影響醫院導入全民健保「電子化醫療影像專業審查系統」之相關因素

The Influential Factors to Hospital’s Implementation in Digitized Medical Image Claim System in National Health Insurance

陳蕾淇(Lei-Chi Chen)

指導教授 ： 溫信財

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00085

摘要

推動電子化行政作業是政府機關近年來積極進行的工作，中央健康保險局為確保醫療院所提供高品質的醫療服務，並避免不當的申報醫療費用，積極導入「電子化醫療影像專業審查系統」，並期望在管控醫療品質的同時，亦可有效提昇工作之效率。本研究主要目的為︰一、瞭解醫院對「電子化醫療影像專業審查系統」之使用意願及使用現況；二、探討影響醫院採用「電子化醫療影像專業審查系統」之因素；三、分析健保行政措施對於醫院採用「電子化醫療影像專業審查系統」之影響。
本研究為一橫斷性研究，研究對象為453家評鑑等級為地區醫院（含）級以上醫院，研究工具採自填式結構性問卷，問卷內容在經過效度及信度檢定後進行測試，調查期間為96年4月20日至96年6月15日，共計回收152份有效問卷，回收率33.55%。所得研究資料以描述性統計、t檢定、卡方檢定、相關分析及羅吉斯迴歸分析等統計方法進行分析，分析工具採用SPSS 12.0版統計套裝軟體，由分析結果得知：
民國94至96年間，醫院資訊化之發展多呈正向成長，包括資訊部門設置、資訊部門人員數、醫療影像儲傳系統（Picture Archiving and Communication System, PACS）設備採用等，共計有83家醫院（54.6%）擁有PACS，其中絕大多數醫院之PACS已與醫院資訊系統（Hospital Information System, HIS）整合；本研究回覆樣本中，有12家（85.7%）的醫學中心、30家（90.9%）區域醫院、15家（93.8%）地區教學醫院及51家（57.3%）地區醫院表示有意願導入「電子化醫療影像專業審查系統」。在實際採用方面，有15家（9.9%）將全部的專業審查案件透過該系統申請，有27家（17.8%）部份使用、22家（14.5%）正進行系統建置。
進一步分析發現，「醫院組織」因素（p < 0.05）會影響醫院「電子化醫療影像專業審查系統」導入意願，其中高階主管支持（p < 0.001）與使用者參與（p < 0.001）為重要變項，但「醫院組織」因素對於醫院是否實際採用審查系統，在統計上不具顯著意義。而「科技認知」因素會影響醫院「電子化醫療影像專業審查系統」之導入意願（p < 0.01），其中知覺有用性（p < 0.01）、易用相容性（p < 0.01）、成本負擔（p < 0.01）均為重要變項。可是「外在環境」因素對醫院的影響，不管在導入意願或實際採用，均無統計上的顯著意義，此結果與相關文獻研究不一致，究其原因，國內主管機關對「電子化醫療影像專業審查系統」導入之政策，在實質誘因不足下，醫院採用與否對健保收入並無顯著影響，進而減弱醫院採用之動機。
而值得注意的是，系統導入意願（Odds Radio = 6.475, p < 0.05）以及醫院有無PACS設備（Odds Radio = 14.695, p < 0.001），為醫院實際採用「電子化醫療影像專業審查系統」之顯著變項，此一結果值得中央健康保險局加以重視。

關鍵字

科技認知 ； 資訊科技採用 ； 電子化醫療影像專業審查系統 ； 醫院

並列摘要

The government has been actively promoting digitized administrative operation in recent years. In order to assure that the medical institutions provide high quality medical service, and to avoid improper claim of medical fees, The Bureau of National Health Insurance implements “Digitized Medical Image Claim System” actively, and the Bureau anticipates effective elevation in work efficiency while monitoring the quality in medical treatment. The major purposes of this research are as follows. 1. To understand the will and current status of hospital’s adoption in “Digitized Medical Image Claim System.” 2. To explore the influential factors to hospitals in adopting “Digitized Medical Image Claim System.” 3. To analyze the influence of administrative regulations of National Health Insurance on hospitals’ adopting “Digitized Medical Image Claim System.”
This research adopts cross-sectional approach. The research subjects are 453 contracted medical care institutions with the evaluated level as community hospital and above. The research tool is structured questionnaire. The questionnaire was put to test in the period of April 20, 2007 to June 15, 2007, after verifying validity and reliability. Total of 152 valid questionnaires were retrieved and the retrieval rate is 33.55%. The methods used to analyze data are descriptive statistics, T test, Chi-Square test, correlation analysis, and Logistic regression. The statistic software tool used for analysis is SPSS 12.0. Major research results are as follows.
Most of the development in hospital informationization, including the establishment of IT department, the staff number in IT department, and the adoption of Picture Archiving and Communication System, PACS, shows positive growth from 2005 to 2007. There are 83 hospitals possessing PACS in the rate of 54.6%. PACS has been integrated with Hospital Information System, HIS in most hospitals. There are 12 academic medical centers (85.7%), 30 metropolitan hospitals (90.9%), 15 community teaching hospitals (93.8%), and 51 community hospitals (57.3%) showing the will to implement “Digitized Medical Image Claim System.” In actual adoption, there are 15 hospitals (9.9%) applying all claim cases through this system, 27 hospitals (17.8%) adopting partially, and 22 hospitals (14.5%) under system installation.
For advanced analysis, the result shows that the factor “medical institution” (p<0.05) will affect the hospital’s will in implementing “Digitized Medical Image Claim System.” Top and middle management’s support (p<0.001) and the users’ participation (p<0.001) are crucial variables in this factor. However, there is no statistical significance regarding the factor “medical institution” in the hospital’s actual adoption of the system. The factor “technological cognition” (p<0.01) will affect the hospital’s will in implementing “Digitized Medical Image Claim System.” In this factor, perceived usefulness (p<0.01), ease-of-use compatibility (p<0.01), and cost (p<0.01) are crucial variables. However, there is no statistical significance regarding the influence of the factor “external environment” to the hospital, whether in the will to implement or in actual adoption. This result disagrees with related document researches. To explore the reasons, we find that due to lack of tangible incentive in the implementation policy for “Digitized Medical Image Claim System” from the authority, there is no significant affect on the hospital’s income from National Health Insurance, whether adopting the system or not. Therefore, it weakens the motive for hospitals to adopt.
What’s noticeable is that system implementation will (Odds radio=6.475, p < 0.05) and hospital possession of PACS facility (Odds Radio=14.695, , p < 0.001) are the significant variables to hospital’s actual adoption in “Digitized Medical Image Claim System.” This result is worthy of the attention from The Bureau of National Health Insurance.

並列關鍵字

Technological Cognition ； Information Systems Adoption ； Digitized Medical Image Claim System ； Hospitals

參考文獻

方鶯珍（2004）。從傳統X光底片運作迅速轉置到全院性醫療影像擷取傳輸系統之差異成本分析。碩士論文，國立臺灣大學醫療機構管理研究所，台北市。

洪新原、丁宏祈、黃心怡（2005）。影響醫院導入醫療網站之關鍵因素分析。醫療資訊雜誌，14（1），65-76。

洪新原、梁定澎、張嘉銘（2005）。科技接受模式之彙總研究。資訊管理學報，12（4 ），211-234。

黃興進、彭振興、連俊瑋（2001）。醫療單位採用醫學影像儲傳系統關鍵因素之研究—以臺中榮民總醫院為例。資訊管理學報，7（2），39-62。

羅萱（2005）。醫院引進及擴張新醫療科技之影響因素與結果。台灣衛誌，24（5），385-393。