台灣全民健保於民國九十一年起開始全面實施總額支付制度，期能借由年度固定之醫療預算來抑制費用支出。然其中醫院總額支付制度遠較其他層級部門來得複雜；在配套措施不完整而倉促上路之情況下，確實造成醫院面臨極大的困境。中央健康保險局於是便推行各種不同管理方案，如「分區總額」、「醫院自主管理」、及「優質管理計畫」等等，以控制預算分配、分散管理風險之方式，交由各健保分局自行和轄區內之醫療單位協商。 國軍醫院在公務預算縮減、人員裁編、健保制度壓縮成長之內外環境衝擊之下，面臨極大之經營困境。本研究乃針對個案醫院運用策略管理模式，建構醫院內部之指標監控系統，和健保局協議「醫院優質管理計畫」，訂定療費用成長之上限及配套管理指標，並藉由內部資訊化管理，提供細部資料之分析與追蹤，在發現異常時依其需求找出問題所在，以達到多角度、持續性之監控及事先預防之目的。 結果顯示個案醫院加入「醫院優質管理計畫」後，藉由資訊管理架構之監控，可以針對總額預算下之健保政策適時反應；提供管理者即時資料獲取、分析、判斷而擬定決策，在激烈的競爭環境下，醫院之經營得以創造永續生存發展之契機。

On coping with the“hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as “global budgeting system by different area＂,“hospital-based self-management＂, and “hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii
problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operationOn coping with the“hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as “global budgeting system by different area＂,“hospital-based self-management＂, and “hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii
problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operation

第一章 緒論------------------------------------------------------1 第一節 研究背景與動機--------------------------------------1 第二節 研究範圍與目的--------------------------------------2 第三節 論文架構--------------------------------------------3 第二章 文獻探討--------------------------------------------------4 第一節 醫療產業之特性--------------------------------------4 第二節 全民健保制度 --------------------------------------9 第三節 總額支付制度探討-----------------------------------15 第四節 醫院經營策略---------------------------------------20 第五節 醫院資訊管理---------------------------------------32 第三章 研究架構與方法-------------------------------------------38 第一節 個案研究-------------------------------------------38 第二節 研究方法-------------------------------------------40 第三節 研究流程-------------------------------------------40 第四節 研究的限制-----------------------------------------42 第四章 個案醫院研究---------------------------------------------44 第一節 國軍醫療體系現況介紹-------------------------------44 第二節 高屏地區健保醫療業務分析---------------------------48 第三節 個案醫院經營現況-----------------------------------50 第四節 個案醫院內外部環境分析-----------------------------57 第五章 個案醫院優質管理指標系統之建構---------------------------62 第一節 個案醫院策略制定模式探討---------------------------64 第二節 個案醫院資訊管理系統之建立-------------------------67
v
第三節 個案醫院管理指標監控模式---------------------------70 第四節 個案醫院推動優質管理之困難與解決辦法---------------88 第六章 結論與建議-----------------------------------------------91 第一節 命題整理與討論-------------------------------------91 第二節 管理實務的意涵-------------------------------------92 第三節 研究建議-------------------------------------------95

第一章 緒論------------------------------------------------------1 第一節 研究背景與動機--------------------------------------1 第二節 研究範圍與目的--------------------------------------2 第三節 論文架構--------------------------------------------3 第二章 文獻探討--------------------------------------------------4 第一節 醫療產業之特性--------------------------------------4 第二節 全民健保制度 --------------------------------------9 第三節 總額支付制度探討-----------------------------------15 第四節 醫院經營策略---------------------------------------20 第五節 醫院資訊管理---------------------------------------32 第三章 研究架構與方法-------------------------------------------38 第一節 個案研究-------------------------------------------38 第二節 研究方法-------------------------------------------40 第三節 研究流程-------------------------------------------40 第四節 研究的限制-----------------------------------------42 第四章 個案醫院研究---------------------------------------------44 第一節 國軍醫療體系現況介紹-------------------------------44 第二節 高屏地區健保醫療業務分析---------------------------48 第三節 個案醫院經營現況-----------------------------------50 第四節 個案醫院內外部環境分析-----------------------------57 第五章 個案醫院優質管理指標系統之建構---------------------------62 第一節 個案醫院策略制定模式探討---------------------------64 第二節 個案醫院資訊管理系統之建立-------------------------67
v
第三節 個案醫院管理指標監控模式---------------------------70 第四節 個案醫院推動優質管理之困難與解決辦法---------------88 第六章 結論與建議-----------------------------------------------91 第一節 命題整理與討論-------------------------------------91 第二節 管理實務的意涵-------------------------------------92 第三節 研究建議-------------------------------------------95