Publications-Theses

題名 醫療資源優先配置決策程序之評估-以全民健保醫療給付協議會議為例
An Evaluation of Decision Procedure in Health Resource Priority Setting: The Payment Committee of NHI in Taiwan
作者 蔡翔傑
Tsai, Hsiang-Chieh
貢獻者 黃東益
Huang, Tong-Yi
蔡翔傑
Tsai, Hsiang-Chieh
關鍵詞 全民健保
要求合理性的課則
資源優先配置
決策程序評估
層級分析法
National Health Insurance
accountability for reasonableness
priority setting
analytical hierarchy process
日期 2008
上傳時間 19-Sep-2009 13:08:18 (UTC+8)
摘要 全民健保醫療給付範圍的相關決策缺乏資訊公開性與參與性,引發許多醫療給付的糾紛案件,加上醫療資源有限,醫療需求隨國內人口平均餘命提升而增加,醫療資源優先配置的問題更顯其重要性。本研究建立一個合理的醫療資源優先配置決策程序評估架構,以改善目前國內資源優先配置決策程序,使用Daniels & Sabin(1997)所提出的「要求合理性的課則」(Accountability for Reasonableness)作為評估架構的主要構面,採用文獻分析法與層級分析法建構出一個完整的評估架構並且比較指標間的相互權重,接著使用深度訪談法試圖探索評估指標相對權重背後所代表的意涵。研究結果顯示醫事團體代表強調相關性與決策修正機會,政府代表則注重公開性與執行力,兩者對於醫療資源優先配置決策程序的期待有相當大的落差。基於研究發現,本研究主張應該增加協商機會以減少決策成員間的認知落差,帶動社會大眾對於資源優先配置的認識與參與,並針對目前決策程序的公開性、相關性、決策修正機會與執行力進行改善。
The lack of information publicity and participation in the payment system of National Health Insurance (NHI) in Taiwan has been a critical issue. Besides numerous insurance payment disputations, the limited health resources and increasing health demand all call for an immediate solution to the problem of health resource priority setting in NHI.. This study aims to establish a systemic evaluative framework to improve on the health resources priority settings. In answer to the need, analytical hierarchy process and in-depth interviews have been conducted to develop a framework based on Accountability for Reasonableness. Qualitative and quantitative analysis of the surveys indicate some criteria and the meaning of the relative weight of each criterion. The results show a discrepancy between the governmental representatives and the healthcare organization ones on the expectation of health resources priority settings. The former focus on relevance, revision and appeals while the latter emphasize publicity and enforcement. According to the findings, this study suggests that an increase of negotiation is necessary to eliminate the discrepancy between the two groups. The government also need to introduce the public the idea of health resources priority settings and to modify the current procedure based on the four factors in Accountability for Reasonableness.
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描述 碩士
國立政治大學
公共行政研究所
95256022
97
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0095256022
資料類型 thesis
dc.contributor.advisor 黃東益zh_TW
dc.contributor.advisor Huang, Tong-Yien_US
dc.contributor.author (Authors) 蔡翔傑zh_TW
dc.contributor.author (Authors) Tsai, Hsiang-Chiehen_US
dc.creator (作者) 蔡翔傑zh_TW
dc.creator (作者) Tsai, Hsiang-Chiehen_US
dc.date (日期) 2008en_US
dc.date.accessioned 19-Sep-2009 13:08:18 (UTC+8)-
dc.date.available 19-Sep-2009 13:08:18 (UTC+8)-
dc.date.issued (上傳時間) 19-Sep-2009 13:08:18 (UTC+8)-
dc.identifier (Other Identifiers) G0095256022en_US
dc.identifier.uri (URI) https://nccur.lib.nccu.edu.tw/handle/140.119/37312-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 公共行政研究所zh_TW
dc.description (描述) 95256022zh_TW
dc.description (描述) 97zh_TW
