政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/143754

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/143754

English | 正體中文 | 简体中文 | Post-Print筆數 : 27 | 全文笔数/总笔数 : 113311/144292 (79%)
造访人次 : 50939722 在线人数 : 925

RC Version 6.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.

搜寻范围

查询小技巧：

您可在西文检索词汇前后加上"双引号"，以获取较精准的检索结果

若欲以作者姓名搜寻，建议至进阶搜寻限定作者字段，可获得较完整数据

进阶搜寻

主页 ‧ 登入 ‧ 上传 ‧ 说明 ‧ 关于政大典藏 ‧ 管理

到手机版

政大機構典藏 > 商學院 > 經營管理碩士學程EMBA > 學位論文 > Item 140.119/143754

请使用永久网址来引用或连结此文件: https://nccur.lib.nccu.edu.tw/handle/140.119/143754

题名:	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
贡献者:	宋皇志 Sung, Huang-Chih 邱倫瑋 Chiou, Lun-Wei
关键词:	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
上传时间:	2023-03-09 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.
參考文獻:	中文：書籍 Porter M. E. & Teisberg E. O., 李振昌、羅耀宗譯 (2014)。醫療革命：善用競爭策略，創造醫病雙贏的療護體制（Redefining health care: creating value-based competition on results）。台北市：遠見天下文化王文科、王智弘 (1995)。教育研究法。台北市：五南圖書出版股份有限公司司徒達賢（2005）。策略管理新論—觀念架構與分析方法。台北市：智勝文化事業有限公司期刊論文王實之，劉嘉仁，吳怡伶，趙康邑，黃遵誠，黃勝堅，(2017)。推動高價值醫療之策略的國際發展與北市聯醫的經驗。北市醫學雜誌 2017；14(SP)：1-16。https://doi.org/10.6200/TCMJ.2017.14.SP.01 李俊秀，李光申，黃勝堅，郭麗琳，(2017)。醫療費用支付制度趨勢—論量計酬轉變為以價值為支付基礎。北市醫學雜誌 2017；14(SP)：50-58。https://doi.org/10.6200/TCMJ.2017.14.sp.05 李政益，江亭誼，羅秀雲，莊人祥，吳怡君，楊祥麟，(2012)。台灣健保論質計酬支付制度之發展—以結核病為例。疫情報導 2012；28(19)：311-326。上網日期：2022年04月20日，檢自：https://www.cdc.gov.tw/File/Get/D6B-SUXzbL1EFnNOe5m-BQ 陳宗泰，鍾國彪，賴美淑，(2007)。另一種流行趨勢—論成效計酬的趨勢與展望。台灣公共衛生雜誌 2007；26(5)：353-370。https://doi.org/10.6288/TJPH2007-26-05-02 謝鈺婷，管中閔，蔡蕙安，謝鈺偉，(2010)。評估健保制度中肺結核的論質計酬專案。人文及社會科學集刊 2010；22(4)：485-519。https://doi.org/10.6350/JSSP.201012.0485 周思源，林哲鈺，張金堅，林高德，(2015)。全民健保「論人計酬試辦計畫」執行經驗與省思。台灣醫界2015；58(10)：43-49 博碩士學位論文鄭集鴻（2010）。時間導向作業基礎成本制度之應用—以血液透析中心為例。國立台灣大學管理學院高階公共管理組碩士論文，未出版。網際網路【大紀元2016年02月02日訊】（中央社台北2日電）. (2016). 搞懂DRGs 懶人包看這裡. 上網日期2022年04月22日，檢自：https://www.epochtimes.com/b5/16/2/2/n4631628.htm 行政院衛生署全民健康保險醫療品質委員會. (2007). 配合二代健保之論質計酬. 上網日期2022年04月12日，檢自：https://service.mohw.gov.tw/MOHW_Upload/dmc_history/UpFile/Period27/配合二代健保之論質計酬.pdf 吳明彥. (2022). 健保總額浮動點值，隱藏醫療危機. 上網日期2022年09月03日，檢自：https://health.udn.com/health/story/7421/6229299?from=udn-relatednews_ch1005 李青縈、譚淑珍、呂雪彗. (2022). 新任衛福部長薛瑞元：健保改革修法打開6%天花板. 上網日期2022年09月03日，檢自：https://wantrich.chinatimes.com/news/20220829900025-420101 沈能元、陳雨鑫、許政榆、李樹人、魏忻忻. (2022). 薛瑞元：健保部分負擔新制今年一定會上路. 上網日期2022年09月03日，檢自：https://udn.com/news/story/122995/6535706?utm_source=lineapi&utm_medium=share 林思宇. (2015). 找回核心價值：為病人追求最大利益. 上網日期2022年09月03日，檢自：https://www.gvm.com.tw/article/20256 哈佛商業評論. (2011). 為醫界把脈. 上網日期2022年04月14日，檢自：https://www.hbrtaiwan.com/article/11770/how-to-solve-the-cost-crisis-in-health-care 姚景星、劉睦雄. (2002). 賽局淺說. 上網日期2022年10月15日，檢自：http://episte.math.ntu.edu.tw/articles/mm/mm_01_3_05/index.html 健保資料站. 健保署英文專書讀書會. 上網日期2022年09月17日，檢自：https://www.nhi.gov.tw/Content_List.aspx?n=CC1DE5219CBB0D38&topn=23C660CAACAA159D 健保資料站. 讀書趣專區. 上網日期2022年09月17日，檢自：https://www.nhi.gov.tw/Content_List.aspx?n=DE3E9679E433CB75&topn=23C660CAACAA159D 商業週刊1067期. (2008). 超推薦百大良醫. 上網日期2022年09月06日，檢自：https://www.businessweekly.com.tw/Archive/MagindexContent?issueNumber=1067 張思遠. (2014). 【探索12】現代醫院的起源與發展. 上網日期2022年04月20日，檢自：https://case.ntu.edu.tw/blog/?p=19659 張曉卉. (2007). 創造醫療價值，從「以病人為中心」做起. 上網日期2022年09月03日，檢自：https://www.commonhealth.com.tw/article/63426 張瓊方. (2002). 