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題名:醫院獨立總額對醫師診療行為之影響:以國軍醫院為例
書刊名:醫務管理期刊
作者:洪世明錢慶文
作者(外文):Hung, Shih-mingChien, Ching-wen
出版日期:2010
卷期:11:4
頁次:頁265-279
主題關鍵詞:醫院卓越計畫醫師行為總額支付制度論量計酬制度Individual hospital budgetingPhysician behaviorGlobal budgetFee-for-service
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(1) 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:1
  • 共同引用共同引用:20
  • 點閱點閱:34
Objective: To explore whether individual hospital budgeting implemented by military hospitals had any influence on physicians' practice behavior. Methods: The study used a Nonequivalent Control Group Design and analyzed the 2003 to 2004 Taiwan National Health Insurance Research Database. We used military hospital physicians as our study subjects: 75 physicians who were involved in individual hospital budgeting (case group) and 40 physicians who were not (control group). Independent variables included the number of outpatient and inpatient visits, the expenditure for outpatient and inpatient visits, the number of outpatient and inpatient examinations, the expenditure for outpatient and inpatient examinations, the number of prescriptions days of outpatient visits and length of inpatient stays. Control variables included physicians' age and department, hospital level, primary care rate of outpatient and the severity of illness for each inpatient. We utilized Chi-Square tests, two sample t-tests, paired t tests, difference-in-difference (DID) and the general linear mixed model (GLMM) to conduct the analysis. Results: The GLMM results showed that the case group had an increase in total inpatient visits (β=28.6, p<0.05), total inpatient days (β=340.0, p<0.05) and total expenditure for inpatient examinations (β=24.4, p<0.05) after the implementation of individual hospital budgeting. Conclusions: After individual hospital budgeting was implemented, the inpatient practice behavior of military physicians changed as they increased the medical utilization of inpatient departments.
期刊論文
1.莊念慈、黃國哲、許怡欣、郭乃文、魏中仁(20040400)。醫院因應總額支付制度之策略方案及其相關因素探討。臺灣公共衛生雜誌,23(2),150-158。new window  延伸查詢new window
2.陳耀東(20040400)。全民健保不同支付制度對醫師執業行為之影響及比較。管理學報,21(2),237-255。new window  延伸查詢new window
3.陳欽賢、劉彩卿、林建仁、朱子斌、邱文達(20030900)。總額支付制度下醫院同儕行為之競合:賽局理論分析。醫務管理期刊,4(3),68-79。new window  延伸查詢new window
圖書
1.吳肖琪、李玉春(2004)。總額支付制度下建立基層與醫院門診分級醫療指標之研究。臺北:全民健康保險醫療費用協定委員會。  延伸查詢new window
其他
1.H Barnum, J Kuizin, H Saxenian(l995)。Incentives and provider payment methods。  new window
2.J Shen, R Andersen, R Brook, G Kominski, PS Albert, N Wenger(2004)。The effects of payment method on clinical decision- making: Physician responses to clinical scenarios。  new window
3.IH Monrad Aas(1995)。Incentives and financing methods。  new window
4.RG Frank, CA Jackson(1989)。The impact of prospectively set hospital budgets on psychiatric admission。  new window
5.C Huttin, J Andra(2000)。How the reimbursement system may influence physicians’ decisions results from focus groups interview in France。  new window
6.黃麗鈴(2005)。由賽局理論看醫院卓越計畫實施後對醫院財務及品質之影響-以高屏轄區區域級以上醫院為例。  延伸查詢new window
7.Aas IHM(1995)。Incentives and financing methods。  new window
8.朱菊新、李玉春、黃昱瞳、葉玲玲、黃光華(2007)。醫院卓越計畫對精神分裂症門診病患換藥行為之影響。  延伸查詢new window
9.江怡雯(2007)。醫院卓越計畫對醫院及醫師醫療行為影響-以精神醫療為例。  延伸查詢new window
10.謝雅竹、吳文娟、鄭雅愛、黃巧慧、蔣淨宜(2007)。健保局醫院卓越計畫對醫院醫療行為之影響-以南部某縣立醫院為例。  延伸查詢new window
11.江宏哲(2006)。醫院卓越計畫對醫療服務提供行為之影響。  延伸查詢new window
12.羅子評(2005)。全民健康保險實施「醫院卓越計畫」對醫療院所醫療行為之影響-以某醫學中心門診為例。  延伸查詢new window
13.蔡永裕(2007)。醫院卓越計畫介入後醫院之價量變動分析-以參加卓越計畫之地區醫院為例。  延伸查詢new window
14.陳素惠(2005)。醫院卓越計畫業門住診費用比例影響之研究:以中區分局為例。  延伸查詢new window
15.楊斯年(2005)。醫院卓越計畫實施前後處方型態分析:以某區域教學醫院精神科為例。  延伸查詢new window
16.陳容珍(2005)。醫院門診限量對急診、住院醫療品質之影響-以某公立醫學中心為例。  延伸查詢new window
17.T Gosden, F Forland, IS Knatiansen et al(2000)。Capitation, salary, fee-for-service and mixed systems of payment. Capitation, salary. fee-for-service and mixed systems of payment: effects on the behavior of primary care physicians。  new window
18.陳炫達(2005)。醫院在參與卓越計畫前後醫療費用變化之探討-以健保局中區分局為例。  延伸查詢new window
19.高森永、王運昌、葉壽山(2000)。國軍官兵對於加入全民健保後的就醫傾向調查分析。  延伸查詢new window
20.行政院衛生署中央健康保險局(20090801)。疾病分類代碼及範圍。  延伸查詢new window
21.JM Lewis, T Marjoribanks(2003)。The impact of financial constraints and incentives on professional autonomy。  new window
22.蕭郁琪(2008)。健保總額支付制度、醫院管理和醫病關係對主治醫師診療行為的影響。  延伸查詢new window
23.賴麗娜(2005)。醫院實施「卓越計劃」對主治醫師醫療行為、專業角色、工作生活品質之影響-以中部四縣市為例。  延伸查詢new window
24.林恆慶、陳楚杰(2003)。管理式醫療對醫師的影響-美國經驗。  延伸查詢new window
 
 
 
 
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