民眾對健保醫療品質資訊公開內容觀感之評估

Public assessment toward the disclosure of medical quality information

本研究以民眾角度探討健保醫療品質資訊公開內容，將研究分為三階段並設計出對應之研究方法。第一階段為檢測現今健保醫療品質資訊公開程度，其主要方式為多元資訊蒐集，包括：國內外文獻分析，彙整目前健保署已有之醫療品質公開資訊並確立完整資訊架構；第二階段評估民眾對健保醫療品質公開資訊需求，以問卷調查、焦點團體訪談等方法蒐集各階層民眾、專家學者對現行健保醫療品質資訊公開內容及特定議題提出感想與建議；第三階段給予健保醫療品質資訊公開的相關建議。本研究共回收575份有效問卷並完成四場焦點團體訪談會，研究結果針對現有民眾關心之醫療品質公開資訊提出以下建議：「住院案件出院後3日內同院所再急診率」及「同院所同日急診返診比率」在蒐集數據時以同一疾病別作為認定。「保險病床設置比率」部分新增各醫院自費、保險病床收費標準及醫院內自費項目說明。「急診轉住院暫留急診2日以上案件比率」結合「保險病床設置比率」，新增醫院過去每季病床佔床率與空床率，供民眾作為參考。整合民眾與專家意見後建議新增「護理人員／病床比例」、「醫師／病床比例」、「手術成功率（人工關節置換術）」、「新生兒死亡率」、「病人住院期間跌倒比率」等五項指標。

The purpose of this study was to explore NHI (National Health Insurance) quality information from the viewpoint of citizens. According to the purpose, the procedure was divided into three stages. The first stage is to examine how data publication of the medical quality operates currently in the National Health Insurance Administration Ministry of Health and Welfare. Multiple methods will be applied to collect data, including literature review and domestic and foreign resources. The present NHI quality information will be coordinated into categories. Research frame will be confirmed in the stage. The following stage was to evaluate the needs of citizens toward NHI quality information. Questionnaire and focus group interview were implemented to collect data from different people and scholars. Specific opinions and suggestions on data publication of the medical quality in the current National Health Insurance Administration Ministry of Health and Welfare will be recorded. In the final stage reports of the current circumstances and future improvements of the publication of the NHI quality information will be proposed according to the analyzed data. At the moment literature review was done. A total of 575 valid questionnaires were collected, and four focus group interviews were held. The following recommendations of the public concern of medical quality information were proposed: 1. When collecting the data of the measures “the re-emergency rate after discharging 3 days from the hospital” and “the re-emergency rate after discharging from the hospital”, it was recommended that the same disease was identified. 2. For the measure “the ratio of the insurance bed set in hospitals”, it was recommended that the charges of the insurance and non-insurance beds should be listed. A description of the non-insurance items within the hospital should be made. 3. It was recommended to integrate “the rate of staying over 2 days in the emergency room before hospitalization” and “the ratio of the insurance bed set in hospitals”. The rate of the occupancy bed and empty bed quarterly within hospitals should be listed as a reference for people. After analyzing data of the questionnaires and focus group discussion, 5 measures were proposed for the citizens, including “ratio of nursing staff / bed'', ''ratio of physician / bed”, “the survival rate of surgery (artificial joint replacement surgery)”, “neonatal mortality”, and “patient falls during hospitalization”.