整合性健康照護系統

Integrated Delivery Systems

10.6288/TJPH2002-21-01-01

林恆慶(Herng-Ching Lin)；趙儷淨(Li-Jing Zhao)

管理式醫療 ； 整合性健康照護系統 ； 臨床整合 ； 功能整合 ； managed care ； IDSs ； clinical integration ； functional integration.

台灣公共衛生雜誌

21卷1期（2002 / 02 / 01）

1 - 8

繁體中文

從1990年開始，因為美國管理式醫療機構(Managed Care Organization)大量使用論人計酬制度來做為對醫療服務提供者的支付方式，而造成醫療服務提供者之間必須相互結合，以便能有足夠的納保人數來分擔財務風險，此種支付方式的改變，不但改變了醫療服務提供者之間的互動關係，也推動了整合性健康照護系統(Integrated Delivery System, IDS)在美國健康照護體系中的蓬勃發展。本文希望藉由介紹美國的整合性健康照護系統，能讓一般民眾更清楚的瞭解促成健康照護系統整合的動力、整合性健康照護系統的參與者及整合性健康照護系統的組成元素。 整合性健康照護系統的主要參與者包括醫師、醫院及保險公司。而整合性健康照護系統的組成元素可包括：臨床整合(Clinical integration)、功能整合(Functional integration)及醫師系統整合(Physician-system integration)。而臨床整合又包含了垂直整合(Vertical Integration)及水平整合(Horizontal Integration)，多家醫院系統(Multihospital system)即為水平整合中的一種。 整合性健康照護系統還一直在持續發展，所以它的模式及所提供的醫療服務，也因應市場的需求而不斷的在更新中，然而整合性輸送系統是否真能降低醫療成本及提供納保人最適當的連續性治療則還未有定論。這種大型整合性輸送系統的形成雖然可以帶給民眾類似大型超級市場的所有服務，但是它也容易造成醫療市場的壟斷。在醫療機構的整合過程中迫切需要資訊系統的輔助，然而醫療機構之間資訊系統的連接往往跟不上整合的腳步，因此如何強化資訊系統實是整合過程中所面臨的最大挑戰。

Managed care organizations (MCOs) have been paying health providers through capitation since 1990s. Under the capitation system, financial risk has been shifted from the MCOs to providers. As a result, health providers including physicians and hospitals began to merge or consolidate to share the financial risk by increasing the number of enrollees. Thus, not only did payment through capitation change the health care delivery system in U.S., it also accelerated the development of Integrated Delivery Systems (IDSs). The purpose of this article is to introduce the forces behind the IDSs as well as their players and components. The major players in IDS include physicians, hospitals, and health plans. However, the role of health plan remains controversial. The IDSs is composed of both clinical integration and functional integration. Clinical integration also consists of vertical integration and horizontal integration. Multi-hospital system is one kind of horizontal integration. The development of IDSs is still in process. The players and components in IDSs are also changing with the demand in the health market. Whether IDSs can lead to cost containment remains unclear. In addition, although the IDSs can provide one-stop medical care shopping for enrollees, it is likely they will monopolize the health care market. How to keep the information system updated is also the greatest challenge for IDSs.

1. Appleby, C.(1997).Organized Chaos.Hospitals and Health Care Networks,71
2. Arndt, M., Bigelow, B.(1992).Vertical Integration in Hospitals: A Framework for Analysis.Medical Care Review,49
3. Balder, R. A.(1998).Managed Care.Worcester:Blackwell Science Ltd.
4. Brock, T. H., Kamoie, B. E.(2000).Partial Integration Raises Antitrust Concerns.Healthcare Financial Management,54(11)
5. Burns, L. R., Bazzoli, G. J., Dynan, L., Wholey, D. R.(1997).Managed Care, Market Stages, and Integrated Delivery Systems: Is There A Relationship?.Health Affairs,16(6)
6. Chandler, A. D.(1990).Scale and Scope: The Dynamics of Industrial Capitalism.Cambridge:Belknap Press of Harvard University Press.
7. Clement, J. P.(1988).Vertical Integration and Diversificaion of Acute Care Hospitals: Conceptual Definitions.Hospital and Health Services Administration,33(1)
8. Coddington, D. C., Ackerman, F. K., Moore, K. D.(2001).Setting the Record Straight: Physician Networking Is An Effective Strategy.Healthcare Financial Management,55
9. Colic, R. C.(1997).The Five Stages of Managed Care. Strategies for Providers, HMDs, and Suppliers..Illnois:Health Administration Press.
10. Drazen, E., Kueber, M.(1998).Mergers in Health Care: Avoiding Divorce IDS Style.Healthcare Financial Management,52
11. Edline, M.(2001).For the Modern IDS, Less is Often More.Managed Healthcare Executive,11
12. Engert, E. B., Emery, D. W.(1999).Integrated Delivery System: non fait accompli.Managed Care Quarterly,7(1)
13. Gillies, R. R., Shortell, S. M., Anderson, D. A., Mitchell, J. B., Morgan, K. L.(1996).Conceptualizing and Measuring Integration: Findings from the Health System Integration Study.Hospital and Health Services Administration,38(4)
14. Goldsmith, S. B.(1995).Managed Care.Gaithersburg:Aspen Publishers; Inc.
15. Kongstvedt, P.R.(2001).Essentials of Managed Care.Gaithersburg:Aspen Publishers; Inc.
16. Morrisey, M., Jeffrey, A., Lawton, R. B., Victoria, J.(1996).Managed Care and Physician/ Hospital Integration.Health Affairs,15(4)
17. Pinkerton S.(2000).Integrated Delivery Systems: What's Happening?.Nursing Economics,18
18. Pinkerton, S.(2000).Integrated Delivery Systems: Improving Loss Prevention.Nursing Economics,18
19. Scott, W. R., Ruef, M., Mendel, P. J., Caronna, C. A.(2000).Institutional Change and Healthcare Organizations.Chicago:The University of Chicago Press.
20. Shi, L., Singh, D. A.(1998).Delivering Health Care in America.Gaithersburg:Aspen Publishers; Inc.
21. Shinkman, R.(1999).Baptist System Close to Announcing Deals.Modern Healthcare,29
22. Shortell, S. M., Gillies, R. R., Anderson, D. A..Remaking Health Care in America: Building Organized Delivery System, 2nd ed.Gaithersburg:Aspen Publishers; Inc.
23. Shortell, S. M., Gillies, R. R., Anderson, D. A.(1996).Remaking Health Care in America: Building Organized Delivery Systems.Gaithersburg:Aspen Publishers, Inc.
24. Shortell, S. M., Gillies, R. R., Anderson, D. A.(1993).Creating Organized Delivery System: The Barriers and the Facilitators.Hospital and Health Services Administration,38(4)
25. Studin, I.(1996).Integrated Delivery Systems: The Edsel of Health Care.Medical Interface,9(6)
26. Weissenstein, E.(1993).HIAA (Health Insurance Association of America)-Led Group Starts Ad Push.Modern healthcare,23(17)

1. 潘淑雅(2017)。醫療資訊系統滿意度與生產力分析：醫師觀點。義守大學醫務管理學系學位論文。2017。1-93。