全民健康保險醫療品質資訊公開網指標對實際提昇醫院醫療品質成效之研究

隨著民眾消費醫療服務自主意識逐漸抬頭，開始期待能了解各家醫療院所的醫療品質相關資訊和掌握內容代表的意義，故醫療品質公開透明化是二代健保的主要改革重點之一，希望能有利於民眾在就醫前後，依據醫療品質公開資訊，做為就醫的參考與選擇，改善醫療專業與民眾間醫療資訊不對等的現象。　　本研究利用全民健康保險醫療品質資訊公開網指標探討醫院的經營效率及醫療品質效率的影響。透過資料包絡分析法和效率差異檢定進行三階段分析：一、分析全部樣本醫院的整體經營效率；二、不同時期醫院醫療品質效率的差異；三、不同健保特約類別醫院在不同時期，醫療品質效率的差異。最後再利用差額變數分析探討相較無效率之醫院可改善的投入資源項目。　　本研究結果發現如下：(一)醫院執行全民健康保險醫療品質資訊公開網指標變數後，整體經營效率顯著提升。(二)醫院隨著執行全民健康保險醫療品質資訊公開網指標時間的遞延，對醫療品質有正向改善的影響。(三)醫學中心在各時期的整體平均醫療品質效率皆高於區域醫院與地區醫院。(四)相較無效率之醫學中心以醫師人數可改善的幅度最大、其他醫事人數最小；相較無效率之區域醫院以其他醫事人員數可改善幅度增加、病床數減少；相較無效率之地區醫院以病床數可改善幅度較大、醫師人數可改善幅度轉為最小。

關鍵字

全民健康保險醫療品質資訊公開網；醫療品質；醫療品質指標；資料包絡分析法

並列摘要

According to health care self-consciousness of the public gradually raise, we are looking forward to understand the information and the meanings of medical quality. One of important innovating issue on second generation Natioanl Health Insurance is health care quality information disclosure. These reference materials become one of standards taking medical treatment in terms of the general public. In order to knowing the impact of health care quality performance disclosure in Taiwan hospitals, we use National Health Insurance quality indicator that choosing common disease indicators. By using data envelopment analysis and Kruskall-Wallis test, we conducted to analysis the impact of National Health Insurance quality indicator in operational efficiency, three stages quality efficiency and different contracted category hospitals in Taiwan. Moreover, less efficient hospitals choose slack varaiable analysis to explore that which the inputs varaible need to improve. We cocluded that all sample hospitals have rasied the operational efficiency and have a positive impact on improving health care quality in different time stages with the implement ing of NHI quality indicators. In every stage, medical centers have better medical quality efficiency than regional hospitals and district hospitals.In addition to those conclusions, we also discover that less efficient medical centers need to mend doctor numbers, less efficient regional hospitals need to improve medical personnel numbers and less district hospitals need to modify the numbers of hospital beds. Ultimately NHI quality indicators have positive impact of improving health care quality performances in Taiwan hospitals.