全民健康保險自實施以來,醫療照護的可近性、費用支付制度、以及確保醫療品質等議題一直是備受討論的焦點。臺灣地區評估醫療品質的方法,除了定期舉辦的醫院評鑑,尚有醫療院所進行的各式醫療品質管理活動。近年關於醫療品質的研究大多著重在醫療品質指標選定以及測量,對於傷害處置的醫療品質管理方向則較少著墨。 受到健保與總額制度實施及國防部精實案的影響,國軍醫院不論在經營上或是長久以來的定位皆受到嚴厲的挑戰,因此,國軍醫院的主管單位必須注重醫院對傷害處置的醫療品質。醫療單位可區分為醫學中心、區域醫院、地區醫院及基層院所,而醫學中心為醫療照護層級之首,對下級醫療院所有帶頭作用,故瞭解國軍醫學中心對傷害處置的醫療品質至為重要。 因此,本研究主要重點在於探討臺灣地區國軍醫學中心與其他公私立醫學中心執行傷害處置的醫療品質現況,並進一步探討其醫療品質之差異,試提出促進傷害處置的醫療品質提昇之方案。 本研究使用2008年全民健康保險資料庫之醫事機構基本資料檔及住院醫療費用清單明細檔,選取事故傷害住院之病患為研究對象,並採用邏輯斯迴歸模式,以分析國軍醫學中心與公私立醫學中心對於事故傷害病患於住院期間的醫療品質之差異。
It has been focused on the issues of the accessibility, payment system, and ensuring to quality for health care since the National Health Insurance has been carried out . Besides holding the hospital evaluations regularly for medical quality evaluated in Taiwan, there are still a variety of activities on medical quality management. In recent years, many studies on the quality of medical care put much emphasis on the selection and the measurement of medical quality indicator but less attention on injurious disposal management, hence the main focus of this study is to discuss the military medical center in Taiwan and the other public and private medical centers conducted the injurious disposal of medical quality so that we can figure out the differences of the quality of medical care further. Here is the proposal of upgrading injurious disposal of medical quality. Owing to the health care system, the Global budget system and the Armed Forces Refining Program, military hospitals are facing the big challenge in business or position. Therefore, military hospitals should have to pay attention to the injurious disposal of medical quality. Medical units can be divided into medical centers, regional hospitals, district hospitals and clinics, and medical centers are the top level of medical units as well as the leadership to other lower level medical units. So, it’s quite important to understand the injurious disposal of medical quality for the military medical center.