全民健康保險為台灣醫療體系中,相當重要的醫療制度。對於醫療品質偵測以及如何提升民眾接受的醫療品質成為近年來備受關注的重要議題。本研究透過檢驗民眾轉換醫院路徑、民眾就診之醫療院所行為以及民眾就醫院所層級合理性,提出如何偵測醫療品質的研究架構。 本研究對於醫療品質議題從民眾就診的轉移行為切入,並使用國家衛生研究院提供之全民健康保險研究資料庫中的門診處方與治療明細檔。本研究藉由民眾因為相同疾病前往不同醫療院所的轉移行為建置網絡,透過不同天數轉移情況下利用社會網絡分析觀察哪些醫療院所會是民眾轉移程度密集的關鍵醫療院所,並藉由C5.0分析關鍵醫療院所的民眾就醫層級合理程度,以及K-Means分析關鍵醫療院所在不同天數轉移情況下是否具有相似的醫療行為。最後,從本研究結果發現若要提升醫療品質可從民眾轉換醫療院所路徑中的關鍵醫療院所著手。
National health insurance (NHI) is an important healthcare policy of medical system in Taiwan. How to detect and improve healthcare quality has become a public issue. This research will construct a structure for detecting healthcare quality by analyzing people who transfer from one hospital to another, diagnosing outpatients’ behavior and rationality of it. This research will study the outpatient transfer behavior for the medical quality issue and use the Ambulatory Care Expenditures by Visits data from National Health Insurance Research Database provided by National Health Research Institutes. This re-search will construct the network conducted form outpatient who transfer form one hos-pital to another for the same disease. This research found that some hospital would be the key-hospital has the most density transfer degree in different time interval by Social Network Analysis, analyzed the rationality of outpatients’ behavior of key-hospital by C5.0, and analyzed the medical treatment of key-hospital in different time interval by K-Means. In conclusion, this research found that if we want to improve healthcare qual-ity it could start from key-hospital in outpatient transfer behavior.