健保雙漲：開源之際，更要節流. 上網日期2022年09月03日，檢自：https://www.taiwanpanorama.com.tw/Articles/Details?Guid=abe5640a-c1b1-49cf-9cff-55124649e6b7 衛生福利部. (2020). 投資健康，110年健保費率調整為5.17%. 上網日期2022年09月03日，檢自：https://www.mohw.gov.tw/cp-4624-57420-1.html 衛生福利部中央健康保險署. (2009). 2009全民健康保險簡介. 上網日期2022年08月27日，檢自：https://www.nhi.gov.tw/Nhi_E-LibraryPubWeb/Periodical/P_Detail.aspx?CPT_TypeID=8&CP_ID=167 衛生福利部中央健康保險署. (2021). 2005-2018年醫院別器官移植術後存活率資訊公開(110.05.11新增). 上網日期2022年09月06日，檢自：https://www.nhi.gov.tw/Content_List.aspx?n=E1D93FD9DB52AD1F&topn=23C660CAACAA159D 衛生福利部中央健康保險署. (2021). 2021-2022全民健康保險年報. 上網日期2022年04月20日，檢自：https://www.nhi.gov.tw/Nhi_E-LibraryPubWeb/Periodical/P_Detail.aspx?CPT_TypeID=8&CP_ID=233 衛生福利部統計處. (2022). 中華民國109年國民醫療保健支出. 上網日期2022年09月06日，檢自：https://dep.mohw.gov.tw/DOS/lp-5071-113.html 衛生福利部統計處. (2022). 世界抗癌日衛生福利統計通報. 上網日期2022年09月05日，檢自：https://dep.mohw.gov.tw/dos/cp-5112-63000-113.html 鄭閔聲. (2020). 解方》「論質支付」減少無效醫療與浪費　以醫療結果作支付依據存活率愈高醫院收入愈好. 上網日期2022年04月22日，檢自https://www.businesstoday.com.tw/article/category/183021/post/202010070018/ 英文：書籍部分 Gosling, G. C., (2017). Payment and philanthropy in British healthcare, 1918-48, UK: Manchester: Manchester University Press Porter, M. E. & Teisberg E. O. (2006). Redefining health care: creating value-based competition on results. Boston, MA. Harvard business school press Yin, R. K., (1994). Case study research: design and methods. Thousand Oaks, CA. Sage publications 期刊 da Silva Etges A. P. B., Cruz L. N., Notti R. K., Neyeloff J. L., Schlatter R. P., Astigarraga C. C., Falavigna M., Polanczyk C. A., (2019). An 8-step framework for implementing time-driven activity-based costing in healthcare studies. Eur J Health Econ., 2019 Nov;20(8):1133-45, https://doi.org/10.1007/s10198-019-01085-8 Donovan C. J., Hopkins M., Kimmel B. M., Koberna S., Montie C. A., (2014). How Cleveland Clinic used TDABC to improve value. Healthc Financ Manage., 2014 Jun;68(6):84-8. PMID: 24968630 Eisenhardt K. M., (1989). Building theories from case study research. Academy of Management Review, 1989 Oct;14(4):532-50. https://doi.org/10.2307/258557 Fayanju O. M., Mayo T. L., Spinks T. E., Lee S., Barcenas C. H., Smith B. D., Giordana S. H., Hwang R. F., Ehlers R. A., Selber J. C., Walters R., Tripathy D., Hunt K. K., Buchholz T. A., Feeley T. W., Kuerer H. M., (2016). Value-based breast cancer care: a multidisciplinary approach for defining patient-centered outcomes, Ann Surg Oncol., 2016 Aug;23(8):2385-90, https://doi.org/10.1245/s10434-016-5184-5 Kline R. M., (2020). Bundled payment models in oncology: learning to think in new ways, JCO Oncol Pract., 2021 Apr;17(4):169-72, https://doi.org/10.1200/OP.20.00735 Martin J. A., Mayhew C. R., Morris A. J., Bader A. M., Tsai M. H., Urman R. D., (2018). Using time-driven activity-based costing as a key component of the value platform: a pilot analysis of colonoscopy, aortic valve replacement and carpal tunnel release procedures. J Clin Med Res., 2018 Apr;10(4):314-20. https://doi.org/10.14740/jocmr3350w Porter M. E., (2010). What is value in health care? N Engl J Med., 23;363(26):2477-81. https://doi.org/10.1056/NEJMp1011024 Porter M. E., Teisberg E. O., (2007). How physicians can change the future of health care, JAMA, 2007 