全民健保醫療給付範圍的相關決策缺乏資訊公開性與參與性，引發許多醫療給付的糾紛案件，加上醫療資源有限，醫療需求隨國內人口平均餘命提升而增加，醫療資源優先配置的問題更顯其重要性。本研究建立一個合理的醫療資源優先配置決策程序評估架構，以改善目前國內資源優先配置決策程序，使用Daniels & Sabin(1997)所提出的「要求合理性的課則」（Accountability for Reasonableness）作為評估架構的主要構面，採用文獻分析法與層級分析法建構出一個完整的評估架構並且比較指標間的相互權重，接著使用深度訪談法試圖探索評估指標相對權重背後所代表的意涵。研究結果顯示醫事團體代表強調相關性與決策修正機會，政府代表則注重公開性與執行力，兩者對於醫療資源優先配置決策程序的期待有相當大的落差。基於研究發現，本研究主張應該增加協商機會以減少決策成員間的認知落差，帶動社會大眾對於資源優先配置的認識與參與，並針對目前決策程序的公開性、相關性、決策修正機會與執行力進行改善。 / The lack of information publicity and participation in the payment system of National Health Insurance (NHI) in Taiwan has been a critical issue. Besides numerous insurance payment disputations, the limited health resources and increasing health demand all call for an immediate solution to the problem of health resource priority setting in NHI.. This study aims to establish a systemic evaluative framework to improve on the health resources priority settings. In answer to the need, analytical hierarchy process and in-depth interviews have been conducted to develop a framework based on Accountability for Reasonableness. Qualitative and quantitative analysis of the surveys indicate some criteria and the meaning of the relative weight of each criterion. The results show a discrepancy between the governmental representatives and the healthcare organization ones on the expectation of health resources priority settings. The former focus on relevance, revision and appeals while the latter emphasize publicity and enforcement. According to the findings, this study suggests that an increase of negotiation is necessary to eliminate the discrepancy between the two groups. The government also need to introduce the public the idea of health resources priority settings and to modify the current procedure based on the four factors in Accountability for Reasonableness.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0095256022 |
| Creators | 蔡翔傑, Tsai, Hsiang-Chieh |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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