dc.description.abstract (摘要) 全民健保醫療給付範圍的相關決策缺乏資訊公開性與參與性,引發許多醫療給付的糾紛案件,加上醫療資源有限,醫療需求隨國內人口平均餘命提升而增加,醫療資源優先配置的問題更顯其重要性。本研究建立一個合理的醫療資源優先配置決策程序評估架構,以改善目前國內資源優先配置決策程序,使用Daniels & Sabin(1997)所提出的「要求合理性的課則」(Accountability for Reasonableness)作為評估架構的主要構面,採用文獻分析法與層級分析法建構出一個完整的評估架構並且比較指標間的相互權重,接著使用深度訪談法試圖探索評估指標相對權重背後所代表的意涵。研究結果顯示醫事團體代表強調相關性與決策修正機會,政府代表則注重公開性與執行力,兩者對於醫療資源優先配置決策程序的期待有相當大的落差。基於研究發現,本研究主張應該增加協商機會以減少決策成員間的認知落差,帶動社會大眾對於資源優先配置的認識與參與,並針對目前決策程序的公開性、相關性、決策修正機會與執行力進行改善。zh_TW
dc.description.abstract (摘要) The lack of information publicity and participation in the payment system of National Health Insurance (NHI) in Taiwan has been a critical issue. Besides numerous insurance payment disputations, the limited health resources and increasing health demand all call for an immediate solution to the problem of health resource priority setting in NHI.. This study aims to establish a systemic evaluative framework to improve on the health resources priority settings. In answer to the need, analytical hierarchy process and in-depth interviews have been conducted to develop a framework based on Accountability for Reasonableness. Qualitative and quantitative analysis of the surveys indicate some criteria and the meaning of the relative weight of each criterion. The results show a discrepancy between the governmental representatives and the healthcare organization ones on the expectation of health resources priority settings. The former focus on relevance, revision and appeals while the latter emphasize publicity and enforcement. According to the findings, this study suggests that an increase of negotiation is necessary to eliminate the discrepancy between the two groups. The government also need to introduce the public the idea of health resources priority settings and to modify the current procedure based on the four factors in Accountability for Reasonableness.en_US
dc.description.tableofcontents 第壹章 緒論 1
第一節 研究背景 1
第二節 研究動機與目的 2
第三節 研究問題 5
第四節 研究範圍 6
第貳章 文獻回顧 14
第一節 資源優先配置之相關研究 14
第二節 決策制定與評估研究 31
第三節 醫療資源優先配置決策程序評估架構 45
第四節 小結 58
第參章 研究設計 60
第一節 研究方法的選擇與說明 60
第二節 層級分析法的應用 62
第三節 深度訪談法的應用 77
第肆章 評估指標之權重分析 79
第一節 全體專家層級分析結果 79
第二節 醫事服務團體代表層級分析結果 84
第三節 政府代表層級分析結果 89
第四節 各群組層級分析結果綜合比較 94
第伍章 結論 104
第一節 研究發現 104
第二節 研究建議 108
第三節 研究貢獻、限制與後續研究建議 113
參考文獻 116
附錄一:全民健康保險醫療給付協議會議設置要點 130
附錄二:TSSCI資料庫部份期刊名稱表 132
附錄三:檢索SSCI期刊名稱表 133
附錄四:醫療資源優先配置決策程序之評估架構問卷 134
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dc.language.iso en_US-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0095256022en_US
dc.subject (關鍵詞) 全民健保zh_TW
dc.subject (關鍵詞) 要求合理性的課則zh_TW
dc.subject (關鍵詞) 資源優先配置zh_TW
dc.subject (關鍵詞) 決策程序評估zh_TW
dc.subject (關鍵詞) 層級分析法zh_TW
dc.subject (關鍵詞) National Health Insuranceen_US
dc.subject (關鍵詞) accountability for reasonablenessen_US
dc.subject (關鍵詞) priority settingen_US
dc.subject (關鍵詞) analytical hierarchy processen_US
dc.title (題名) 醫療資源優先配置決策程序之評估-以全民健保醫療給付協議會議為例zh_TW
dc.title (題名) An Evaluation of Decision Procedure in Health Resource Priority Setting: The Payment Committee of NHI in Taiwanen_US
dc.type (資料類型) thesisen
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