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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

我國長期照護政策之財源籌措方式探討 / A Study on Financing Methods of Long-term Care Policy in Taiwan

蘇品心, Su, Pin Hsin Unknown Date (has links)
近年來,由於家庭型態急速變遷,受少子女化現象、公共衛生發展、疾病之有效控制,及科技醫療發達等影響,全球人口高齡化現象日益顯著。根據內政部統計統計,我國截至2012年止,老年人口所佔比率,已大幅攀升至11.15%,該現象顯示未來,老年生活之經濟安全保障,已成為國內重大社會課題之一,而政府為了加強老人福利服務、醫療照護與保健等,近幾年來更是積極規劃「長期照護」等相關政策。 在我國,「長期照護」主要係指針對缺乏自我照顧能力者,提供健康與社會照顧之服務,雖然各年齡層人口均有發生長期照顧需要之風險,惟老人係照護服務需求之主要族群;由於照護時間往往漫長且無法預期,其成本往往超出家庭成員可負擔之範圍,普遍認為需由政府積極介入;惟中央財政缺口日深,舉債額度業逼公債法之上限,如何籌措財源即成為首要之務,按政府目前規劃方向,係朝開辦單一制之社會保險因應。 然而,我國已開辦之社會保險種類繁多,根據立法院預算評估報告,勞保、退撫、國民年金保險三大退休保險基金財務缺口總額已逾台幣八兆元,且持續惡化中,如今再將全民強制納入長期照護之被保險對象,是否適當有待商榷,且長期照護保險未來開辦後,若仍維持「高給付、低費率」之設計,恐落入相同財政困境,使負債世代移轉問題日益嚴重,且影響基金永續經營。 況且,如何說服所有民眾願意繳納長達數十年之長照保險費,直至「有可能發生」身心功能障礙,且持續達六個月以上時,始得被列為長期照護服務之對象,獲取保險給付及相關補助等,亦是項艱難的任務;另外,開辦後對於國內經濟將產生之影響與衝擊,更須妥為評估。 本研究將以目前已開辦之社會保險經營現況、國家財政、經濟發展情況及各界觀點等為切入點,佐以他國實施之經驗為參考,並就各種財源籌措方式之優缺點,以及社會民眾之接受度等,討論我國長期照護財源籌措較可行之方式。 / Globally, population aging has become an increasing trend in recent years due to rapid changes in family patterns, low fertility rate, development of public health and effective control of diseases, and advanced medical technology. According to local statistics, as of 2012, Taiwan’s elderly population has substantially increased to 11.15%. This denotes the future economic security of old people which has become one of the major social issues in Taiwan. In recent years, the government has also actively implemented policies relating to “long-term care” in order to strengthen welfare services, nursing and medical care for the elderly. In Taiwan, “long-term care” means to provide health and social care for dependent-care patients. Old people are the primary focus of care services, although people of all ages are likewise at risk of requiring long-term care. Given the long-term and unexpected time involved in care giving as well as the high expense that families could incur, the government is actively considering a social insurance system. With the increasing gap between the national budget and the debt limit which affects the law governing government bonds, raising funds has become a priority. To establish a unitary social insurance system is the current direction that the government wants to take. However, Taiwan has already established various forms of social insurance. Based on reports from the legislatures’ budget and assessment, there is a financial gap in three major pension funds including labor protection, civil service pension and national annuity insurance, which has exceeded NTD 8 trillion and is constantly getting worse. Recently, there was an issue whether to require everyone to apply insurance with long-term care. By implementing a long-term care insurance in the future, there would be a constant need to maintain a “high pay, low rate” package that could possibly lead to a similar fiscal difficulty, which would increasingly aggravate the transfer of debt from generation to generation, affecting sustainable operation of the fund. It is also difficult to persuade people to pay insurance premium for decades until physical and mental problems occur and last for over 6 months. It is only during this period that people can avail long-term care services and receive compensation and subsidy. The effect and impact of introducing this form of insurance on the domestic economy needs to be further evaluated. With an established social insurance management status, the national budget, the economy and opinions from all members of society as well as experience of other countries should be considered as a starting point or reference in initiating such plans. This study discusses potential measures for long-term fund raising based on the advantages and disadvantages of various fund raising measures as well as social acceptance.
12

