醫院委託經營與非委託經營管理績效之探討-以高雄市立醫院為例

研究目的本研究目的在比較8家高雄市立醫院於民國97至99年間之管理績效，並透過管理績效指標及影響其績效之因素對委託經營與非委託經營間之方式進行差異性研究，不僅可了解目前市立醫院營運現況，並可進一步探討市立醫院管理方式之效益並期望維持永續經營研究方法本研究係採用回溯性之次級資料分析方式，研究對象為位於高雄市之市立醫院，在排除1家99年方成立之醫院後，餘8家市立醫院納入本次研究樣本。研究資料則針對97年-99年間，該8家醫院之不同醫院規模、不同經營方式(委託經營及非委託經營)及不同人事結構資料對於管理績效(含醫療服務量、年度收支餘絀與重大儀器投資)進行比較及探討。本研究採用SPSS 19.0版本與JMP 9.0統計套軟體工具、進行資料整理與統計分析，主要的統計方法有描述性統計、獨立樣本t檢定、卡方檢定及無母數Mann Whitney分析。本研究之有效樣本為8家高雄市市立醫院，研究結果顯示在不同醫院規模中，區域醫院在服務量(329,754±163,905 v.s 140,999±61,693)及財務收支餘絀-扣除政府公務補助款(-114,601,501.10元±90,986,949 v.s 26,415.67元± 36,819.29)皆高於地區醫院並達統計上顯著差異。其中區域醫院內委託經營醫院之管理績效皆高於非委託經營醫院並達統計上顯著差異；另，綜合醫院之服務量(406,618±101,742 v.s 130,540±55,918)及重大儀器投資(19,656±17,037.90 v.s 2,173.80元 v.s 3,690.20)皆高於非綜合醫院達統計上顯著差異，而其中綜合醫院裡委託經營醫院管理績效皆高於非委託經營醫院並大部分達統計上顯著差異。非綜合醫院裡則僅有財務收支餘絀(扣除政府公務補助款)高於非委託經營醫院。在經營方式與醫院人事成本結構探討上，委託經營醫院在醫師、護理人員、醫事人員及行政人員與全院總人事成本的平均數均較非委託經營醫院低，其中護理人員與行政人員達統計上顯著差異，若將該兩類職等進行服務量與財務收支餘絀分析，則研究發現每增加一位護理人員可提高875.75次的服務量及346.05元的收入並有統計意義；另每增加一位行政人員可提高1,552.37次的服務量及提高585.38元的收入，並具統計意義。結論與建議現今台灣公、私立醫療院所雖以非營利機構著稱，但實際上也必須考量營運以維持永續經營，且在台灣有一定比例的公、私立醫療院所經常陷入經營不善之困境，尤其以公立醫院最為顯著。若以管理績效來探討醫院經營，建議市立醫院之財務支出餘絀應排除政府補助收入款，才可反應出經營上真實之管理績效。另持續建立市立醫院資料庫，進行高雄市內與市立醫院同等級醫院之管理績效資料收集再進行更大範圍的探討，例如是否委託由醫療體系經營之成效比較。

關鍵字

委託經營；市立醫院；管理績效；醫院規模；人事結構

並列摘要

Research purposes This study compares the performance of eight Kaohsiung municipal hospitals in the period 2008-2010. The indicators are identified to study the difference in performance and current operation status between contracted and public management of public hospitals. The effectiveness of management and the sustainability of operation are also discussed. Research Methods The study conducted a retrospective analysis of secondary data from eight Kaohsiung municipal hospitals, excluding the one established in 2010. The data included organizational scale, management type (contracted or public), personnel structure and performance indicators, such as service volume, finance (revenue, expenditure, surplus/deficit), and major equipment investment. All statistical tests were conducted using SPSS version 19.0 software, JMP 9.0, descriptive statistics, independent samples t-test, Chi-square test, and Mann-Whitney U test. Conclusions and recommendations The study included eight Kaohsiung municipal hospitals. The results showed the service volume (329,754±163,905 vs. 140,999±61,693) and fiscal surplus (-114,601,501.10 TWD±90,986,949 vs. 26,415.67 TWD± 36,819.29) of regional hospitals are statistically significantly higher than local hospitals. Among regional hospitals, the performance of private management is better than those of public management. The service volume (406,618±101,742 vs. 130,540±55,918) and major equipment investment (19,656 TWD±17,037.90 vs. 2,173.80 TWD±3,690.20) of general hospitals are statistically significantly higher than none-general hospitals. Among general hospitals, the performance of private management is better than those of public management. The personnel costs of public hospitals under private management are lower than those of public management. The study found that to hire on more nurse increases 875.75 visits and 346.05 TWD in revenue; to hire one more administration staff will increase 1552.37 visits and 585.38 TWD in revenue. These results are statistically significant. Although current public and private healthcare organizations in Taiwan are for non-profit, the operation sustainability is critical. Certain percentage of hospitals encounters operational difficulties, especially for public hospitals. To truly reveal the performance, the municipal hospitals should exclude government grant while evaluating financial indicators. The future goal is to continually establish database of municipal hospitals for further comparison in performance with private hospitals in Kaohsiung city.