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The policy-making, implemention and outcomes of referral and the hierarchy of medical care policy in Taiwan
No full text轉診制度與分級醫療一直是一個很受重視的政策問題，這樣的制度可以使我們得到完整且持續的醫療照護，也可以使得醫療資源的使用更有效率，但至今仍無令人滿意的結果。因此本研究以政策分析的方式，希望能達到下列研究目的：（一）瞭解從過去到現在，轉診制度及分級醫療的概念或理念。（二）整理轉診制度及分級醫療發展歷程、政策制訂目的及成效評估。（三）瞭解轉診制度及分級醫療目前的實施概況、推動策略及未來成效預估，並提出政策建議。
研究方法為檔案分析法，政策分析的模式，以W. N. Dunn所建構「以問題為中心的政策分析模式」（problem-centered policy analysis）為主，並將利害關係人加入分析架構。
結果發現我國轉診及分級醫療的相關政策，可分為勞保時期、醫療網時期、健保開辦至2000年和2000年以後四個時期，轉診制度及分級醫療在各個時期被賦予的意義不同。並提出對於衛生主管機關、中央健康保險局及醫療提供者的政策建議。The referral system and the hierarchy of medical services are importanr policy. The referral system and the hierarchy of medical services may help people to obtain comnplete and continual health cars, to allocate the medical resources more efficiently. But the policy of the referral system and the hierarchy of medical services have not been implemented in Taiwan. The purpose of the study includes: 1. to identify the meaning of referral system and the hierarchy of medical services in the past and nowadays. 2. to study the referral system and the hierarchy of medical services, the policy purposes and policy assessment. 3. to analysis policy objectives, the policy strategies and policy suggestions.
The method of this study is archives analysis and the model of policy analysis is the problem-centered policy analysis by W. N. Dunn. The analysis framework is also inclueded the analysis of stakeholers.
The main result is that the referral system and the hierarchy of medical services were separated into four periods: Labor Insurante, Medical Care Network Program, the National Health Insurance in 1995 until 2000 and the National Health Insurance after 2000. The policy meanings were differenc in each period. Base on the study results, we purpose some policy suggestions for the government, the Bureau of National Health Insurance and the providers of health care serices.第一章 緒論 1
第一節 研究動機及目的 1
一、研究動機 1
二、研究背景 2
三、研究目的 4
第二節 研究方法及資料蒐集方式 5
一、研究方法 5
二、資料蒐集方式及轉診範圍的界定 6
第三節 研究問題、研究流程及架構 7
一、研究問題 7
二、研究流程 8
三、研究架構 9
第四節 預期成果及貢獻 10
第五節 研究限制 10
第二章 轉診與分級醫療的意義及發展歷程 12
第一節 學理上的意涵 12
一、轉診 13
二、分級醫療 17
第二節 各國推行轉診制度及分級醫療的發展背景及歷程 22
一、醫療體系發展歷程 22
二、各國轉診制度及分級醫療概況簡述 22
三、小結 36
第三章 台灣轉診制度及分級醫療相關的政策發展歷程 37
第一節 台灣健康照護體系發展的簡介 37
一、公共衛生時期（1945年至1970年） 38
二、醫療體系發展時期（1971年至1984年） 38
三、健康照護體系整合期（1985年至1994年） 38
四、健康照護服務與財務整合期（1995年至今） 39
