有全民健康保險的民眾在出院後，健保申報單位會需要向健保署申請醫療費用。而健保申報作業流程中，會需要該病患住院時的相關資料，因此需要醫院各相關部門的協助。因為申報具有時效性，而健保規範相當繁瑣且時常異動更新，讓人員時常需要加班，而研究個案醫院的健保申報單位更因上述各項之作業管理問題，造成離職率高達100%。因此，健保申報作業流程的問題改善成為醫院管理上的重要課題。 在問題解決上常會遇到許多衝突，即使是管理問題也不例外，常為了改善A問題，而衍生出B問題。系統性創新TRIZ (萃智)為一有路徑可遵循的問題解決方法，透過問題分析，找出根源問題，再藉由TRIZ工具來提供可能之創新方法。本研究透過萃智中之物質場分析，進行健保申報作業流程與管理上之應用探討，經過近一年半的時間，提出各種問題改善方案，並證實這些方案可以有效解決各種問題，經過改善各項問題後，促使健保申報單位原有之100%離職率降逐漸降為0%。 The patients who have National Health Insurance have medical allowance for their medical treatment, so the health insurance application unit of hospitals need to claim the fee from National Health Insurance Administration. The declaration process needs patients' information during their stay in the hospital, so it needs all relevant departments' assistance. Therefore, employees of the hospitalization health insurance declaring process play the role of the final check. Because the declaration is time-sensitive, and the health insurance standard is rather cumbersome and frequently changes, staff often need to work overtime. Furthermore, the health insurance reporting unit of the case study hospital is due to the above-mentioned declaring management problems, resulting in a turnover rate up to 100%. Therefore, the improvement of the health insurance declaring process has become an important issue in hospital management. There are often many conflicts encountered in the resolution of problems, and even management problems are no exception. Often, in order to improve A, B arises. Systematic Innovation TRIZ is a path-based solution to problem solving. Through problem analysis, we can identify root causes and then use TRIZ tools to provide possible innovative approaches. This study explored the application process and management of health insurance declaration through the analysis of the substance-field in TRIZ. After nearly one and a half years, it proposed various problems improvement programs and confirmed that these programs can effectively solve various problems and improve. After improving all kinds of problems, the original 100% dropout rate of the health insurance application unit was gradually reduced to 0%.
