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  • 學位論文

全民健康保險支付制度下牙醫診所水平整合 趨勢之探討

An Investigation on the Trend of Dental Clinics Horizontal Integration Executing under National Health Insurance Payment System

指導教授 : 陳平舜

摘要


企業為了提升自身的競爭優勢,開始與其他企業、供應商或客戶進行協同。隨著網際網路的發展,逐漸演變成協同商務的時代。協同商務可分為垂直整合及水平整合,但根據過去文獻,水平整合的文獻不多,而醫療產業更少見。隨著1995年全民健保開始實施,牙醫醫療採用論量計酬制度,但健保局為避免財務虧損,牙醫醫療於1998年則改採總額支付制度。我國醫療費用與日俱增,如何使用水平整合概念來有效利用醫療資源是一個關鍵及具有挑戰性的研究議題,所以本研究針對醫療產業中水平整合的現象作研究。 本研究旨在探討健保支付制度下牙醫診所水平整合趨勢,且深入了解背後驅動牙醫診所水平整合的原因。由於健保支付制度分為許多種類,本研究僅探討最常見的論量計酬制度與總額支付制度,並結合牙醫職業分類,研究方法則使用Arena軟體模擬六種模式,研究對象為個人牙醫診所及聯合牙醫診所。 研究結果顯示聯合牙醫診所利潤比個人牙醫診所多,但聯合牙醫診所利潤需分擔給所有的牙醫師,因此以牙醫師而言,在個人牙醫診所從事醫療服務薪水較高。然而聯合牙醫診所有輪休排班機制,可提升牙醫師的生活品質,且聯合牙醫診所有師徒制,可提升執業年限較資淺牙醫師的專業水準,所以牙醫師得針對各自需求選擇個人牙醫診所或聯合牙醫診所從事醫療服務。如此一來,未來此兩種類型的牙醫診所依然存在。總結而言,本研究希望能提供執業年限較資淺牙醫師、聯合牙醫診所中的牙醫師和執業年限較資深牙醫師選擇是否開始加入或繼續加入聯合牙醫診所的相關建議。

並列摘要


Enterprises begin to work in coordination with other companies, suppliers and customers in order to increase the companies’ competency. With the Internet development, the business model of enterprises becomes the collaborative commerce age. The collaborative commerce can be divided into the vertical integration and the horizontal integration. However, few studies have been studied in the area of the horizontal integration, especially in the medical horizontal integration. The national health insurance payment system started in 1995. At that time, the dental insurance payment system was adopted with the fee for service payment. To avoid the financial deficit, the Bureau of National Health Insurance transferred the dental insurance payment system from the fee for service payment system to the global budget system in 1998. As the medical expenses increase annually, how to apply the horizontal integration to utilize the medical resources efficiently becomes a critical and challenging issue. Hence, this research considers the medical horizontal integration as a case study. The objective of this research is to explore the trend of the horizontal integration of dental clinics, and discuss the reasons of the medical horizontal integration. This study focuses mainly on the most commonly insurance payment systems which are the fee for service payment and global budget system. This study adopts the Arena software to simulate six models, the subjects of which include individual dental clinics and group dental clinics. The results of this research show that profits of group dental clinics are more than those of individual dental clinics, but the individual dentist’s income of group dental clinics is less than that of individual dental clinics. However, there is a take-turn system for dentists in the group dental clinics, and this can promote a dentist to have a better life quality. Moreover, the group dental clinics have complete training programs for novice dentists to increase their professional skills. Dentists may, therefore, choose to serve in an individual dental clinic or a group clinic depending on their needs. Overall, the findings of this research show that two types of dental clinics will still exist in future which is consistent with simulation results. Furthermore, this research also provides useful suggestions for novice dentists, dentists in a group clinics and senior dentists if they can join or keep working in the group dental clinics or not.

參考文獻


[26] 李志宏、施肇榮 (2008):全民健康保險解讀系列9:總額支付制度,台灣醫界 51(11),480-486。
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[32] 黃旭明,全民健保制度與醫療院所經營關聯之研究─以病人為中心之多贏策略,國立台灣大學高階公共管理組碩士論文,2006。
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被引用紀錄


楊淳懿(2011)。運用系統模擬探討醫院協同環境之轉院機制〔碩士論文,中原大學〕。華藝線上圖書館。https://doi.org/10.6840%2fcycu201100253

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