從醫院管理角度論全民健保資料庫

The Application of National Health Insurance Database to Hospital Management

曾淑芬(Su-Feng Tseng)

《中華公共衛生雜誌》 18卷5期 (1999/10) Pp. 363-372

https://doi.org/10.6288/CJPH1999-18-05-10

摘要

背景說明與目標：我國全民健保制度的實施，對於醫院的經營管理，造成許多直接與間接的衝擊，尤其是在醫療成本控制與醫療品質管制等方面影響最大，醫院管理者除了要確實作好內部控制外，對於外在環境的變化與政府政策走向，更要瞭若指掌。隨著社會時代的變遷，「閉門造車」與「單打獨鬥」的醫院經營型態，已不合時宜了，因此，透過健保的行政作業系統，將各醫院的資料彙整建立後所形成的健保資料庫，對於醫院管理者而言，將能更快速便捷的掌握院際間的動態。資料來源：本文乃參考國家衛生研究院所召開的「全民健康保險學術研究資料庫開發與應用研討會」，將學術界對健保資料庫在學術研究可用性等方面的意見，加以整合後，從醫院管理的角度，來討論健保資料庫對醫院管理層面的應用。結論與建議：所謂「知己知彼，百戰百勝」，醫院管理者若欲充分利用健保資料庫，使其發揮最高效益，則必須要有如下幾個條件的配合：建立院內完整的資料庫、確立院內的管理重點與指標項目、院內明確的管理目標與策略、及管理者具備足夠的資料統計分析能力等，經由醫院對內部控制的努力與對外部資料的分析研判，將可強化醫院的管理系統。

關鍵字

健保資料庫 ； 醫院管理系統 ； 配合條件 ； 特性 ； 策略分析

並列摘要

Backgrounds and Objectives: The implement of National Health Insurance in Taiwan [beginning in 1995] has causesed a lot of direct and indirect impacts on hospital management, especially in the areas of cost and quality control related to medical care. In addition to well-conducted internal controls, a hospital supervisor must remain well-informed about a variety of external environments and government health policies. As the society changes, working behind closed doors and in a single-handed hospital management style have become obsolete. Therefore, a sound database of National Health Insurance is critical and valuable for hospital management. It can provide a hospital supervisor with quick and comprehensive information about various hospitals. Data Sources: In this paper, comments and suggestions concerning how to apply NHI Database to hospital management are made based on opinions expressed at ”The symposium of the NHI database Development and Application” held in Taipei on 12 April 1999. Conclusions and Suggestions: There is an old saying ”Know enemy and know yourself, and you will fight with no danger of defeat”. A hospital supervisor who wishes to take advantage of the NHI database system more efficiently will have to establish a sound, integrated hospital database with clear goals and strategies of management, and posses capabilities of data analysis. In brief, it is important for us to realize that hospital management system will be improved through efforts of internal control and research on external environments. In this regard, a sound NHI database can be a great assistance.

並列關鍵字

health insurance database ； hospital management system ； supporting condition ； characteristics ； strategy analysis