公私立綜合醫院服務層面效率差異之探討

A Study on the Efficiency Difference between Public and Private General Hospitals

石淦生(Kan-Shan Shih) ； 羅紀琼(Joan C. Lo) ； 陳國樑(Kuo-Liang Chen)

《中華公共衛生雜誌》 15卷5期 (1996/10) Pp. 469-482

https://doi.org/10.6288/CJPH1996-15-05-07

摘要

過去國外文獻針對醫院所有權對其效率影響的分析，結論頗為分歧，美國的研究文獻中，有公立醫院效率較私立醫院為低者[1]；亦有公立醫院效率較私立醫院為高者[2]；還有公私立醫院效率與顯著差異者[3]。日本的研究結果則一致顯示合立醫院效率較高[4,5]。
羅紀琼等[6]採用民國八十二年『台灣地區公私立醫療院所現況與服務量調查』青料，以DBA的分析方法，對台灣地區公立及私立綜合醫院的效率予以衡量，研究結果顯示，公立醫院較私立醫院與效率。
本研究採用了羅紀琼等的資料，嘗試分解公私立醫院效率差異的原因，分析結果顯示，公立醫院相對於私立醫院的與效率，有一部份應歸因於二者生產技術的差異，另有一部分則和醫療產業多屬遞減規模報酬有關。由於公立醫院一般而言規模較大，適減規模的特性即會使公立醫院效率較差。Logit模式廻歸結果更進一步證實，護士與病床比值和遞減規模報酬呈正相關，醫院所在地區的醫療需求則和遞減規模報酬呈負相關。

關鍵字

醫院效率 ； 醫院所有權 ； 資料包絡分析法

並列摘要

There were numerous studies concerning the impact of hospital ownership on their technical efficiencies, however, the results were inconclusive. Some studies have demonstrated that the efficiency of public hospitals is higher than that of private hospitals [1]. Some studies have demonstrated that the efficiency of private hospitals is higher [2], and there were also studies exhibited that there were no differences [3] between the two. The similar studies in Japan have indicated the efficiency of public hospitals is consistently higher [4,5].
Joan C. Lo et. al. [6] employed the DEAmethod on the 1993 Medical Facility Survey of Taiwan, and reached the conclusion that public hospitals uniformly had a lower technical efficiency for all three input-output combinations. Even after taking into consideration of inefficiency of the public hospitals, hospitals affiliated with medical schools still had a lower technical efficiency.
In this study, we adopted the same data and same analytical method, i.e. DEA, as Joan Lo et. al., but further decomposed the efficiency. The empirical evidence has shown that not only the difference in production technology, but also the characteristics of decreasing returns to scale pertaining to the medical industry warrant the result that public hospitals are relatively inefficient to private hospitals. Moreover, the regression result of the Logit model indicates the positive correlation between bed-staff ratio and decreasing returns to scale, and the negative correlation between area medical needs and decreasing returns to scale.

並列關鍵字

Hospital Efficiency ； Hospital Ownership ； Data Envelopment Analysis