Participating Process of Southern Taiwan''s Regional/Area Hospitals in "National Health Insurance Pilot Project of Family Physician Integrated Care System"

• Main Authors: Wei-Yi Jiang, 蔣維宜
• Other Authors: Chu-hui Chang
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/02284962538135291161

碩士 === 長榮大學 === 醫務管理學研究所 === 94 === Bureau of National Health Insurance proposed the “Trial Plan for the National Health Insurance Pilot Project of Family Physician Integrated Care System” in 2003. It is the first attempt in the country to form a community care network by bringing together local medical facilities and area/regional hospitals. This research uses area/regional hospitals in southern Taiwan as subjects and employs process theory to scrutinize the situation and influencing factors. The purpose of this study is to: 1)investigate the circumstances under which hospitals join the system and the influencing factors in each process/stage, as well as the system enabling the hospitals to join; 2)discuss the direction of the cooperative relationship as well as the characteristics and the influencing factors of the network; 3)explore the impacts and effects of the participation on the hospital. The study collected data by conducting semi-structured interviews with 33 participating hospitals, which signed on in October of 2004. Using the year the hospital joined and the number of hospital cooperating as theory-base sampling and using data saturation as a principle, interviews were conducted with a total of 12 hospitals. From the transcripts of the interviews, we developed concepts, underwent category analyses and combined scenario analyses. The synopsis of the results is as follow: 1) According to the concerns in the participatory system and external opportunities, the manners of participation are categorized as seeking, going with the flow, leading, and match-making. Influencing factors of hospitals'' participation include relationship forming background, balance of incentives and cost, and hospitals’ external communication network. 2) The cooperative relationship is multiplicity and decision-making power leaning. The network has characteristics of homogeneity, connectivity and bridge. Differences in factors, such as hospitals’ ability, reinvention (reinvent referral system/rebuild information system) considered by hospital in benefit assessment, and risk, affecting the amount of resources hospitals invest. The differences are reflected in the multiplicity of the cooperative relationships. Decision-making power is weak in hospitals where relationship-forming background is the external opportunity interference causing the hospitals to join. However, in hospitals where network structure plays the middleman/bridge, decision-making power is on equal footings. 3) Cooperation results can be categorized as willingness and unwillingness. Factors affecting willingness include trialability (following through with the idea of community) under hospitals'' benefit assessment, decision-making powers being on equal footings, network structure having the characteristics of being a yardstick or bridge, and the number of participating medical facilities showing signs of gradual increase. Factors determining unwillingness include weak decision-making power and characteristics of bad participants in the network structure. The number of participating hospital shows signs of being single or sharp increase.