurance Administration’s pay-for-performance plan for the treatment of breast cancer has proved that bundled payment system for a full cycle of medical care could balance quality and expenses. Medical cost must be accurate and a time-driven activity-based costing can be adopted. Hospitals should report outcomes to the public to help patients choose programs for themselves. It is better for the care team to move from traditional functional unit towards integrated practice unit, which would help both patients and medical teams move toward same goals of health care, and finally achieve value for patients. Medical information technology platform should be patient-centered and designed for data-driven and user friendly. Finally, institution needs to integrate care delivery systems, defines the scope of services, and expands geographic reach, which would make value to be substantially increased on a large scale.

There has a foundation for the development of value-based health care under Taiwan`s National Health Insurance system. The pay-for-performance plan for breast cancer is worthy of becoming a reference model for healthcare reform.
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英文:
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描述 碩士
國立政治大學
經營管理碩士學程(EMBA)
109932162
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0109932162
資料類型 thesis
dc.contributor.advisor 宋皇志zh_TW
dc.contributor.advisor Sung, Huang-Chihen_US
dc.contributor.author (Authors) 邱倫瑋zh_TW
dc.contributor.author (Authors) Chiou, Lun-Weien_US
dc.creator (作者) 邱倫瑋zh_TW
dc.creator (作者) Chiou, Lun-Weien_US
dc.date (日期) 2022en_US
dc.date.accessioned 9-Mar-2023 18:20:05 (UTC+8)-
dc.date.available 9-Mar-2023 18:20:05 (UTC+8)-
dc.date.issued (上傳時間) 9-Mar-2023 18:20:05 (UTC+8)-
dc.identifier (Other Identifiers) G0109932162en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/143754-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 經營管理碩士學程(EMBA)zh_TW
dc.description (描述) 109932162zh_TW
dc.description.abstract (摘要) 健康照護體系面臨費用快速高漲與品質差距過大的問題,究其原因主要是醫療體系內所有的人在錯誤的層級上競爭。麥可・波特與伊莉莎白・泰絲柏格提出以價值為基礎的醫療照護,定義價值是每花一塊錢可以得到的健康結果,鼓勵醫療照護體系追求卓越的結果,降低系統的成本,協助病人創造最大的價值,達成健康照護的改革。

台灣全民健康保險因為全民納保的設計,除了保障全民的基本健康,也減少了民眾因病而貧的困境。然而單一保險人制度的設計,在面臨費用高漲與品質不一的問題時,並未讓醫療改革比其他國家容易。本研究參考波特與湯瑪斯・李提出邁向價值醫療的六項策略任務,藉由文獻回顧與資料收集,根據六項策略任務的核心概念設計問卷,以S醫院乳癌照護團隊核心成員為對象,收集意見,釐清個案團隊的照護模式與波特六項策略任務的異同,同時採用司徒達賢的事業策略六項構面與策略矩陣分析法,分析S醫院乳癌團隊的優劣之處,提出改善劣勢的競爭策略,作為台灣癌症照護轉型為價值醫療的參考。

台灣健保的乳癌試辦計畫證明癌症照護採用完整醫療週期的包裹式支付制,可以兼顧醫療品質與費用支出;而成本計算必須精確,可以採用時間導向作業基礎成本制;強制公布醫療結果,幫助民眾做出價值選擇,是尚未開始的重要步驟;癌症照護團隊應該屏棄傳統職能分科,邁向整合醫療單位的組織架構,結合病人與醫療團隊的目標,達到最大的價值;醫療資訊系統需要以病人為單位,收集完整資訊,方便被團隊成員與病人所用,同時促進病人成果回報與即時照護改善的功能;最後醫療機構根據資源與成本訂定最適當服務目標,推展卓越服務、擴大服務地區,將整個醫療體系的價值最大化。

台灣健保制度具有朝向價值醫療的基礎,乳癌試辦計畫值得成為醫療改革的參考模式,進而推進醫療全領域的價值。
zh_TW
dc.description.abstract (摘要) The health care system faces problems with rapidly rising costs and disparities in quality, largely because stakeholders in the system are competing at the wrong level. Michael Porter and Elizabeth Teisberg propose value-based health care and defines value as the health outcomes achieved per dollar spent. He encourages all medical professionals to pursue excellent outcome and reduce the cost, further, to create value for patients and facilitate the health care reform.

