第四章 結 果
三、 研究限制
1、試辦計畫執行前無法將三家參與試辦單位所制定之目標予
一致性，而出現部份計畫目標無法量化測量，及無法明確 說明每一項量指標的操作型定義。
2、本研究參與試辦單位無法配合學術評估單位之需求填寫資 料，使得成本評估無法獲得較完整的資料分析。
3、三家試辦單位所使用的評估方法不同，目標也不一致，容 易造成多重目標間比較難以分析之困擾。
4、各試辦單位所使用指標不一致，定義混淆，造成試辦結果 之間指標無法比較。
第六章 結論與建議
本研究以國內北、中、南地區三家不同等級、不同屬性、不同 地區之不同層級的醫院分別進行全責護理照護模式試辦計畫，分 別針對不同照護模式進行分析，再將其執行成效與推動多年的台 北巿立聯合醫院作為比較，以推論實施全責護理所節省之人力成 本及提昇護理照護品質是否有其推廣性，並由成本分析中探討不 同照護模式確實有不同的推廣價值，並將經濟評估效益方式納入 試算，以作為日後政策推動之參考。
以表 16 顯示，以單一時間點由 1 位照顧服務員負責照顧 4 張 病床而言，其社會總效益及社會總成本較低於1 位照顧服務員負責照 顧2 張病床之效益及成本，高於 1 位照顧服務員負責照顧 6 張病床之 效益及成本，假如照顧費用全部由健保支出，則健保局每月必須支出 10 億 8 千萬元費用，其每月益本差為 2 億 9 千 8 百萬元，益本比為 1.275，是單一時間點由 1 位照顧服務員負責照顧 2 張病床或 6 張病 床之三個方案中益本差最大，益本比也最高的方案，因此是三種不同 照護人力之中最有效率的方案，但是，健保局必須每月支出 10 億 8 千萬元，相當於台灣地區的人民，每人每月必須多繳48.63 元健保費，
此一方案之所以可行，乃是因為台灣地區的人民，每人每月願意多繳 58.97 元健保費來支持這項政策。
本研究評估，以有意願參加的病患之收費作為試辦計畫或未來政 策推動照顧服務員經費之來源，應為現行制度執行比較具有可行性的 做法，不過，將照顧服務員指定派遣給繳費病患使用，病患感受的合 理性較高，但可能會因為病患通常無法集中在同一病房內由同一位照 顧服務員負責照護，而可能會出現照顧服務員與病患之間不容易配對 的問題，而因在未來政策推動上比較不容易執行。
如果以政策補助計畫投入經費作為計算基準，則每人次所投入的 計畫經費較高。如果病患同意自行支付費用，並且由病房護理人員指 揮調度所聘請之照顧服務員，病患可以擁有收費較低的優點，但病患 所接受照顧的感受合理性可能較低。如果照顧服務員來自於外包人力 公司所累積的回饋人力，這樣的安排病患有不必繳費的優點，但是，
以醫療體系現狀而言，其可行性較低。
但是，由另一個角度來看，如果政府進行試辦計畫成本效益分析 的目的，是嘗試評估全責護理模式由健保给付的可能性時，則不向病 患收費的模式，反而最接近民眾參與政策情境。但是，在試辦計畫的 執行上，單由外包公司所累積回饋的服務員人力在配置上與政策推動 上可能執行較為不足。
不過由於不同照護人力之方案其益本差均為正值，或者說益 本比均大於 1，是屬於可以推動的政策，如果醫療政策將此項計
畫之支付費用納入健保给付範圍，民眾願意繳交的健保費用高於 實施全責護理計畫所需之成本，推動全責護理照護活動，將是一 個政府單位、保險人、民眾、醫療人員各方均共同獲益的資源配 置，因此，以完善的「全責護理」取代家屬留院制度，建構全責 護理照護計畫提供全方位醫療照護品質，應是目前人口趨於高齡 化，社會健康需求改變，疾病形態漸趨複雜，所必須面對的重要 課題及克不容緩的重要工作。
建議事項：
一、計畫目標與資料蒐集：
(一)計畫書目標與執行成果目標不一致之問題，可以由由學術 評估單位與政府委託單位合作，於執行計畫開始前即組成專家學 者委員會，將試辦單位必須按期回報的資料予以規格化，再要求 試辦單位按期回報。
(二)資料取得執行過程，因為必須透過各試辦單位的人體試驗 委員會審核，才可取得相關統計資料，因此學術評估單位極可能 在耗費大量行政接洽與時間等待之後，才發現無法取得試辦單位 的資料，所以學術評估單位如果無法向政府委託單位合作取得該 項資料，則學術評估單位必須主動與試辦單位接洽，先瞭解試辦 單位之內部程序，以順利取得試辦單位內部行政統計資料。
二、計畫評估依據：
(一)由於各試辦單位所用方法不同，追求目標不一致，試辦計 畫所欲達成的多重目標之中，並未有主導性的目標存在，因此容 易造成多重目標之間比較上的困難。應於推動前即予以量化，在評 估方面較有一致性，此點，可作為未來政策推動的參考依據。
(二)各目標的定義在辦計畫之中未完全統一，因此進行成本 效果分析有一定程度的困難，後續的評估計畫應該考慮以執行內 容 分 析(implementation analysis)、 成 效 或 效 果 分 析 (effectiveness analysis)、成本效益分析(cost-benefit analysis)為主。
(三)每日到院陪病時間少於 4 小時者定義為「病患陪客率」，
值得作為二者不同區別之參考，其餘二家試辦單位並未將陪病率 與陪客分開計算及定義，未來政策推動後續評估計畫有必要訂出 更為周延的定義與更為明確的測量方式。
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