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  • 學位論文

行政院退輔會醫療體系整合之研究-以台中榮總嘉義分院暨灣橋分院整合案為例

A study on the integration of Veterans Affairs Commission’s health care system Taking example of Taichung Veterans General Hospital’s integration in Chia-Yi Branch and Wanqiao Branch

指導教授 : 李佩珊
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摘要


摘要 退輔會為落實政府醫療政策、共享醫療資源、因應醫療市場激烈競爭、健 保制度變革、公務預算刪減、病患就醫呈 M 型及提昇醫療品質,於民國九十七 年頒布「榮民醫療體系經營整合作業規範」,指定台北、台中、高雄三所榮民 總醫院負責規劃垂直整合區域榮民醫院,以資源共享、提升榮民醫院營運績 效、醫療品質、服務品質及具有競爭力為目標。 本研究以台中榮總垂直整合嘉義分院暨灣橋分院為案例,以收集「質化」 及「量化」資料,採個案分析法、文獻分析法及深度訪談法,探討該案例之整 合策略是否確實達到醫療資源共享、提升競爭力、提升服務品質,解決健保制 度束縛、公務預算縮減、醫院內部問題、經營困境及民眾需求等。經研究分析, 本文發現嘉義分院與灣橋分院透過水平與垂直整合模式、科特變革步驟及科層 組織理論的行政運作,確實達到預期目標。另從深度訪談中發現,主管、醫師、 病患及大多數員工對整合案都持贊同看法,只有少數護理及行政人員持反對看 法,其主要原因在於缺乏溝通、害怕不確定的未來、害怕增加工作及工作分配 不均,因此隨著時間的調適與磨合,兩分院員工已逐漸融合在一起,且經過領 導者多次宣導與溝通,員工的抗拒已轉變為認同且發展為合作的共識。 就本研究分析,該整合案尚屬成功案例,值得退輔會醫療體系或其他醫療 機構未來整合之參考與借鏡。

並列摘要


ABSTRACT For carrying out government’s health care policy , sharing health care resources ; and in response to the intense competition of health care market , the change of health insurance institution, the reduce of public affairs budgets ,M-shape medical treatment , promoting health care quality. Veterans Affairs Commission, Executive Yuan promulgated the “Veterans Health Care System Operating-Integration Management Practice” in 2008 , assigned Taipei Veterans General Hospital , Taichung Veterans General Hospital and Kaohsiung Veterans General Hospital to be in charge of planning the vertical integration of local Veterans hospitals. As sharing resources, promoting veterans hospitals’ operation performance and health care quality, stronger competitive strength for the goals. This study took example of the Taichung Veterans General Hospital’s vertical integration in Chia-Yi Branch and Wanqiao Branch. Collecting the qualitative and quantitative data ; using case study research , literature analysis and in-depth interviews methods to investigate this integration for the accomplishment on sharing health care resource , promoting competitive strength and quality of service ; and resolving the constraints of health insurance system , internal problem of the veterans hospital , operating difficulties and populace’s requirements. Through the research and analysis , discovered that through the horizontal and vertical integration mode, Kotter’s change steps , the operation on bureaucratic organization theory , Chia-Yi Branch and Wanqiao Branch did achieve the excepting objectives. Form the in-depth interviews discovered that executive officers , doctors , patients and most of the employees positively agreed to the integration ; only few registered nurses and administrative staffs opposed to it . The major reasons for opposing were lacking of communication, the fear of uncertainty for the future and increasing workload, uneven work assignment. As time of the adaption and run-in, the staffs and employees of these two hospitals fused together. And after times of communictaion between the managers and employees, the resistance of integration had turned into agreement and developed as the consensus of cooperation. The analysis on this integration showed that it was still a successful case, deserving for Veterans Affairs Commission’s health care system and other medical institutions to consult and use as a reference.

參考文獻


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