Under National Health Insurance’s compulsory enrollment system, it not only provides the citizen’s basic health, but also ensures patients not being driven into poverty by medical bills. In the face of high costs and inconsistent quality, the design of the single insurer system does not make health care reform easier than in other countries. Porter and Thomas Lee proposed six strategic agenda to move towards value-based health care. This study conducted a literature review, data collection and questionnaire designed with reference to the six strategic agenda. The core members of the breast cancer multidisciplinary team at Hospital S were targeted to collect opinions. Based on the opinions and breast cancer care’s advantages and disadvantages at Hospital S by Seetoo’s 6-dimention strategy analysis and Strategic Metrix Analysis, a strategic planning is proposed to gain competition for the team and, taking it as a model, for transforming current cancer care into value-based health care in Taiwan.

National Health Insurance Administration’s pay-for-performance plan for the treatment of breast cancer has proved that bundled payment system for a full cycle of medical care could balance quality and expenses. Medical cost must be accurate and a time-driven activity-based costing can be adopted. Hospitals should report outcomes to the public to help patients choose programs for themselves. It is better for the care team to move from traditional functional unit towards integrated practice unit, which would help both patients and medical teams move toward same goals of health care, and finally achieve value for patients. Medical information technology platform should be patient-centered and designed for data-driven and user friendly. Finally, institution needs to integrate care delivery systems, defines the scope of services, and expands geographic reach, which would make value to be substantially increased on a large scale.

There has a foundation for the development of value-based health care under Taiwan`s National Health Insurance system. The pay-for-performance plan for breast cancer is worthy of becoming a reference model for healthcare reform.
en_US
dc.description.tableofcontents 第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與研究議題 3
一、 研究目的 3
二、 研究議題 4
第三節 名詞釋義 4
第四節 研究範圍 5
第二章 文獻探討 6
第一節 醫療保險支付制度 6
一、 歷史沿革與支付制度比較 6
二、 台灣全民健康保險支付制度的沿革 9
三、 台灣全民健康保險的現狀 10
第二節 價值醫療之概述 14
一、 醫療照護的問題 14
二、 零和競爭(Zero-sum competition)的影響 15
三、 健康照護領域的「價值」 18
四、 照護提供價值鏈(Care Delivery Value Chain) 20
五、 時間導向作業基礎成本制(Time-Driven Activity-Based Costing) 21
第三節 波特(PORTER)和李(LEE)六項策略任務概述 23
一、 整合醫療單位(IPU: integrated practice unit) 24
二、 結果測量與成本計算 26
三、 醫療週期包裹式支付制 (Bundled payment) 28
四、 醫療系統整合 30
五、 拓展卓越服務至其他地區 31
六、 建立資訊科技平台 32
第四節 策略矩陣分析概述 33
第五節 價值醫療與乳癌照護 34
第三章 研究方法 36
第一節 個案研究法 36
第二節 個案背景說明 37
一、 台灣的乳癌現況 37
二、 台灣的乳癌保險支付現狀 39
三、 S醫院乳癌照護的現況 41
第三節 問卷設計 45
第四章 研究結果與討論 47
第一節 問卷結果 47
一、 整合醫療單位(IPU) 47
二、 結果測量與成本計算 48
三、 醫療週期包裹式支付制 49
四、 醫療系統整合 51
五、 拓展卓越服務至其他地區 52
六、 建立資訊科技平台 53
七、 個案團隊六項策略任務現狀整理 54
第二節 乳癌照護價值鏈與策略矩陣分析 56
一、 S醫院乳癌照護策略矩陣分析 56
二、 個案團隊的選擇 60
三、 個案團隊邁向價值醫療與競爭力並重的策略方案 61
第五章 結論與建議 65
第一節 結論 65
第二節 建議 67
第三節 研究限制 68
參考文獻 70
附錄 76
zh_TW
dc.format.extent 8189930 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0109932162en_US
dc.subject (關鍵詞) 價值醫療zh_TW
dc.subject (關鍵詞) 論質計酬制zh_TW
dc.subject (關鍵詞) 包裹式支付制zh_TW
dc.subject (關鍵詞) 乳癌照護zh_TW
dc.subject (關鍵詞) 時間導向作業基礎成本制zh_TW
dc.subject (關鍵詞) 策略矩陣分析法zh_TW
dc.subject (關鍵詞) Value-based health careen_US
dc.subject (關鍵詞) Pay for performanceen_US
dc.subject (關鍵詞) Bundled paymenten_US
dc.subject (關鍵詞) Breast cancer careen_US
dc.subject (關鍵詞) Time-driven activity-based costingen_US
dc.subject (關鍵詞) Strategic Matrix Analysisen_US
dc.title (題名) 台灣全民健康保險制度下癌症照護轉型為價值醫療的策略:以S醫院乳癌照護為例zh_TW
dc.title (題名) A Strategy for Transforming Cancer Care into Value-based Medicine under Taiwan`s National Health Insurance System: Breast Cancer Care at Hospital Sen_US
dc.type (資料類型) thesisen_US
dc.relation.reference (參考文獻) 中文:
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