The Study of Possible Cooperative Models between Clinics and Hospitals under the Global Budget System for Primary Health Care

• Main Author: 劉智綱
• Other Authors: Ming-Chin Yang
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/52484204048865859950

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 90 === The global budget system has been came into effect step by step in recent years. Clinics were included in the global budget system since July 2001 after dental health care system and Chinese medicine. And furthermore, hospitals will be included on July 1, 2002. Under the premise of budget control, the Bureau of National Health Insurance can focus more on the control of medical quality. Due to the segmented implementation of primary physicians and hospitals and to explore the possible cooperative models of cinics and hospitals which benefit the integration of medical system horizontally and vertically to reach the goal of impoving medical quality and saving medical sourses. It’s therefore of great necessity of researching the cooperative models between clinics and hospitals. The objectives of this study were: 1.Understanding the level of importance, urgency and feasibility of the possible cooperative models between clinics and hospitals. 2.Analyzing whether the cognitions of the possible cooperative models among different groups of experts would be different. We used expert questionnaire which used 5 points of Likert scale questionnaire as the basic structure and collate the related literature domestically and abroad to design a semi-open structured questionnaire. Two rounds of Dephi investigation among clinics , hospitals and experts yielded the level of importance, urgency and feasibility toward possible cooperative models. The important results are as follow:1.The possible Cooperative models of high importance, high urgency and high feasibility: This research takes cut point 4.0 as a border and define the grade higher than 4.0 as the possible cooperative models of high importance, high urgency and high feasibility, then we get 7 items of the possible cooperative models of high importance, high urgency and high feasibility. They are the Sharing expensive medical equipments, Sharing the incinerator, United incinerator service, Establishing the cooperative agreement of transfer, Establishing the cooperative agreement of examing, The backup of physicians, interaction (ex: the backup of physicians mutually, surgery, education etc.), Medical and Nursery training, backup, interaction (ex:continuous education, training, practicing). 2.The influences of the possible cooperative models cognitions by different groups of experts: in order to know whether they would be different and obvious decisions of the possible cooperative models because of different groups, we exam them by Kruskal-Wallis test and find just 4 obvious differences of cognitions in the part of importance. They are united out-sorting pathological examine service, united out-sorting laundry service, united purchasing and united maintenace. That means there is the same viewpoint on cognition of importance in three groups. In the part of urgency, there are 6 obvious different viewpoints showed in the possible cooperative models: Sharing the incinerator, united out-sorting information service, united out-sorting pathological examine service, united out-sorting X-ray service, united out-sorting laundry service and united incinerator service. In the part of feasibility, there are also 6 obvious different viewpoints showed in the possible cooperative models: Sharing the incinerator service, united out-sorting information service, united out-sorting laundry service, sharing the service fee of consultants, medical and nursery training, backup & interaction and to establish management alliance with hospital or consult company. And they have the same viewpoints in the other possible cooperative models.