日本長期照護保險法制之研究

李志妤 Unknown Date (has links)
人口老化是全世界共同面對的問題,台灣對於國民的老年生活,該如何保障?除了目前正研議中的年金保險,高齡人口的醫療保健問題,更顯重要。近年來,台灣開始討論有關高齡者的長期照護問題,不過該以何種體制,尚未有所定論。觀諸先進國家之經驗,對於長期照護制度有多種建制方式。本論文以鄰近之日本為對象,研究以社會保險作為社會安全制度核心的日本,如何繼德國之後,將長期照護保險法作為其第五大社會保險制度。 本論文分為六章,約九萬字。第一章緒論,就問題緣起與研究範疇說明。第二章敘述日本實施長期照護保險法之經社背景及當時之社會安全法制背景。第三章針對日本建制長期照護保險法之過程中,論述其學術界之討論與行政上之規劃及其而後之立法過程及相關的過渡措施。第四章說明日本現行之長期照護保險制度,內容包括長期照護保險之適用對象、保險給付、保險財務、長期照護保險之組織、支付制度及長期照護保險爭議之處理。第五章為日本實施長期照護保險制度後之檢討與評估。第六章則先論述台灣目前之經社背景及長期照護體系,且說明其缺失。最後,以日本實施長期照護保險法之經驗,論述其對台灣之啟示。 在台灣,社會安全為憲法所明文規定之國家政策,並為政府歷次政策宣示所強調。從德國及日本陸續於原有之四大社會保險之外,另行實施長期照護保險,而擴增為五大社會保險,更顯示社會保險制度所獲之廣泛信賴與支持。據此發展,亦可見以社會保險為核心之社會安全制度,非但有退縮現象,甚且百尺竿頭更進一步。在2002年全國社會福利會議中,已提出以建立長期照護保險制度為目標,並於10年內完成之分組報告。台灣未來如何抉擇制度之走向,尚待觀察。
13

電子健康服務設計之適配度 / Examining the fit between e-Health service features and patient segments

蔡亞霖, Tsai, Ya Lin Unknown Date (has links)
由於社會人口結構逐漸老化,電子健康照護服務的需求日漸增長,在今日成為健康照護服務中成長最迅速的領域,因此,服務設計就在健康照護產業中成為一個關鍵的議題。設計一個成功且完善的服務系統,首先要先了解病患的特性及需求,我們引用調節變項模型的概念,提出一套電子化健康照護服務設計架構,研究病患的服務偏好以及服務特色之間的配適性關係。本研究採個案研究法,透過台大醫院遠距醫療照護服務計畫中收集資料,我們研究結果發現在病患服務偏好以及服務特色當中存在著高度的配適性關係,如同我們的假設,在這之間的配適度將是一個影響服務效能的關鍵因素之一,本篇論文的貢獻在於為電子健康照護服務產業上提供一個良好的服務系統架構,並且提出一個驗證後的模型以了解關鍵的相關服務特色。 / The demand of e-Health care has been dramatically increasing and is quickly becoming one of the fastest growing areas of health-care today, due to today’s rapidly aging society; service design has therefore become a critical issue in the e-Health industry. To design a successful e-Health system, one must consider the different characteristics and preferences of each patient and design a system from a practical point of view. According to the concept of fit through moderation, this research aims to propose an e-Health design framework that examines the correlational fit between e-Health features and patient preference for achieving the best performance. We conducted a survey, where data was collected from the e-Health care program at the National Taiwan University Hospital (NTUH). From these sources, we found that there is an existing fit between e-Health service features and the preferences of different patient segments. Our findings also coincide with our pervious hypotheses that the fit between service features and patient preference contribute the service performance. The contribution of study is to provide a better understanding of critical service features through a validated framework in order to develop a better service system design for the provision of e-Health service.
14

遠距照護產業營運模式-以心電圖監測為例 / A Study on Telemedicine Industry Business Model – Taking ECG Monitoring as an Example

