醫學中心及區域醫院對勞工保險實施診療費用支付標準（甲）表因應策略之研究

Strategice of Medical Centers and Regional Hospitals in Response to New Labour Insurance Fee Schedule

王素真(Su-Chen Wang) ； 沈柏青(Pai-Ching Sheen) ； 葛應欽(Ying-Chin Ko)

《The Kaohsiung Journal of Medical Sciences》 9卷2期 (1993/02) Pp. 94-102

https://doi.org/10.6452/KJMS.199302.0094

摘要

本研究選取醫學中心、區域醫院共計51家（回收率92.73%）。研究其在勞工保險實施新制診療費用抜付標準表時所採行之因應策略。作者參考相關文獻後，以自行設計並經評估的問卷，採郵寄方式，請樣本醫院的院長或相關業務主管填答。
本研究將因應策略區分為機構層次（例如：參與醫院間聯合抗爭法規訂定的活動）、管理層次（例如：增加醫師參與醫院整體政策制訂的活動。立或擴充企劃部門）及支術層次（例如：加入醫院間醫療項目的聯合服務，如聯合檢驗、X光、藥局服務）等三類。
研究結果發現，私立醫院、或是評鑑層級愈高、規模愈大、投入行政人員數愈多的醫院，較常運用機構層次的因應策略，而對勞保門診、住院之醫療給付依賴呈度愈高的醫院，其所採行的策略較偏向於技術層次因應策略。

並列摘要

The purpose of this parper is to evaluate the medical centers and regional hospitals. Strategic response to the implementation of new labour insurance fee schedule. This survey selects fifty-one medical centers and regional hospitals, with the response rate of 92.73%. This questionnaire was developed and evaluated by the authors and mailed to the questionnaire reponse by hospital’s director or relative department director.
We have selected Shortell et al (1985) theory as the framework for evaluating and explaining hospital response to regulation environment (ex: change in the reimbursement system) at institutional-level response (ex: hospital association activity aimed at influencing regulation), managerial-level response (ex: increased physician participation in hospital-wide decision making; starting or expanding a planning department) and technical-level response (ex: shared clinical services such as lab., X-ray, pharmacy).
The result found that hospitals with the characteristics as non-public ownership, medical centers, bigger size, and more administrative staff are more inclined to adopt institutional-level response.
And a technical-level response occurs to hospital when market compatibility becomes more intense which leads to higher reimbursement resource dependency.

並列關鍵字

institutiohnal-level response ； managerial-level response ； technical-level response