家庭醫學科基層診所居家醫療整合照護之研究─以A診所為例

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Title:	家庭醫學科基層診所居家醫療整合照護之研究─以A診所為例
Authors:	洪國泰;Hung, Kuo-Tai
Contributors:	高階主管企管碩士班
Keywords:	基層診所;居家醫療照護;醫療服務行銷;Primary Clinics;Home-based Medical Care;Medical Service Marketing
Date:	2023-05-15
Issue Date:	2024-09-19 16:14:22 (UTC+8)
Publisher:	國立中央大學
Abstract:	隨著臺灣社會環境快速變遷及醫療技術與衛生環境的進步，人口高齡化之進程迅速，且近年來臺灣社會傳統家庭的功能逐漸式微，在老人化日益嚴重下，產生不少社會問題。臺灣衛生福利部中央健康保險署自2016年起開辦「全民健康保險居家醫療照護整合計畫」，以病患需求為導向，提升因失能或疾病特性致使外出就醫不便的病人，提供醫療照護之可近性，並鼓勵醫事服務機構連結社區照護網絡，減少病人住院需求或尋求更多替代方式，以提供失能者更多全面性的照顧。本研究回顧並彙整相關居家醫療與照護以及醫療服務模式的文獻，並提出服務行銷金三角架構，首先剖析臺灣居家醫療市場概況，再進行研究對象之個案運作與服務模式的說明與闡述，最後進行個案分析與現況問題探討。本研究個案所面臨的困境與問題，包括：收案來源不穩定、與A單位建立關係的成本高、與社區民眾建立信任感的時間付出多等，因此期望透過為社區提供服務，以建立良好的聲譽，將短中期對於社區的付出轉化為未來的長期效益。為提升診所整體營運的績效與外界形象，導入以病患需求為出發點的醫療服務行銷理念，藉以提升醫療服務價值，期待有長期與隱形的價值與獲利。本研究建議政府應增加居家醫療照護整合計畫之健保給付，以實質方式鼓勵醫事人員積極從事居家醫療照護工作外，也應改變與調整安寧藥物的開立限制，並借鏡他國經驗重新思考全民健保制度的問題，更應加強宣導在宅善終的觀念，來提升年長者善終的生活品質，以及鼓勵基層診所醫師走入社區，參與居家醫療照護的工作，以服務更多有需求的民眾。然本研究恐受質性訪談限制而產生偏差，無法呈現全貌，亦因僅針對一家基層診所進行分析，研究推論過程中恐有主觀意識的誤差，研究結論難以概化。期待未來有興趣從事相關研究者，能從更多不同地區與居家醫療照護成員組合之訪談對象，再深入探究居家醫療整合照護的整體面向。;The population of Taiwan is rapidly aging as a result of rapid social change, advances in medical technology and improved sanitation infrastructure. The traditional family in Taiwan has been losing ground in recent years. As the global population ages, many new social problems have surfaced. The National Health Insurance Administration, Ministry of Health and Welfare in Taiwan has been carrying out the “National Health Insurance Home-based Medical Care Integration Plan” since 2016. With the patients’ needs as the orientation, it will benefit those who have trouble getting into the hospital because of dysfunction or the nature of their illness, providing more accessible medical care and encouraging medical service institutions to connect with community care networks. The patients’ hospitalization needs can in turn be reduced, or more alternative methods can be thought of to provide people with disabilities more comprehensive care. This study reviewed and compiled literature on home-based medical care and medical service models and proposed a marketing framework based on the service triangle. First, the market summary for home-based medical care in Taiwan was analyzed. The case-based operations and service models of the research subjects were explained and elaborated on. Finally, the case study and current issues were examined. The plights and problems faced by the research case include: unstable sources of cases accepted, the high cost of establishing relationship with Unit A, the time spent on establishing a sense of trust with the general public in the community, etc. Therefore, it is expected that through services provided by the community, a good reputation can be established, turning middle-term investment in the community into long-term benefits in the future. In an effort to improve the overall operating performance of clinics and their public image, concepts of medical service marketing geared toward patients’ needs have been proposed in an effort to increase the value of medical services, with the expectation of reaping long-term and unseen value and profit. This study recommends that the government incorporate the Home-based Medical Care Integration Plan into the coverage of the National Health Insurance in order to encourage medical personnel to engage in home-based medical care work. Similarly, the restrictions on the distribution of palliative drugs should be modified and adjusted. In addition, the experiences of other nations should be considered when reevaluating the National Health Insurance system’s problems. In addition, advocacy for the concept of a “good death at home” should be bolstered, thereby enhancing the quality of life of elderly individuals nearing the end of their lives and encouraging primary clinicians to enter the community to serve more individuals in need. However, due to the restrictions of the study’s qualitative interviews, it’s possible that its findings are skewed, unable to present the whole face. Furthermore, generalizing the results of the study is challenging because they are based on a single case study of a primary clinic. More interviewees from different places and sets of home-based medical care providers will allow future researchers interested in this area to dig deeper into the bigger picture of home-based medical integrated care.
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