2013-01-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657504摘要：照護連續性為健康照護體系的重要基石，目前已有回顧性研究證實照護連續性與照護結果之正向關係。在台灣，我們初步研究結果發現照護連續性除了可帶來較佳的照護結果外，亦可節省醫療費用。不適當用藥為健康照護體系重要的議題，特別是針對罹患多重慢性病的老年族群。然而，迄今照護連續性和不適當用藥之研究仍有許多尚待解決的問題，包含甚少探討照護連續性和用藥管理之相關，以及不適當用藥是否為照護連續性和照護結果之中介機制等研究。健康照護改革為世界各國關注的重要議題，其中健康保險的支付制度扮演一個重要的角色。論人計酬支付制度為美國健康照護服務組織的原型。相關研究指出論人計酬支付制度提高預防保健服務，反之降低醫療利用。然而，對於照護可近性和醫療品質仍未具有一致性的結論。健保局自2011年實施論人計酬方案，期能讓民眾得到更周全的整合性照護。該制度是否會提高民眾的照護品質和減緩醫療體系之財務負擔；照護連續性和不適當用藥是否為上述關係的中介機制，是一個值得探討的研究議題。因此，本計畫之目的和研究方法如下：(1)採用長期研究設計搭配傾向分數配對法，探討照護連續性對於不適當用藥的影響；(2)使用Baron和Kenny提出檢驗中介機制之模型，探討照護連續性、不適當用藥以及照護結果和醫療費用的關係；(3)採用自然實驗設計，探討論人計酬實施對於照護連續性和不適當用藥的影響；(4)採用自然實驗設計搭配Baron和Kenny之模型，探討論人計酬政策、照護連續性和不適當用藥與照護結果之關係。本計畫的研究結果，除了可填補目前在論人計酬制度、照護連續性、不適當用藥和照護結果與醫療費用之相關研究中的知識缺口外，相關實證發現亦可以做為政策制訂者在推行論人計酬支付制度之參考。<br> Abstract: Continuity of care is a significant hallmark of a healthcare delivery system. The positive effects of COC on healthcare outcomes are well-recognized in peer-reviewed articles. In Taiwan, our preliminary studies also indicate that better continuity of care can produce better healthcare outcomes and also save healthcare expenses. Potentially inappropriate prescription is an important issue in health care systems, especially for the elderly with multiple conditions. However, there are unsolved questions concerning the issues of continuity of care and potentially inappropriate prescription.Healthcare reform is an important issue around the world. Payment design under health insurance plays an influential role in health care reform. Health maintenance organization in the United States is one of the prototypes of capitation payment. Significant impacts have been reported such as reduced healthcare utilization and increased preventive services. However, the effects of capitation payment on access to care and quality of care were inconclusive. The Bureau of NHI introduced capitation payment which provides strong incentives for healthcare providers to provide integrated health care in 2011. Its impacts on healthcare outcomes and expenses need to be evaluated. Specific aim and research method include: (1) Examining the effects of continuity of care on potentially inappropriate prescription using a longitudinal study design with propensity score approach; (2) Investigating the medicating effects of potentially inappropriate prescription on the association between continuity of care and healthcare outcomes/expenses using Baron and Kenny’s strategy; (3) Analyzing the effects of the NHI capitation payment program on the changes of continuity of care and potentially inappropriate prescription, and evaluating the effects of NHI capitation payment program on healthcare outcomes and expenses using a natural experiment design; (4) Examining the mediating effect of continuity of care or potentially inappropriate prescription for the association between capitation payment program and healthcare outcomes as well as healthcare expenses using a natural experiment design with Baron and Kenny’s strategy.Findings from this research project may fill the knowledge gap of current literature concerning the relationship among capitation payment, continuity of care, potentially inappropriate prescription, and healthcare outcomes and expenses. In addition, findings from this study provide scientific evidence on the impact of the Taiwan’s capitation payment pilot program which is valuable to the policy makers for further decision.照護連續性不適當處方照護結果論人計酬實驗研究Continuity of CareInappropriate PrescriptionHealth OutcomeCapitationExperiment