臺灣版診斷關聯群制度接受意圖關鍵影響因素探討

Key Factors Influencing Intention to Accept “Taiwan Diagnosis-Related Groups”

本研究目的為探討臺灣版診斷關聯群制度Taiwan Diagnosis-Related Groups, Tw-DRGs實施後，影響利害關係人接受Tw-DRGs的主要因素。經文獻回顧顯示利害關係人受到的主要衝擊為住院天數限制，本研究方法以臺北市某區域醫院之骨科進行質性訪談該科不同疾病類別的病患，收集可能影響接受意圖的原因，再用量化分析來驗證變數間的關係。本研究以計畫行為理論為基礎來推導假說，研究結果顯示利害關係人的安全感及所感受到的服務品質為影響對行為的態度之主要變數，而正向影響一般民眾對於Tw-DRGs之住院天數限制接受意圖的因素則為對Tw-DRGs之住院日控制的態度、醫護人員或者利害關係人身邊的重要他人對Tw-DRGs之住院天數限制的看法或者接受程度、面臨到住院天數限制情況時是否有足夠資源或能力去應付。醫院體系應試圖提升利害關係人正面感受，期許研究結果可提供為現今Tw-DRGs之住院天數規範下醫院體系的因應策略參考，期望使健保政策改革更適用於我國醫療體系。 This study investigates the key factors that affect stakeholders’ intention to accept Taiwan Diagnosis-Related Groups (Tw-DRGs). The literature shows that the factor most strongly influence the acceptance of Tw-DRGs is the length of hospital stay policy. Participants in the qualitative interview included patients in the orthopedic department of a Taipei regional hospital and their companions during their hospital stay. Factors that affect the intention to accept the length of hospital stay were explored in this study, and the relationships among them were verified using quantitative analysis. This study uses the theory of planned behavior to develop the hypotheses. The research results show that the sense of security and perceived service quality of the stakeholders are the main factors influencing attitude and behavior. The results also show that both have a positive influence on the intention to accept the limited length of hospital stay of Tw-DRGs. Other factors that may affect the intention to accept are the following: (1) attitude toward control of the length of hospital stay; (2) perception of the limited length of stay by patients’ relatives or companions in the hospital; and (3) financial capacity to cope with the extended hospital stay once the length of stay has been reached. The hospital system should improve the attitudes of stakeholders’ regarding policies on Tw-DRGs. This study can help hospitals understand how to encourage patients to accept Tw-DRG policies on the length of hospital stays. This study can deliver some positive advices to make policy in Tw-DRGs more applicable to Taiwan’s medical policy system. Furthermore, the results can guide decision-makers in effectively reforming Taiwan health insurance policy.

This study investigates the key factors that affect stakeholders’ intention to accept Taiwan Diagnosis-Related Groups (Tw-DRGs). The literature shows that the factor most strongly influence the acceptance of Tw-DRGs is the length of hospital stay policy. Participants in the qualitative interview included patients in the orthopedic department of a Taipei regional hospital and their companions during their hospital stay. Factors that affect the intention to accept the length of hospital stay were explored in this study, and the relationships among them were verified using quantitative analysis. This study uses the theory of planned behavior to develop the hypotheses. The research results show that the sense of security and perceived service quality of the stakeholders are the main factors influencing attitude and behavior. The results also show that both have a positive influence on the intention to accept the limited length of hospital stay of Tw-DRGs. Other factors that may affect the intention to accept are the following: (1) attitude toward control of the length of hospital stay; (2) perception of the limited length of stay by patients’ relatives or companions in the hospital; and (3) financial capacity to cope with the extended hospital stay once the length of stay has been reached. The hospital system should improve the attitudes of stakeholders’ regarding policies on Tw-DRGs. This study can help hospitals understand how to encourage patients to accept Tw-DRG policies on the length of hospital stays. This study can deliver some positive advices to make policy in Tw-DRGs more applicable to Taiwan’s medical policy system. Furthermore, the results can guide decision-makers in effectively reforming Taiwan health insurance policy.