背景：中央健康保險局於2001年11月開始推動「全民健康保險氣喘醫療給付改善方案試辦計劃」，藉由論質計酬的整合性照護，希望能提升病患自我照護能力及醫療照護品質。但目前針對實施成效之評估大多為分析醫療資源的耗用與醫療費用支出情形，鮮少探討病人照護結果是否改善。因此本文以醫療資源使用及照護成效結果作為評估標準，探討「全民健康保險氣喘醫療給付改善方案試辦計畫」介入後的影響。
研究方法：本研究使用單一實驗組進行前、後測比較，資料來源為全民健康保險研究資料庫。研究樣本為2007年間新收案之氣喘病患，共3,764位。醫療資源使用的評估方式為因氣喘至急診與住院之次數，以及因氣喘使用口服、注射型類固醇之次數。而病患照護成效結果則以是否因氣喘使用急診、是否因氣喘住院及是否因氣喘使用口服、注射型類固醇為評估基準。分析方法為配對t檢定及ｚ 檢定，統計工具為STATA 12.0版。
結果：統計結果顯示，在醫療資源利用方面，氣喘急診與住院次數呈現下降趨勢，分別下降0.4、0.5次，而口服、注射型類固醇的使用次數則出現上升趨勢，共增加0.2次。在醫療資源照護效果部分，僅有是否因氣喘而使用急診或住院達到統計上顯著差異且出現使用比例的下降。但是在使用口服、注射型類固醇的可能性方面沒有影響。
結論：氣喘論質計酬的介入可有效控制病情使急性發作的機會降低，並減少病患急診或住院的次數(以及機率)。而使用口服、注射型類固醇的次數也隨著加入方案而明顯增加。(類固醇使用次數增加是否在長期可能影響病患健康，可能是未來研究需要進一步探討的。)因此建議未來研究者可延長追蹤時間，以了解整體表現脈絡，及把口服、注射類固醇的使用，納入方案稽查獎勵標準或執行成效的評估等，以確保醫療照護品質之落實。

Background: In November 2001, the Bureau of National Health Insurance (BNHI) implemented the Pay for Performance Program for Asthma. The Program aims to provide support for self-care for patients and improve quality of care. However, the existing work on the effects of implementation mainly focuses on healthcare resource use and expenditures. Few studies have looked into changes in patient outcome related to introduction of the program. Hence, this study analyzes the effect of the Pay for Performance (P4P) Program for Asthma on the utilization of healthcare resources and patient outcome.
Methods: This study uses a before-and-after comparison on a single experimental group. The data were collected form the National Health Insurance Research Database (NHIRD). The sample includes 3,764 patients who were diagnosed with asthma in 2007. The healthcare resource use is measured by the number of Emergency Department (ED) and inpatient visits, and the frequency of usage of oral and injected corticosteroids due to asthma. The patient outcome is measured by whether the patient visited the ED, whether the patient was hospitalized, and whether the patient was prescribed with oral and injected corticosteroids due to asthma. The statistical method used includes the paired t-test and z-test. All analysis was conducted by using STATA 12.0.
Results: The results show that, in terms of the utilization of healthcare resources, the number of ED and inpatient visits reduced 0.4 and 0.5 visits, respectively. The frequency of usage of oral and injected corticosteroids increased 0.2 times. With respect to patient outcome, both the probability of the patient visiting ED department and being hospitalized were reduced. However, the program had no effect on the probability of the usage of oral and injected corticosteroids.
Conclusion: P4P for asthma can efficiently reduce the number and the probability of A&E and inpatient visits. The use of oral and injected corticosteroids clearly increases with the implementation of the program. However, it is not clear whether this outcome would have any adverse impact on patient health in the long term. In the future, researchers may consider use a study period that is longer to clarify this issue. The government may closely monitor the utilization of oral and injected corticosteroids in P4P programs to promote better health outcome.

目錄
論文審定書 i
論文公開授權書 ii
摘要 iii
Abstract iv
目錄 v
圖次 vi
表次 vii
第一章　緒論 1
第一節　研究背景 1
第二節　研究目的與研究問題 4
第三節　研究之重要性 5
第二章　文獻探討 6
第一節　論質計酬 6
第二節　氣喘醫療與照護 15
第三節　氣喘與論質計酬方案於結果面評估 24
第三章　研究方法 26
第一節　研究設計 26
第二節　研究架構及研究假設 28
第三節　資料來源與研究樣本 30
第四節　操作型定義 35
第五節　統計分析工具與方法 37
第四章　研究結果 38
第一節　描述性統計 38
第二節　推論性統計 45
第五章　討論 48
第一節　研究結果之討論 48
第二節　研究限制及建議 51
第六章　結論 52
參考文獻 53

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