謝夢蝶 Unknown Date (has links)
隨著少子化、老年化的時代來臨,以「銀髮族」為目標客戶的產業前景看好。全世界已開發國家人口老化日趨嚴重,社會醫療成為各國財政越來越沈重的包袱,於是以提升高齡者自立能力、降低醫療負擔,提高生活品質為目的的「遠距照護產業」備受重視。相較於其它先進國家,我國遠距照護產業發展較晚。衛生署主導的「遠距照護試辦計畫」第一階試辦已完成,目前進入第二階段擴大推廣。因而,本論文探討的核心問題,在於如何建立成功的遠距照護產業營運模式。 本論文選擇遠距照護應用中的「遠距心電圖監測」作為研究標的,乃因心電圖監測技術已有成熟發展,且全世界心臟病人口日益增加,值得投資。本論文修改技術與市場二分法的研究模式,除了「產業環境」與「營運模式分析」,更將「專利」與「查驗登記制度」納入研究環節。技術、專利與查驗登記制度雖非傳統營運模式分析的重要核心,但對於發展此產品、服務,有一定的影響。由於美國遠距心電圖產監測業發展較我國成熟,本論文比較美國與台灣發展現況,並選擇兩家於美國提供遠距心電圖監測服務的LifeWatch AG與CardioNet, Inc.作為個案研究的對象。 研究結果發現,遠距心電圖監測服務在美國主要用於輔助醫師診斷心臟疾病。不受限於環境,長期連續不間斷監測心電圖的特性,使其市場表現快速成長。美國成功建構產業的關鍵在於完善的商業機制。此外,亦發現美國針對六十五歲以上高齡人口的政府保險Medicare,其給付金額對市場發產有舉足輕重的影響,值得我國政府借鏡。建議台灣應該在保護民眾生命財產安全,以及發展產業之間取得平衡,建構一個適合發展創新技術、創新服務的產業環境。 此外,研究結果發現,台灣尚未能成功發展遠距心電圖監測服務的關鍵,並非技術,而是商業模式。台灣以保守的醫院為服務窗口的營運策略,是衛生署比擬全民健保機制,推動年長者長期健康照護制度的產物,屬於社會福利的性質,與發展產業的概念背道而馳,而且成本過高。另一方面,民眾沒有長期測量生理參數的習慣,拓展市場不易,此二者為台灣長期推動服務失敗的主要原因。因此,本研究最後建議,應捨棄以醫院為中心的服務模式,設計一套能夠被民眾廣為接受的營運模式,提供彈性的價格與服務,搭配適當的宣傳,方能突破現狀。 / Population aging is getting more and more serious among developed countries, as well as the extremely heavy medical treatment budgets. Consequently, governments start to think about how to make medical service more efficient by means of information technology; businessmen start to provide telemedicine service, in order to let the elder live more independently and healthier. A pilot remote health care project, held by the Department of Health, is moving to the second stage this year. Many telemedicine service centers had been built in the hospitals at the first stage, and now government is seeking for more hospitals and companies setting up more service centers in Taiwan. This is time to check weather it is a good business model worthy of working on, or there is a better way to develop telemedicine business. Remote ECG monitoring is one of the typical telemedicine services. Many people are suffering from cardiac disease in developed countries, and there are already some successful business models in the U.S. This is the reason why this studies focuses on remote ECG monitoring. This study takes into account technology, patent, FDA regulations, markets, and industrial environment aspects. Usually, only markets and industrial environment would be taken into account in this kinds of theses. Technology, patents, and FDA regulations, however, may have significant impact on business. The purpose of this essay is to advice to Taiwan, by comparing the difference between the U.S. model and Taiwan model, and analyzing two cases, LifeWatch AG and CardioNet, Inc.. According to the above surveys, remote ECG monitoring is mostly used for diagnosis. The key factor is the well-built U.S. medical system. The U.S. governmental health insurance, the Medicare, has huge influence on remote the ECG monitoring industry. The medical treatment system is open and well-governed, and suits for incubating new products. Although the medical system is relatively conservative in Taiwan, it is recommended that the Taiwan government should create some mechanisms that will encourage innovative telemedicine services. There are two reasons that make remote ECG monitoring services in Taiwan is not as successful as those in the U.S. Firstly, the services are provided by hospitals. Hospitals are conservative, and services doctors are expensive. So, there are less innovative business models, and the costs rocket high. Monitoring centers should be set outside the hospitals. Secondly, patients don’t “feel” the benefit from monitoring ECG constantly, so usually they quit the services in the second month. Therefore, marketing and promotion should be taking place. Services and prices should be more flexible and cost-effective as well. At this moment, the biggest challenge of remote ECG monitoring is business model, not technology, FDA regulations, or even patents
15