第二節 公務人員保險及勞工保險時期（1958年至1986年） 39
一、政策發展簡介 39
二、轉診制度 41
二、部分負擔制度的規劃 48
第三節 醫療網計畫（1986年至2004年） 49
一、醫療網計畫的提出 49
二、醫療網計畫的分期及目的 49
三、醫院評鑑扮演的角色 50
第四節 全民健康保險開辦後（1995年起） 51
一、實施全民健保的前提 51
二、規劃全民健保時期 52
三、實施部分負擔制度，推動分級轉診制度 56
四、李明亮署長的重要施政方向—轉診制度、醫院合理門診量 60
五、總額制度下的轉診與分級醫療 62
六、部分負擔的再次調整 63
七、家庭醫師制度 65
八、全國醫療政策會議及後SARS健保體系改造計畫 66
第四章 台灣過去轉診制度及分級醫療相關的政策分析 71
第一節 勞保時期的轉診與分級醫療制度 72
一、背景及面臨的問題 72
二、政策的提出及修正 74
三、政策的成效與評論 76
第二節 醫療網時期的轉診與分級醫療制度 78
一、背景及面臨的問題 78
二、政策的提出及修正 80
三、政策的成效與評論 81
第三節 健保開辦至2000年的轉診與分級醫療制度 87
一、背景及面臨的問題 87
二、政策的提出及修正 89
三、政策的成效與評論 91
第四節 2000年之後轉診及分級醫療制度 94
一、背景及面臨的問題 94
二、各項政策的提出 94
三、實施成效的預估 98
第五節 轉診及分級醫療未能落實的原因剖析 100
一、相關研究結果 100
二、歸納分析轉診與分級醫療未見落實的原因 103
第五章 台灣無法建立轉診制度及分級醫療之原因探討 107
第一節 民眾的行為及態度 108
一、民眾的就醫行為 108
二、民眾對轉診及分級醫療的態度 115
第二節 醫界對轉診與分級醫療的態度 121
一、醫院經營者 121
二、基層醫師 123
三、其他 124
四、小結 125
第三節 勞工團體對轉診的態度 125
第四節 專家學者的看法 126
一、勞保時期 126
二、健保時期 127
第六章 結論與建議 130
第一節 結論 130
第二節 討論 133
一、政策制訂與修正的理論詮釋 133
二、推動轉診及分級醫療的策略演變 134
三、轉診與分級醫療在台灣的意義 135
第三節 政策建議 135
一、對衛生主管機關的建議 136
二、對中央健康保險局的建議 137
三、對醫療提供者的建議 137
參考文獻 138
英文部分 138
中文部分 14
Research on Offset Quadrature-Quadrature Phase Shift Keying Signal
No full text本篇論文提出一對較為平滑（smoother）且相互正交的資料成形脈波（data shaping pulse），使偏移正交-正交相位鍵移調變（offset quadrature-quadrature phase shift keying, OQ2PSK）訊號具備頻譜旁波（spectral sidelobe）快速衰減的特性，能達到比Saha和Chung的正交-正交相位鍵移調變更高的頻譜緊密度與頻譜效率（spectral efficiency），且可確保頻譜旁波以f-2(N+M)-2以上的速度在衰減，其中N和M為與訊號的資料成形脈波有關。在論文中將與Saha及Chung的系統就頻帶外功率比例（fractional out-of-band power）與峰值對平均功率比（peak-to-average power ratio, PAPR）來互相比較。
同時我們在論文中探討偏移正交-正交相位鍵移調變訊號在通過加成性白高斯雜訊（addictive white Gaussian noise，AWGN）通道及多重路徑雷力衰減（multipath Rayleigh fading）通道下之效能分析。在多重路徑雷力衰減通道下中，偏移正交-正交相位鍵移調變訊號將會引起碼際戶擾（inter-symbol interference, ISI）及相互碼際戶擾（cross-symbol interference, CSI）而影響系統效能，這些效應的大小與訊號的資料成形脈波有關，在論文最後將與Chung的系統比較位元錯誤率（bit error probability）。In this thesis, we propose a much smoother data shaping pulse pairs for offset quadrature-quadrature phase shift keying. Thus, offset quadrature-quadrature phase shift keying provides higher spectral compactness and spectral efficiency than CL-Q2PSK and SB-Q2PSK. Because offset quadrature-quadrature phase shift keying meets the fast sidelobe-decaying constraint, it ensures the power spectral sidelobe decaying asymptotically with f-2(N+M)-2 as f approaches infinity. We compare the fractional out-of-band power and peak-to-average power ratio with SB-Q2PSK and CL-Q2PSK in the thesis.