Mar;297(10):1103-11, https://doi.org/10.1001/jama.297.10.1103 Van Egdom L. S. E., Lagendijk M., van der Kemp M. H., van Dam J. H., Mureau M. A. M., Hazelzet J. A., Koppert L. B., (2019). Implementation of value based breast cancer care, Eur J Surg Oncol., 2019 Jul;45(7)1163-70, https://doi.org/10.1016/j.ejso.2019.01.007 Wang C. J., Cheng S. H., Wu J., Lin Y., Kao W., Lin C., Chen Y., Tsai S., Kao F., Huang A. T., (2016). Association of a bundled-payment program with cost and outcomes in full-cycle breast cancer care, JAMA Oncol., 2017 Mar;3(3):327-34, https://doi.org/10.1001/jamaoncol.2016.4549 Weisbrod B. A., Fiesler R. J., (1961). Hospitalization insurance and hospital utilization, The American Economic Review, 1961 Mar;51(1):126-32, https://www.jstor.org/stable/1818914 網際網路 Haas D. A., Helmers R. A., Rucci M., Brady M., Kaplan R. S., (2015). The Mayo Clinic Model for running a value-improvement program, retrieved August 21, 2022, from: https://hbr.org/2015/10/the-mayo-clinic-model-for-running-a-value-improvement-program Kaplan R. S., Porter M. E., (2011). The big idea: how to solve the cost crisis in health care, retrieved September 9, 2022, from: https://hbr.org/2011/09/how-to-solve-the-cost-crisis-in-health-care Minor D., Kimball, Justin Ford: Handbook of Texas Online, retrieved April 20, 2022, from: https://www.tshaonline.org/handbook/entries/kimball-justin-ford Pendleton R. C., (2018). We won’t get value-based health care until we agree on what “value” means, retrieved April 4, 2022, from https://hbr.org/2018/02/we-wont-get-value-based-health-care-until-we-agree-on-what-value-means Porter M. E., Baron J. F., Wang C. J., (2009). Koo Foundation Sun Yat-Sen Cancer Center: Breast cancer care in Taiwan, retrieved June 1, 2011, from https://store.hbr.org/product/koo-foundation-sun-yat-sen-cancer-center-breast-cancer-care-in-taiwan/710425?sku=710425-PDF-ENG Porter M. E., Lee T. H., (2013). The strategy that will fix health care, retrieved April 15, 2022 from: https://hbr.org/2013/10/the-strategy-that-will-fix-health-care Soberman M. S., (2018). Cancer as a model for value-based care, retrieved September 10, 2022, from: https://www.accc-cancer.org/docs/documents/oncology-issues/articles/2018/jf18/jf18-president.pdf?sfvrsn=75d28c8a_7 Teisberg E. O., Porter M. E., Brown G. B. (1994). Making competition in health care work, retrieved July 24, 2022, from: https://hbr.org/1994/07/making-competition-in-health-care-work The World Bank. (2022). Current health expenditure per capita (current US$), retrieved September 10, 2022, from: https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?end=2018&start=2000&view=chart
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
数据类型:	thesis
显示于类别:	[經營管理碩士學程EMBA] 學位論文

文件中的档案:

档案	描述	大小	格式	浏览次数
216201.pdf		7997Kb	Adobe PDF2	33	检视/开启

在政大典藏中所有的数据项都受到原著作权保护.

社群 sharing

著作權政策宣告 Copyright Announcement

1.本網站之數位內容為國立政治大學所收錄之機構典藏，無償提供學術研究與公眾教育等公益性使用，惟仍請適度，合理使用本網站之內容，以尊重著作權人之權益。商業上之利用，則請先取得著作權人之授權。
The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

2.本網站之製作，已盡力防止侵害著作權人之權益，如仍發現本網站之數位內容有侵害著作權人權益情事者，請權利人通知本網站維護人員(nccur@nccu.edu.tw)，維護人員將立即採取移除該數位著作等補救措施。
NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.

DSpace Software Copyright © 2002-2004 MIT & Hewlett-Packard / Enhanced by NTU Library IR team Copyright © - 回馈