遠距居家照護系統應用之實證研究 / The study of the application to the telehomecare system

徐仁熙 Unknown Date (has links)
台灣正逐步邁向高齡化社會,慢性疾病的人口增加,連帶著醫療費用高漲,導致全民健保財務收支失衡,可預見健保制度必須在未來有所改變,並且逐漸以品質及預防為重。由於疾病型態逐漸由「急性」轉為「慢性」。國民對醫療照護之需求將由「治療」轉為「治療與照護並重」。整體醫療型態的改變,加上國內資訊通訊產業發達,醫療器材產業的發展,遠端醫療照護的前景十分看好。國內過去遠距醫療服務的研究,多著重於趨勢與未來商機,較少有臨床效果的研究,且多闡述技術發展,對服務系統的建置與運作較少著墨。本研究提出國內一家遠距居家照護的營運個案,由醫院、資通訊業者以及醫療器材廠商合作共同發展的「高齡者照護服務平台」。此服務平台整合了醫療服務端、設備端以及系統端,且以醫院服務端為主導,對生理訊號進行監測。個案可於家中自行依據醫師建議量測生理訊號,或是於安養中心由照護人員量測,由量測器材經RFID手環身分辨識後透過網路,自動將生理訊號,傳遞至「照護服務平台」資訊系統,並由醫院Call center做生理資訊之監控及異常事件回應。資訊分析結果,可提供醫院醫療團隊或在地開業醫師,作為醫療照護服務之參考。在一年的期間,有287位個案安裝遠距居家照護系統,包含長照機構50位住民與家居使用者237位,續監測血壓及血糖變化。使用成效上,健康常事件發生率從第一個月的36.6%下降至第六個月的32.2%;糖尿病患的平均血糖值,由159mg/dl降至151mg/dl;糖化血色素HbA1C由8.36%下降至8.05%;平均血壓值的波動減少漸趨穩定。半年內平均住院天數由1.23天下降至0.97天,降幅達21%;平均每人每半年醫療費用支出減少3,514元;使用者滿意度調查結果滿意與非常滿意的達81%。至於建置及使用成本,若能達每月6000人的使用人數,每月之器材及資通訊系統成本約650元。使用的醫師認為遠距居家照護所帶來的益處為:1.對慢性病照護有實質幫助,2.醫師可以隨時關懷病患,3.更良好的醫病關係,4.提升門診品質。至於使用本服務平台的費用,72%的使用者傾向支付小於500元的月費。使用者期望付最低的費用而享有遠距居家照護服務是可預期的結果。但也使得長期營運維持不易。可能的解決方案有:1.開發新的使用情境,在原有基礎上產生更大的服務價值,2. 以創新的應用情境,導入「家庭病房,遠端管理」的服務概念,讓留院觀察的時間縮短,縮短總住院天數。不僅減少健保醫療費用支出,也增加醫院收入的雙贏局面。未來長期照護保險納入遠距照護並實施,將可帶動整體產業的發展。政府也應鼓勵長期、大型的遠距照護服務計畫,讓國人享有更好的健康照護。
16

轉型長期照護導向營運模式之研究-以地區醫院為例 / A case study of long-term care oriented operational mode of transformation : an example of a local hospital

