高科技醫療服務之評估－－以正子斷層造影為例

High Technology Health Service Assessment--An Example of Positron Emission Tomography

近年來，國內醫療機構面臨外在環境的急速改變，隨著消費者的期望增 加及醫療政策的改變，使得醫院為求生存及發展，必須開發自費項目以為因 應。因為高科技的發明提供醫療供給者許多診斷或治療疾病的方法，所以各 大醫院紛紛想購買高科技醫療設備，希望能提供大眾除了健係給付之外的醫 療產品及服務。一般醫院在探討高科技醫療設備採購多以成本效益或成本效 果分析法進行評估，然而醫療資源有限，如何選擇較好的評估方式，以避兔 醫療資源投資不當，進而影響到對氏眾提供的醫療服務品質。因此以「正子 斷層造影」為例，從Aday and Andersen（1974）健康系統模式中的「服務提供 體系的特徵」、「個人特徵」、「滿意度」以及「衛生服務的利用」等四個構 面來分析。由於此四個構面已完整合蓋了醫療服務的結構面、過程面和結果 面，因此可作為醫院在成立正子斷層造影中心之參考，並藉此類推到其他高 科技醫療服務之評估標準。

Recently, the health care industry in Taiwan is facing dramatic changes in external environment. As competitors, customer expectation and changes of medical policy increase, hospitals are now forced to seek ways to survive or to become industry leaders. As the result of hospitals wanting to stay competitive, they strive to purchase technologically advanced medical devices (though these devices often require customers to pay out-of-pocket) because innovations have given health service providers better means to diagnose and treat greater number of illnesses and health-related problems. This phenomenon of combining technology and health care are only partially based on cost-benefit or cost-effectiveness consideration. It is true that, due to medical resource limitations, hospitals have to consider the financial cost and benefit of any new device before spending on it. Nevertheless, hospitals also have to include in their assessments of any new medical devices, its greatest impact on service quality and health-related improvement, to better prioritize their budget plan. For instance, when our hospital was assessing before purchasing the positron emission tomography device, we used four elements of the health behavioral model (Lu Ann Aday and Ronald M. Andersen, 1974) to explain: (1) population characteristics, (2) health care system, (3) use of health services, and (4) consumer satisfaction that people have about health and health services that might influence their subsequent perceptions of need and use of health service. These four elements explain the structure, the process, and the outcome of the service that entails from using a medical device. When our hospital first instituted the positron emission tomography center, we used this model to assess, which could also serve as a reference for other hospitals familiar with this assessment model to assess other high technology health services.