| Summary: | 博士 === 國立臺灣大學 === 健康政策與管理研究所 === 104 === Backgrounds: Health promotion is a key of improving the public’s health. In recent years, reorienting health care toward health promotion has been considered as a major challenge for health service providers. The Department of Health started the Building Healthy Communities Program since 1999 and the National Health Insurance Administration also introduced a 3-year pilot capitation payment program which is similar to the accountable care organization in the United States in 2011. With these policy incentives, participating hospitals are encouraged to improve or maintain the health status of their enrollees, and community health promotion approaches are usually adopted. Given this groundwork, the aims of this study are to (1) investigate the backgrounds of promoting health in the community by a hospital; (2) figure out the processes and structures of the hospital-community partnership; and (3) profile the implementation of health promotion tasks by a hospital in the community context.
Methods: The National Taiwan University Hospital Jinshan Branch was established in 2010 and it was also the only hospital in the northeast district of Taiwan. After participating in the capitation payment program of the National Health Insurance Administration and health promotion programs led by the Health Promotion Administration, the Jinshan hospital initiated several community-based health programs. This study, a field research, collected data by participant observation, documentary analysis and open-ended interviews with hospital staffs, community residents and relevant stakeholders.
Results: The hospital participated in the capitation payment program and health promotion programs for gaining more resources and incentives in order to perform community health services. Nevertheless, scarcity of resources and conflicts among institutions limited the development of the hospital’s community health promotion works. On the other hand, promoting health in the community was also subjected to local social networks. Facing those community groups with high perception of health, the role of the hospital was to provide specialized healthcare services to meet the demands. On the contrary, the hospital had to approach local social networks to learn the needs of community members and assist them in improving or promoting health. The results showed non-institutionalized and informal characteristics of the hospital-community partnership and the structure constrains influenced the hospital''s community-based health promotion implementations.
Conclusions: Through qualitative approach, this study observed that the relationship between local community and the hospital is multi-faceted and dynamic. The results also provided first-hand information for future policy formulation. By exploring the real practices of hospitals’ community health promotion works will help develop a proper operation model.
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