李明勇, Lee, Ming Yung Unknown Date (has links)
在分級醫療體制三段五級規劃中,地區醫院肩負診所、醫學中心轉診重要樞紐,扮演橋樑的重要角色。台灣的地區醫院在健保實施的20多年來,減少2百多家,而大型醫學及診所的數量卻大增,加上民眾不論大小病都愛跑大型醫院、健保給付有利大型醫院、和護理人力荒及一例一休勞基法的規範,都是造成現在地區醫院經營困難的主要原因。目前地區醫院仍無力與大醫院競爭,多以收治慢性照護患者為主,不再扮演大醫院和診所間的橋樑角色。政府部門也注意到這個問題,近年來開始推動醫療資源垂直整合,針對中風病患等急性後期照護患者,讓患者在大醫院接受完急性期治療後,再回到原先看診的地區醫院慢性復健治療,除了讓民眾獲得妥善照護,也盼扭轉民眾就醫的習慣,提升地區醫院的角色及地位,但成效不彰。 K地區醫院也面臨著目前的健保困境,和經營瓶頸的問題,加上今年實施的長期照護法又將影響台灣的醫療環境與生態,K地區醫院必須提早因應。K地區醫院須考慮如何利用本身的優勢,在外在環境的改變下(例如人口老化及長期照護法的實施),去利用內外部的資源,進行醫院組織變革,以擬定經營策略使危機變為轉機,讓長期照護成為發展轉型的助力。 本研究即在探討K地區醫院為了改變現狀,針對本身的資源與能力、願景與目標和外在環境的政府政策及地區需求,並參考標竿醫院,所提出的一個解決方案-轉型長期照護導向的營運模式,期能達到醫院永續發展的目標。K地區醫院採用的長期照護導向策略是運用醫學中心急重症醫療支援作為後盾,並結盟長照機構,深耕社區營造與健康促進,落實社區慢性疾病的管理,建立部門負責以長照為導向的組織營運模式。
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建置電子健康照護服務之績效評量架構 / Assessing the performance of e-Health service

王育聖, Wang, Yu Sheng Unknown Date (has links)
This study develops quality evaluation criteria that consider both service provider satisfaction and patient perspective in assessing e-Health services; additionally, it evaluates the impact of these criteria on the performance of e-Health services. Utilizing data from the Tele Care Center in National Taiwan University Hospital (NTUH), one of the largest hospitals in Taiwan, this research framework extends the service-profit chain by integrating service triangle concept and emphasizing the relationships among three stakeholders: the firm, the customer, and the employee. The results suggest that the positive relationships among hospital’s business value, physicians’ value, and patients’ value can contribute to customer retention. In sum, this study expects to contribute to literature by providing an e-Health service performance assessment framework, which systematically develops a scale to evaluate e-Health service quality that concerns multiple stakeholders’ perspectives.
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台灣新熟年族群選擇老年居住方式之研究 / The study of the middle-aged generation's perspective on the choices of residential after retirement in Taiwan

陳斐娟 Unknown Date (has links)
近年隨著國人「養兒防老」的觀念式微,越來越多老年人傾向與配偶一起生活而不與子女同住,老年人居住安排不再拘泥於傳統上與子女共居的型式。老年人口的增加及家庭結構型態轉變,使家庭原本功能產生變化,進而影響老年人的居住安排。國內外已有許多相關研究進行老年人居住選擇因素的探討,但對於45-64歲新熟年族群則未見探討,因為每個世代的觀念不同,其所面臨的課題也有所不同,故影響居住型態選擇情形也不完全相同。希望能透過本研究之進行,瞭解影響新熟年族群選擇老年居住方式的相關因子為何,提早規劃理想居住方式,並作為政府、社會及民間企業針對未來新熟年族居住安排及福利相關措施。 本研究導入多元邏吉斯迴歸分析,研究自變數(包含性別、年齡、居住區域別、婚姻現況、教育程度、健康狀態、收入(元)、主要經濟來源、規劃未來養老經濟來源等人口學變項,以及工作身分和工作職務等工作變項)對依變數(養老居住方式)間的關係。研究結果顯示,新熟年族群的居住安排與婚姻現況、教育程度、主要經濟來源、健康狀態及居住區域有關。若新熟年族群的年紀越大、有配偶,則越傾向於與晚輩同住;但若新熟年族群的教育程度越高則越傾向於獨居;新熟年族群若無配偶且自覺健康狀況不好但有規劃未來養老經濟者,則較傾向於住進安養機構。此結果可提供政府、社會及民間企業規劃未來新熟年族之社會安養照護政策的參考依據。
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高齡者照顧機構之損害賠償責任 —以臺日照顧事故判決之比較為中心 / The Liability for damages of elder care facilities- focusing on judgments about care accidents in R.O.C and Japan

