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| Title: | 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 |
| Authors: | 邱倫瑋
Chiou, Lun-Wei |
| Contributors: | 宋皇志
Sung, Huang-Chih
邱倫瑋
Chiou, Lun-Wei |
| Keywords: | 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 |
| Date: | 2022 |
| Issue Date: | 2023-03-09 18:20:05 (UTC+8) |
| Abstract: | 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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| Description: | 碩士
國立政治大學
經營管理碩士學程(EMBA)
109932162 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0109932162 |
| Data Type: | thesis |
| Appears in Collections: | [經營管理碩士學程EMBA] 學位論文
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