總額支付制度實施後醫院的適應策略分析

Adaptation Strategies of Hospitals under the Global Budget System

黃國哲(Kuo-Cherh Huang) ； 陳怡樺(Yi-Hua Chen) ； 張蕙芝(Hui-Chih Chang) ； 張維容(Wei-Jung Chang) ； 溫信財(Hsyien-Chia Wen) ； 邱瓊萱(Chiung-Hsuan Chiu)

《台灣公共衛生雜誌》 26卷4期 (2007/08) Pp. 283-291

https://doi.org/10.6288/TJPH2007-26-04-05

摘要

目標：本論文旨在探討國內醫院在總額支付制度實施後所採取的適應策略，並分析影響醫院採取不同類型的適應策略之因素。方法：本研究以加入全民健保特約並通過醫院評鑑屬地區醫院層級（含）以上之醫院為研究母群體，合計462家受訪醫院（民國九十三年度的評鑑資料）。研究人員於民國九十四年三月下旬向上述醫院寄發結構式問卷，問卷詢問對象則設定為受訪醫院的院長等高階經營主管，最後的有效回覆問卷數計有194份(42.0%)。結果：依據因素分析的結果將回覆醫院所採取的適應策略分為市場導向及資源基礎策略兩類，累計可解釋總變異量的64.02%。樣本醫院所採取的適應策略是市場導向策略為主流。另一方面，醫院評鑑等級、醫院權屬別及是否屬於教學醫院等變項對於醫院採取市場導向策略則具有顯著性的影響力。結論：實證結果顯示，國內醫院在總額支付制度實施後所採取的適應策略，是以顧客為主的市場導向策略為主，而醫院屬性則對於醫院採取市場導向策略的傾向具有顯著性的影響力。

關鍵字

適應策略 ； 市場導向策略 ； 資源基礎策略

並列摘要

Objectives: The current study aimed to explore adaptation strategies utilized by Taiwan's hospitals under the global budget system and examine the factors which influence the types of adaptation strategies among the various hospitals. Methods: The study population included all 462 district (and higher level) hospitals in Taiwan using 2004 data. Structured questionnaires were mailed to the responsible management personnel for the hospitals in late March 2005. After two rounds of mailing, the final effective sample size was 194, with an effective response rate of 42.0%. Results: The results of factor analysis identified two types of adaptation strategies: 1) market-oriented strategy and 2) resource-based. The total explained variance by the two factors was 64.02%. Moreover, the sample hospitals were more likely to execute market-oriented strategies. Predictive factors of a hospital carrying out market-oriented strategies included hospital ownership, the level of the hospital, and the hospital's teaching status. Conclusions: The empirical research has demonstrated that Taiwan's hospitals employ adaptation strategies which are market-oriented and resource-based under the global budget system, and the former strategy is more prevalent. Moreover, hospital characteristics are related to a hospital's adoption of market-oriented strategies.

並列關鍵字

Adaptation strategy ； Market-oriented strategy ； Resource-based strategy

參考文獻

陳婉茗、吳肖琪(2005)。模擬DRGs實施對我國醫院的財務衝擊。台灣衛誌。24，306-314。

李靜玟、吳肖琪(2005)。市場競爭及其他因素對精神科急性住院病患醫療利用之影響。台灣衛誌。24，296-305。

Barney J(1991).Firm resources and sustained competitive advantage.J Manage.17,99-120.

Beer M,Voelpel SC,Leibold M,Tekie EB(2005).Strategic management as organizational learning: developing fit and alignment through a disciplined process.Long Range Plan.38,445-465.

Birkinshaw J,Lingblad M(2005).Intrafirm competition and charter evolution in the multibusiness firm.Organ Sci.16,674-686.