洪懷舒 Unknown Date (has links)
在高齡化的潮流下,對於高齡者照顧機構的需求與日俱增,受照顧者在照顧機構內發生事故的案例也隨之增加。然而,我國對於高齡者照顧機構損害賠償責任之討論卻相對稀少。本文以事故類型化我國判決,並透過日本法相同類型之判決內容加以比較,得出以下結論:一、各事故類型之主要爭點及照顧機構之具體義務,亦即事故發生前之照顧義務,以及事故發生後之處理、急救義務內容。二、我國有消費者保護法無過失服務責任可資主張,但僅限於非醫療輔助行為之照顧行為。三、照顧機構對於無責任能力之受照顧者所造成之他人損害,日本有成立監督義務者責任之可能。三、與有過失於照顧事故中適用之前提要件,應僅限於受照顧者有積極不為防範之行為之情形。   觀諸我國照顧事故之判決,法院認定照顧機構成立責任者,多為照顧機構實際提供受照顧者之照顧服務行為上有所疏失之情形。因此在涉及受照顧者疾病感染或復發、因其他受照顧者行為所致之事故類型中,法院多以臨床標準為判斷基準,並限縮因果關係之解釋,減輕照顧機構所課與之注意義務,進而否定照顧機構有義務之違反。   相較於此,在日本照顧事故之判決中,法院著眼於照顧契約之保護照顧義務,認定設施方負有確保受照顧者生命、身體安全不致發生損害之義務,進而判斷具體個案中受照顧者方所主張違反之義務是否屬於前述設施方之義務範圍內,再加以審酌設施方有無預見及防免之可能,以認定設施方是否成立責任。又法院雖賦予設施方較高之注意義務,卻將所認定之損害賠償額控制在較低之標準,因此課與設施方之責任亦非過重。   因受照顧者身處設施方緊密控制之封閉組織內,仰賴設施方提供服務,設施方於契約締結、履行,乃至於終結,均處於較受照顧者更為優勢之地位。因此,我國若同日本,採取以保護照顧義務架構設施方之責任依據,並寬認設施方所負確保受照顧者生命、身體安全不致發生損害之義務範圍,再由設施方舉證證明其不具有預見事故發生及防免之可能,對受照顧者之保護應較為周全。
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銀髮族的智慧穿戴服務設計 / A Service Design of Smart Wearable Device for Seniors

葉致豪, Yeh, Chih Hao Unknown Date (has links)
本論文研究專注於研究穿戴科技對於銀髮族遠距照護服務創新的可能性,利用系統思維與設計思維的研究方法來進行服務設計。研究問題設定為”一個罹患慢性病並獨自在家生活的銀髮族,如何自主健康生活,並能讓家人感到安心呢” 。透過顧客驅動價值共創的服務設計模型,確認利害關係人,並實際訪談利害關係人後深入分析使用者潛在問題及需求,以不同視角來找出創新的洞見。依據此洞見來發展可行的方案,並展開成為完整的服務系統,再將此服務系統雛型具體化產出後進行風險分析。最終的研究結果以商業模式草圖來呈現完整的商業模式。 / The aim of this thesis is to study the possibility of the wearable technology and to create a service innovation toward the tele-health for elders. The research method of the service design is based on the design thinking and the system thinking.We set up a hypothetical situation as follows: A solitary elder who has chronic diseases knows to how to manage her/ his life well without making the family worry. Through the service design models from the co-creation of the customer empowerment, we affirm the stakeholder at the beginning and then interview her/ him to get to know more about the needs and some main details. The purpose is to look for the insight into the innovation in different aspects. Based on this insight, we start a feasible plan and develop the integrity of the service design. Next thing we externalize the service design prototype and provide the follow-up risk assessment.As the final result, we use business model canvas to bring out the coherence and the integrity to our business models.

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