Meanwhile, the error performance over additive white Gaussian noise channel and multipath Rayleigh fading channel will be analyzed in this thesis. In the multipath fading channel, the error performance of offset quadrature-quadrature phase shift keying will be influenced by inter-symbol interference and cross-symbol interference related to the data shaping pulse. We will compare the error performance with CL-Q2PSK in the end
Integration of the Higher Education Industry in Taiwan
No full text台灣高等教育產業正面臨來自外部的衝擊，如總體經濟情勢變化、國際化、少子化現象，以及內部衝擊，如各校資源分配不均；私校倒閉、報到率降低的困境隨之而來。教育部因此加快學校整併的腳步，使學校資源能有效運用。然而在整併過程中，教職員工去留將會成為整併的一大問題；再者，各大專院校經營模式、教學風格亦自成一格，整併後的發展方向統合也會因為原校風格差異而多有阻礙。 如何解決這樣困境？除政府擬定長期教育政策、媒合兩家以上大專院校整併以達到規模經濟外，各校亦可在國際化招生、開辦進修推廣部課程等面向上進行多角化經營，開拓校內各個項目經費財源。在教育部主導七大公立大學合併案中，有四案推行順利，這樣成果表示政府推動對大專院校整併有很大一部分影響力，而若能解決雙方對於人力資源、經費等配置的意見不一致，合併案順利推行的可能性即可提高。 本研究從相關文獻了解企業組織間的合併與多角化經營之理論及型態，進而探討台灣高等教育產業的過去與現況，研究高教產業之內外部需求，並整理台灣高教產業過去資源整合案例，由歷史數據與質化資料解釋高教組織整併與多角化發展的必要性與未來經營模式的參考方向。Standing on the macro side, there are different kinds of changing pounding higher educational industry in Taiwan, like overall economic situation, internationalization or the tendency to have fewer children. On the other side, universities and colleges are under attack of uneven distribution of resources, closure of private schools and the plight of registration rate reduction. Government tries to save education institutions from various dilemmas but more problems rise up, for instance, staff placement, conflict views of school running and so on. How to resolve this difficulty? While ministry of education is busy at framing long-term education policy, universities could do their jobs on international enrollment, professional education and continuing studies to provision enough financial resources of multiple projects. Also, communication plays an important role in integration. To settle a dispute from two parties, like re-allocation of human resources, is to increase possibility of fulfilling merging case without a hitch. In this study, I try to arrange reference documents to understand theories and patterns combined with the diversification of organizations, thus to discuss with the past and status of higher education industry in Taiwan. Moreover, by studying demand side of education industry and finishing resource integration cases in this field, I would attempt to explain the need of merging and diversification development and provide some future directions
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
職災補償制度之國際比較及台灣制度之改革方向
No full text社會安全制度旨在確保人民的基本生存權，其中，職災補償救濟乃是先進國家中最早 出現的社會安全制度之一。為瞭解職災補償制度的核心精神，以釐清台灣職災補償制 度的問題與改革方向，本文回顧國際間職災補償制度之發展歷史以及國際勞工組織相 關公約，並選取特定國家，比較其法源依據、行政組織、涵蓋人口範圍、財源、給付 內容與給付方式等。從國際比較分析可發現，台灣職災補償制度的問題包括：相關法 規分散、缺乏專責於職災保護制度的主管機構、職災補償制度未涵蓋所有受僱者、保 險費率偏低、給付不足、健保代辦職災醫療給付而造成部份的職災門診醫療被全民健 保吸收。我們建議，台灣職災社會保險制度應獨立立法且應設置獨立的業務專責機關 ；此外，職災保險應涵蓋所有受僱者、應強化職災預防之誘因機制、應適當提昇給付 額度與範圍，並應與健保醫療照顧制度作適度區隔。 The purpose of social security is to ensure people's basic right to existence. In the developed countries, workers' compensation is one of the oldest types of social security system. To better comprehend the problems of the current workers' compensation system in Taiwan, we reviewed the historical development of workers' compensation systems worldwide, as well as the related conventions adopted by the International Labor Organization. In addition, we compared workers' compensation schemes in selected countries with regard to legislative framework, administrative organization , coverage of workforce, source of funds, and content and means of delivery of benefits . Based on international comparative analyses, we concluded that the problems with the workers' compensation system in Taiwan include: a complicated legislative framework with multiple laws and regulations, lack of an administrative authority specializing in workers' compensation, exclusion of some employees from the coverage, low premium rates, insufficient benefits, and inadequate coordination with the national health services and other social security systems. We suggest that changes in the legislative framework and administrative infrastructure should be the priorities in policy reform. In addition, the workers' compensation system should cover all salaried employees, incentive mechanisms for prevention should be strengthened, benefits provided should be adjusted and the benefit levels raised, and a clear line should be drawn between medical care services offered by the workers' compensation system and the National Health Insurance
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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