全民健保下私立小型醫院困境與策略-
發展以醫院為基礎的護理之家可行性研究

余政經

doi:10.6342/NTU.2006.00818

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全民健保下私立小型醫院困境與策略- 發展以醫院為基礎的護理之家可行性研究

The Difficulties and Strategies of Private District Hospitals under National Health Insurance System—the Feasibility of Developing Hospital-Based Nursing Homes

余政經 , Masters　　Advisor：薛亞聖　　

繁體中文 DOI： 10.6342/NTU.2006.00818

地區醫院；亞急性照護；護理之家；長期照護； SWOT分析；健康保險；策略； district hospital ； sub-acute care ； nursing home ； long-term care ； SWOT analysis ； health insurance ； strategy

Abstract │ Reference (107) │ Times Cited (8) │ Altmetrics

Abstract 〈TOP〉

Parallel Abstract 〈TOP〉

Objective
The objectives of this study are to understand: (1) the characteristics of the district hospitals; (2) the management problems that district hospitals are facing currently; (3) the feasibility of developing hospital-based nursing home (4) the SWOT analysis of hospital-based nursing home (5) the key factors that have helped district hospitals transformed into nursing homes.

Method
This study has adopted in-depth interview of qualitative research in 2005 on three individuals who were CEO of district hospitals to discuss the management problems that the district hospitals are facing currently and whether the establishment of nursing home can be the solution. Subsequently, interview with two former health officers are supplemented to address the dilemma faced by district hospitals and broader viewpoints on the establishment of nursing home.

Significant findings & conclusion 
The major dilemma faced by district hospitals: the difficulties of recruitment, the decreasing source of income from inpatients, the inadequacy of competitive advantages, the tightening of health insurance subsidy and the rigidity of evaluation standard. The strategies of district hospitals: the strategic alliance, the joint venture, the hospital-based nursing home, the joint outpatient service and collective purchase. The SWOT analysis for hospital- based nursing home: (1) Strengths (S) – the better hardware equipments, the outstanding emergent nursing quality, the flexible human resource allocation, the abundant medical resources and the professional nursing staff; (2) Weaknesses (W) – more medical disputes, worse atmosphere in hospitals, high turnover rate of nursing staff and higher charges; (3) Opportunities (O) – the increasing needs for sub-acute care, the rising medical treatment of chronic illness for elderly, the ageing needs and the social needs; (4) Threats (T) – keen competition in prices and demand for improving quality.

Suggestions
Policy and management: (1) The government should establish sub-acute care system and assist small-scaled hospitals to develop hospital-based nursing home, converting them into sub-acute care institutions, as well as consolidating their concepts of long-term care and reduce the minimum number of bed for acute illness from 20 to 10. (2) The Bureau of National Health Insurance should subsidize sub-acute care. (3) The district hospitals should improve their management quality to ward sub-acute residents from large-scaled hospitals to independent nursing home. Future study: (1) Conduct more interviews in district hospitals, large scale hospitals and independent nursing homes in the Northern cities or other cities in Taiwan to get a better understanding of whether there are cultural differences between the Northern cities and Southern cities, as well as participation and interaction among all levels of health care organizations; (2) investigate the number of potential sub-acute patients and using the results as references for assisting district hospitals to develop sub-acute care institution.

Reference ( 107 ) 〈TOP〉

2.劉容華、江東亮（2001）•台灣小型醫院新設與歇業之影響•台灣公共衛生雜誌，20（1），27-33。
連結：
4.謝琇蓮、江東亮（1994）•台灣地區醫院歇業及新設之決定因素•中華民國公共衛生雜誌，13（6），453-457。
連結：
5.陳純慈（2004）•台灣健保實施後地區醫院經營策略與績效探討•高雄醫學大學公共衛生研究所醫務管理碩士在職專班碩士論文。
連結：
6.張彩秀（1997）•中部某區域醫院慢性病病人選擇長期照護方式之評估研究•弘光學報，30，1-12。
連結：
10.邱文達、朱子斌、陳欽賢、劉彩卿（2001）•兩岸醫療保險制度變革的比較與剖析•醫務管理期刊，2（3），1-26。
連結：

Times Cited (8) 〈TOP〉

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