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博碩士論文 etd-0720113-221131 詳細資訊
Title page for etd-0720113-221131
論文名稱
Title
體制壓力與高階主管擁護中介效果對電子化醫療同化之影響
The Effect of Institutional Pressures and the Mediating Role of Top Management Championship on E-Health Assimilation
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
92
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2013-07-19
繳交日期
Date of Submission
2013-08-20
關鍵字
Keywords
體制理論、健保制度、電子化醫療同化作用、高階管理者、組織壓力
institutional theory, institutional pressures, National Health Insurance, top management, E-health assimilation
統計
Statistics
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The thesis/dissertation has been browsed 5903 times, has been downloaded 154 times.
中文摘要
台灣健保制度肇始於1995年三月,此後健保制度便成為台灣最大與成長最快之服務產業,台灣健保制度基本上在同一等級之醫院其給付方式是一致的,漸漸地將醫療給付為病例給付。由於就醫並沒有制度上的障礙,病人可以任意選擇他相信的任何等級的醫院以完成病人醫療服務。就如同其他產業,醫療院所使用資訊科技已漸漸普及,它包括了醫療、電腦及資訊科技、資訊網路使得醫療電子通訊與溝通成為可能。電子化醫療使得醫療裝置、臨床治療準則及利用資訊系統能在醫療治療服務上,並且有可能即時反應外部嚴苛的醫療環境。
我們發展並且測試一個體制理論模型,以研究在醫院電子化醫療同化作用,這個模型說明了醫療高階管理者對於外部環境衝擊對於電子化醫療之中介效果。我們利用問卷調查資料訪問台灣大、中、小醫院醫療高階管理者,來驗證我們的假設,由partial least squares統計分析來檢定結果,仿效的壓力在電子化醫療同化作用,正面影響高階管理轉型信念接著也同時會正面影響高階管理倡導醫療電子化,而高階管理倡導醫療電子化也正面影響醫療電子化使用程度。仿效的壓力在電子化醫療同化作用正面影響高階管理倡導醫療電子化,由此可看出高階管理轉型信念為部份中介效果,而從高階管理轉型信念至電子化醫療同化則倡導醫療電子化為完全中介效果。強制的壓力對於電子化醫療同化作用及電子化醫療同化則無任何統計義意。規範的壓力僅對電子化醫療同化有正面效果。由於健保制度之獨特性,我們研究發現強制的壓力與規範的壓力並無中介效果,而仿效的壓力對高階主管擁護為中介效果,希望此研究得以對臺灣醫院管理者提出適當的建議。
Abstract
The National Health Insurance (NHI) Program in Taiwan began in March 1995. The implementation of this program resulted in health care becoming one of the largest and fastest growing industries in Taiwan. The implementation of the NHI resulted in a uniform payment system within a given class of homogeneous hospitals, thus ensuring a level playing field, at least with respect to payment driven incentives. Under the NHI Act, the Bureau of National Health Insurance in the Department of Health has developed a uniform payment system for reimbursement of services rendered by each individual category of health care providers. This payment system is essentially a fee-for-service, an d will be modified toward a fee-per-case basis gradually. Hence, patients can choose hospitals where they believe they will receive the most appropriate treatment regardless of the type of hospital.
Like other industries, the utilization of the Information Technology (IT) has increased in the healthcare sector. It includes a range of services that intersect medicine, computer and information science. The presence of the internet helps healthcare practice with the use of electronic processes and communication. Also, E-health deals with the devices, clinical guidelines and methods required to improve the management of information in healthcare and reflect the external environment demands.
We developed and tested a theoretical model to investigate the assimilation of E-health in hospital organizations. Specifically, this model explains how top management mediates the impact of external institutional pressures on the degree of usage of E-health. The hypotheses were tested using survey data from the large to small size hospital in Taiwan. Results from partial least squares analyses suggest that mimetic pressures positively affect top management transformational beliefs, which then positively affects top management championing E-health in the E-health process. In turn, top management championing E-health is confirmed to positively affect the degree of E-health usage. Results did not suggest that coercive pressures positively affect top management championing E-health without the mediation of top management transformational beliefs. Surprisingly, we did not find support for our hypothesis that top management championing E-health mediates the effect of normative pressures on E-health usage, but instead we found that normative pressures directly affect E-health assimilation. Our findings highlight the important role of top management championship in mediating the effect of institutional pressures on IT assimilation in hospital sector. We confirm that institutional pressures (mimetic and normative), which are known to be important for IT adoption and implementation, also contribute to E-health assimilation when the integration processes are prolonged and outcomes are dynamic and uncertain.
目次 Table of Contents
VERIFICATION LETTER FROM THE ORAL EXAMINATION COMMITTEE i
ACKNOWLEDGMENTS ii
ABSTRACT IN CHINESE iv
ABSTRACT vi
TABLE OF CONTENTS viii
LIST OF FIGURES x
LIST OF TABLES xi
1. Introduction 1
1.1 Background and Motivation 1
1.2 Research Objectives 3
1.3 Research Questions 4
1.4 Research Design 6
2. Theoretical Foundation 12
2.1 Institutional Isomorphism and E-health Assimilation 14
2.2 Top Management Championship and E-health Assimilation 19
3. Research Model and Hypothesis 21
3.1 Top Management Championship with Transformational Beliefs and Champing E-health in E-health Assimilation………………………………………………21
3.2 The Role of Institutional Pressures in Assimilation 27
3.2.1 Mimetic Pressures 27
3.2.2 Coercive Pressures 29
3.2.3 Normative Pressures 30
3.2.4 Control Variables 32
3.2.4.1 Organization Size 32
3.2.4.2 Geographic Location 33
3.2.4.3 IT Usage 34
4. Research Method and Data 34
4.1 Construct Operationalization 34
4.2 Assimilation 35
4.3 Top Management Transformational Beliefs 38
4.4 Top Management Champion E-health 38
4.5 Mimetic Pressures 38
4.6 Coercive Pressures 39
4.7 Normative Pressures 39
4.8 Data Collection 40
5. Data Analyses and Results 42
5.1 Measurement Model 43
5.2 Common Method Bias 46
5.3 Hypothesis Testing 49
6. Discussion and Conclusions 54
6.1 Discussion 55
6.1.1 Managerial Implications 57
6.1.2 Limitations and Future Research Directions 59
6.2 Conclusions 60
REFERENCE 61
APPENDIX A. Survey Instrument in Chinese 70
APPENDIX B. Transformational beliefs -E-health assimilation, championing E-health as complete mediation role…………………………………………………..79
APPENDIX C. Mimetic pressure -E-health assimilation, championing E-health as partial mediation role 80
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