| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 94 === 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.
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