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題名:組織理論與醫院DRGs因應準備作業
書刊名:健康保險雜誌
作者:陳建立黃瑞典
作者(外文):Chen, Chien-liHuang, Ruey-dean
出版日期:2006
卷期:2:2
頁次:頁1-13
主題關鍵詞:診斷關聯群支付制度代理理論正當性同形化Diagnosis related groupsPayment systemAgent theoryLegitimacyIsomorphism
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(0) 博士論文(1) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:0
  • 共同引用共同引用:19
  • 點閱點閱:32
93年11月健保局公告第二版診斷關聯群(DRGs; Diagnosis Related Groups)的分類架構,總共區分為9676組,供醫界模擬使用並提出修訂意見,準備導入作為支付制度之一,預期將會對醫界造成重大影響。支付制度的修訂在於提供不同的誘因機制,藉由移轉風險,課以醫療服務提供者之財務責任,改變醫療行為,減少過當的醫療服務。誘因的設計除了提供酬償之外,也隱含著控制機制,從論量計酬改變為論病例計酬,試圖從結果導向調整為行為導向,其中的機制是本文探討的課題之一。再者,強制的保險體制,使得保險人具有獨斷的權力,可以輕易的將不同的制度遂其所願的實行。醫療服務提供者必須配合醫療環境的改變,調整其組織結構與組織實務,這是情境觀點的組織與環境配適;此外,醫療服務提供者為獲取所需資源以求生存,須先取得正當性,也就是獲得制度環境的認同,經由同形化使得組織實務越來越相像,以適應不同的環境壓力。最後,本文提出某醫院準備DRGs/PPS之相關實務,以供醫界參考。
Bureau of National Health Insurance announced the second edition of the framework for categorizing Diagnosis Related Groups in Nov. 2004 which is expected to have great impact on the medical industry. With 976 categories, this framework is to invite opinions from the medical industry before its official inclusion in the payment system. The purpose to amend the payment system is to provide different incentive mechanism which shifts the risk from the insurance company to the medical service providers by making the latter be responsible for financial duties, changing medical practices and reducing inadequate medical services. In addition to reimbursement, the design of the incentive mechanism implicitly includes measures for control, i.e. a direction towards behavior-based rather than outcome-based payment system. We intend to explore how this mechanism operates. Furthermore, the insurance company is empowered with direction to do what is most beneficial for them since it is obligatory to join the insurance system. Based on the contingency perspective, medical service providers should adapt to the changing medical environment and adjust their organizational structure and practices for the fitness between organization and environment. Furthermore, medical service providers should gain the institutional legitimacy to acquire the resources for survival. By mimicking the organizational practices with each other, the medical service providers would be able to adapt to different environmental pressure. At the end, we present the related practices for preparing DRGs/PPS of a hospital for your reference.
期刊論文
1.Hornbrook, M. C.(1985)。Techniques for Assessing Hospital Case Mix。Annual Review of Public Health,6,295-322。  new window
2.Hennart, Jean-Francois(1993)。Explaining the swollen middle。Organization Science,4(4),529-547。  new window
3.Trinh, H. Q.、Begun, T. W.(1988)。Hospital Response to the Implementation of Prospective Payment。Health Service Management Review,11(3),163-173。  new window
4.韓揆(20010800)。互斥、非互斥?診斷組合(DRGs)分類結構之辨。臺灣公共衛生雜誌,20(4),259-264。new window  延伸查詢new window
5.韓揆(20050300)。診斷組合制在臺推行問題(上)--DRGs之支付精神,支付邏輯及侷限。醫務管理期刊,6(1),1-19。new window  延伸查詢new window
6.DiMaggio, Paul J.、Powell, Walter W.(1983)。The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields。American Sociological Review,48(2),147-160。  new window
7.Lawrence, Paul R.、Lorsch, Jay W.(1967)。Differentiation and Integration in Complex Organizations。Administrative Science Quarterly,12(1),1-47。  new window
8.韓揆(20050300)。診斷組合在臺推行問題(下)--論病例計酬及實施準備。醫務管理期刊,6(1),20-36。new window  延伸查詢new window
9.Eisenhardt, Kathleen M.(1989)。Agency Theory: An Assessment and Review。The Academy of Management Review,14(1),57-74。  new window
10.Jensen, Michael C.、Meckling, William H.(1976)。Theory of the firm: Managerial behavior, agency costs and ownership structure。Journal of Financial Economics,3(4),305-360。  new window
研究報告
1.韓揆(1986)。DRG償付制度與住院醫療費用相關性研究報告。  延伸查詢new window
圖書
1.Scott, Wood Richard(1998)。Organizations: Rational, Natural, and Open Systems。Prentice Hall。  new window
2.Rumelt, R. P.、Schendel, D. E.、Teece, D. J.(1994)。Fundamental Issues in Strategy: A research Agenda。Harvard Business School Press。  new window
3.Chandler, Alfred D. Jr.(1962)。Strategy and Structure: Chapters in the History of the American Industrial Enterprise。MIT Press。  new window
4.Pfeffer, Jeffrey、Salancik, Gerald Richard(1978)。The external control of organizations: A resource dependence perspective。Harper & Row。  new window
圖書論文
1.Lewin, A. Y.、Volberda, H. W.(2003)。The future of organization studies: Beyond the selection-Adaptation debate。The Oxford Handbook of Organization Theory: Meta-theoretical Perspectives。NY:Oxford University Press。  new window
2.Thompson, J. D.(1987)。Organizations in action。Classics in Organization and Management。The Dorsey Press。  new window
3.Arrow, K. J.(1985)。The Economics of Agency。Principals and Agents: The Structure of Business。Boston, MA:Cambridge, MA:Harvard Business School Press。  new window
 
 
 
 
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