運用DANP-mV模型優化台灣社區高齡健康照顧系統永續發展

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林培堅(Pei-Jian Lin) 查詢紙本館藏

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運用DANP-mV模型優化台灣社區高齡健康照顧系統永續發展
(Optimizing the Sustainable Development of the Community-based Senior Healthcare System of Taiwan via the DANP-mV Model)

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摘要(中)

「晚期的青春是永恆的青春—弗裡德里希•威廉•尼采」。第二次世界大戰後出生的嬰兒潮現在都已經到了退休年齡，這一代人曾爲經濟繁榮與社會穩定付出重大貢獻，因為人數龐大，已成爲今日的「銀髮海嘯」。隨著社會經濟環境的變化，這些老人逐漸失去了原有的社會功能和定位，甚至隨著退化的身體，老年病綜合症狀的產生，面臨著需要被照顧的處境。在過去，大多數的高齡健康照顧服務工作對家庭來說，都是沉重負擔。然而，隨着出生率的下降和社會經濟的低迷，高齡健康照顧服務系統機制的良窳對整個社會安定發展會產生一定的影響。因此，完善的照顧系統就顯得非常重要，要使這系統制度可持續發展，其中“資金充足”和“持續改善”是非常關鍵的因素。台灣人口急速老化，人口結構變遷，面臨經濟發展停滯，如何使高齡健康照顧服務系統永續發展已是當務之急。以往，社會福利系統會盡量避免對營利組織的資金進行流動；然而，當現在社會經濟環境蕭條的時候，商業保險、調整稅賦、消費成本等各種方法都是因應之道，當然，企業組織的運用也是重點。因此，本研究由文獻調查法採用了「人力資源」、「資金來源」、「科技運用」、「服務範圍」及「法律規範」等五個主要構面和廿個準則探討高齡健康照顧服務系統，研究方法運用決策實驗室分析法（DEMATEL）結合網路層級分析法 (ANP) (稱DANP) 和改善型的VIKOR的混合方法(DANP-mV)，其中DEMATEL分析法，尋找構面及準則的相依關係和回饋關係以及其間的因果關係，然後用DANP方法確定權重，再加上運用改善型的VIKOR方法評估績效，探索出各構面與各準則間的績效改善關係，並以對台灣的高齡健康照顧系統進行實證分析。根據影響網絡關係圖(Influential Network Relation Map簡稱INRM)找出問題的根源；然而，本研究發現「台灣社區高齡健康照顧系統永續發展」的影響根源根問題在於「資金來源」構面。由此深入探索發現「資金來源」構面中最大的影響關鍵根源在於「穩定的退休金」準則。因此，需要從問題的根源出發，從最大影響關鍵準則改善，並以各個構面中尋求關鍵影響準則，並嘗試進行可持續的各構面配套建議優化改善方法，進而達到全面改善社區高齡健康照顧系統永續發展，實踐健康老化、在地老化、活躍老化的願景。

摘要(英)

A Friedrich Nietzsche quote goes like this: “Late youth is the eternals youth.” As the baby boomers, who were born in the years immediately after World War II, reach retirement age, they are referred to as today’s “silver tsunami” because of the significant size of this demographic cohort. Boomers made major contributions to economic prosperity and social stability during most of their active years. However, with socio-economic changes in recent years, this cohort has begun to lose its social functions and previous social status. The baby boomers have found themselves in situations where their ailing bodies with complex symptoms need to be taken care of. In former times, caring for senior family members was a huge burden for a majority of households. With the falling birthrate and recent recessions in economy, the quality of senior healthcare services has started to exert a considerable impact on social stability and development. On that account, a sustainable and comprehensive healthcare system becomes very important. Two key factors: “sufficient funds” and “continual improvement” are required to attain sustainability of said system. In times past, social welfare systems tended not to collect funds from for-profit organizations. However, in order to maintain the healthcare system sustainable, a range of strategies, including commercial annuities, adjustment of taxation and consumption costs can be employed in periods of recession. Certainly it also matters that the government induces corporate powers to address this issue. Creating sustainable senior healthcare systems has become an urgent mission in today’s circumstances where the population is rapidly aging, demographic structure is changing, and economic development is coming to a halt. Consequently, this study employed the literature survey method consisting of five dimensions that include human resources, sources of funds, implementation of technology, scopes of services, and regulations and 20 criteria, using a combined method called DANP (DEMATEL based on ANP) and a modified VIKOR model (DANP-mV model). The DEMATEL method was utilized to seek an interdependent relationship between the dimensions and criteria, as well as related feedback and cause-effect relationships. The influential weights were then calculated using DANP, whereas a modified VIKOR model was employed to evaluate performance, thus exploring how performance improvement was executed, and making a thorough empirical analysis of the senior healthcare system of Taiwan. Following that, this study used the Influential Network Relation Map (INRM) to identify root causes of the relevant problems and found that the root cause of the sustainable development of the community-based senior healthcare system of Taiwan is the dimension of "sources of funds". And through in-depth exploration the criterion of “defined benefit pension” was found to be a key factor affecting the dimension of “sources of funds”. By identifying the root causes of problems and attempting to undertake continuous optimization, whereby improvement plans are drawn up and system design created, this study seeks to create a more effective senior healthcare project for sustainable development, in order to achieve multiple goals of the senior healthcare system of Taiwan: healthy aging, active aging, and aging in place.

關鍵字(中)

★ 嬰兒潮
★ 銀髮海嘯
★ 高齡健康照顧系統
★ DANP-mV模型
★ 可持續的改善方案

關鍵字(英)

★ baby boomers
★ silver tsunami
★ senior healthcare system
★ DANP-mV model
★ continuous improvement plan

論文目次

Table of Contents
摘要 i
Abstract iii
Acknowledgment v
Table of Contents vi
List of Figures vii
List of Tables viii
Chapter 1 Introduction 1
1.1 Research motivation and purpose 1
1.2 Thesis overview 4
Chapter2 Literature review 7
2.1 The five architecture pillars generated during the process of constructing the sustainable community-based senior healthcare system 7
2.2 Community-based sustainable senior healthcare service system assessment 14
framework 14
2.3 Pretest the index architecture of the criteria of the healthcare system 20
2.4 Establish a sustainable development assessment framework 29
Chapter 3 Research methods and procedures 36
3.1 The research process of developing a sustainable improvement model 36
3.2 Methods flow 37
3.3 Data collection 41
Chapter 4 Development of Taiwan’s empirical case of senior healthcare services 43
4.1 The background of Taiwan’s senior healthcare policy and industry 43
4.2 Evaluation framework 49
4.3 Interpretation of the INRM 56
4.4 Problems found when comparing performance between experts and users 70
4.5 The systemized improvement implementation should be based-on “cause-effect” relationships 76
4.6 Results and discussion 79
Chapter 5 Conclusions 84
References 87
Appendix 95
Appendix A Questionnaire 95
Appendix B Research steps 106
Appendix C Result in detail 113

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指導教授

薛義誠

審核日期

2019-11-20

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