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系統識別號 U0026-1501201509475200
論文名稱(中文) 全民健康保險論人計酬試辦計畫-建立忠誠病患挑選模型
論文名稱(英文) Trial Plan with Capitation Payment of the National Healthcare Insurance-Establish the Selective Model for Loyal Patients
校院名稱 成功大學
系所名稱(中) 會計學系
系所名稱(英) Department of Accountancy
學年度 103
學期 1
出版年 104
研究生(中文) 陳品燁
研究生(英文) Pin-Yeh Chen
學號 R16001352
學位類別 碩士
語文別 中文
論文頁數 44頁
口試委員 指導教授-徐立群
口試委員-陳政芳
口試委員-蕭鉢
中文關鍵字 論人計酬  RFM  忠誠病患 
英文關鍵字 capitation payment  RFM  loyal patients 
學科別分類
中文摘要 全民健保開辦接近二十年來對於改革支付制度不遺餘力,但改革內容缺乏足以影響提升醫療品質,還是著重在「價格」的控制。因此支付方式會造成醫療院所對於病患所提供醫療服務品質降低,且並無誘因促使醫療院所投入預防醫學與健康促進活動。而「論人計酬」是以「人」為支付單位,一旦「人」越健康,醫療院所得到的保險給付就越多。在論人支付制度下,醫療院所必須要承擔財務風險,因此醫療團隊必須控制服務量,才能維持醫療服務的品質與效率。基於此本研究擬探討此一相關議題,藉由醫院提供個別病患的就診記錄,利用 RFM 模型,進行病患持續就醫機率分析、預測病患未來是否持續忠誠及預測病患未來在此醫療院所之花費。期能經由機率分析,建構挑選忠誠病患之模型並研擬適當的行銷策略,作為醫療機構醫病關係管理的參考期待能提升醫院形象及強化經營效率。
英文摘要 The National Health Insurance System has spared no effort in the reform of the payment system since its inception nearly two decades ago. However, the content of the reform was deficient and affected the improvement of the quality of medical care. The reform emphasized price controls. Therefore, the method of payment will cause the quality of service of medical institutions to decrease and there would be nothing to induce medical institutions to provide preventive medicine and health promotion activities. Capitation regards Person as the unit of payment. Once Person is healthier, medical institutions will obtain more insurance benefits. Under a capitation system, medical institutions must bear the financial risks. Therefore, medical institutions must control the volume of services to maintain the quality and efficiency of its health care services. This paper aims to investigate the related issue. With individual patient’s medical records provided by hospitals, the Recency, Frequency, and Monetary Amount model is used to analyze the probability of continuing hospitalization of patients and to predict the continuing loyalty of patients to a particular medical institution in the future. Probability analysis can be used to establish a model to select which ones are the loyal patients and determine the proper marketing strategy as a medical doctor-patient relationship management reference to help enhance the image of the hospital and operation efficiency.
論文目次 摘要........................I
Trial Plan with Capitation Payment of the National Healthcare Insurance-Establish the Selective Model for Loyal Patients..............II
誌謝........................V
目錄........................VI
表目錄......................VIII
圖目錄......................IX
第壹章、緒論.................1
第一節、研究背景..............1
第二節、研究動機..............2
第三節、研究目的..............3
第四節、研究貢獻..............4
第五節、章節架構..............4
第貳章、文獻探討..............5
第一節、健保支付制度..........5
第二節、忠誠病患..............11
第三節、RFM..................13
第參章、研究方法..............15
第一節、研究假設..............15
第二節、病患持續就醫機率.......16
第三節、預測病患持續就診費用....16
第四節、忠誠病患..............17
第五節、預測之演算法...........17
第肆章、實證結果與分析........ 19
第一節、病患資料..............19
第二節、總體預測..............23
第三節、個體預測..............25
第四節、忠誠病患..............31
第伍章、討論..................40
第陸章、結論..................41
參考文獻.....................43
參考文獻 中央健康保險局(2005)。全民健康保險醫療費用協定委員會:全民健康保險醫療費用總額支付制度問答輯。
中央健康保險局(2011)。全民健康保險論人計酬試辦計畫。台北:行政院衛生署中央健康保險局。
林妍如、萬德和(2003)。健康照護組織之價值創造:整合性照護之基本概念與設計入門。雙葉書廊有限公司。
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