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  • 學位論文

台灣醫院屬性與醫護人力服務績效相關之探討

The study on the relationship between hospital attributes and service efficiency by physicians and nurses in Taiwan’s hospital

指導教授 : 張肇松
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摘要


研究目的 醫療產業是屬於高技術、高人力密集的產業,近年來醫療環境快速變化,醫師及護理人力受到學者及專家的重視。不同醫院性質將會對醫護人力的醫療服務量及品質效率上造成影響。所以本研究目的為:一、探討醫師及護理人力與服務量之關係,二、探討不同台灣醫院服務量之影響因素為合。 研究方法 本研究為回溯性縱貫研究,係以行政院衛生次級資料分析統計,研究對象為2001年至2010年之707家醫院,自變項為醫院屬性,分別為公私立醫院、教學醫院及非教學醫院、財團法人醫院及非財團法人等;與醫院床數及高科技設備數目包含電腦斷層、核磁共振、放射治療設備、核子醫學技術、正子造影設備等。服務量指標以門急診人次及住院人日與每醫師及每護理人員之住院、門診、急診服務量作為本研究之依變項。研究採用SPSS for windows 18.0版統計套裝軟體進行描述性統計及推論性統計分析;使用資料包絡分析軟體(DEA)來進行效率評估;使用SATA 11.0軟體進行廣義估計方程式(general estimating equation, GEE)檢視不同屬性之醫院對人力服務量之影響。 研究結果 研究結果顯示,教學醫院規模較大而服務量也較多;規模越大之醫院同時也有較多比例擁有高科技設備。由DEA efficiency score圖表可發現床數越多之醫院效率表現較好。廣義估計方程式(GEE)分析發現高科技設備數目、病床數及教學醫院別為主要影響醫院服務量因素;而公私立醫院在服務量上無達顯著差異。   結論與建議 醫護服務量效率隨著醫院屬性的差異有所不同,主要影響每醫師及護理人員服務量為病床數、教學醫院別及高科技設備數目。本研究證實醫師及護理人力與服務量之關聯性,在未來希望進而研究醫護人力與醫療品質之相關探討。

並列摘要


Objective With implementation of global budget policy of Taiwan National Health Insurance the issues of physician and nurse workforce were greatly concerned in recent years. The shortage of physician and nurse workforce in various healthcare subspecialties has a great impact on the medical quality and healthcare efficiency. The aims of this study have first, to investigate the relationship between physician or nurse staffing and service efficiency, and second, to find the impacting factors on service efficiency in Taiwan’s hospitals. Methods The study was a retrospective, longitudinal analysis. A total of 707 hospitals from 2001 and 2010 were enrolled for analysis. The hospital characteristics including ownership of hospital, teaching status, hospital bed numbers and number of high-tech equipment, such as computed tomography (CT), magnetic resonance imaging (MRI), radiation therapy, nuclear medicine and positron emission tomography (PET) were used as predicting variables. The service volume including admission, outpatient and emergency service were used as dependent variable. All the data were retrieved from the annual report dataset of Department of Health, Taiwan. Statistical analysis including descriptive statistics and inferential statistics were performed using SPSS 18.0 software. The data envelope analysis (DEA) were used to evaluate the hospital service efficiency. Generalize estimating equation (GEE) model was used for longitudinal analysis to study the relationship between hospital attributes and service volume by using STATA 11.0 software. Results The results showed that teaching hospitals had larger scale and more service volume than non-teaching hospital. The hospitals with larger scale have more high-tech equipment. The result of DEA analysis showed hospitals with higher number of beds had a higher efficiency score than those with less bed numbers. The GEE mode analysis showed that the major impact factors of service efficiency were the number of high-tech equipment, hospital bed number and teaching status. There was no significant difference between public and private hospitals. Conclusion Hospitals with different attributes have various service efficiencies by physicians or nurses. The major variables affect service volume by physicians or nurses including hospital bed numbers, teaching status and the numbers of high-tech equipment. Our results provided evidence on the association between physician or nurse workforce and service efficiency for human resource management in Taiwan’s healthcare service under NHI. Further studies are needed to answer the association between healthcare workforce and medical outcomes or quality.

並列關鍵字

physician nurse service volume hospital attribute

參考文獻


中文文獻
毛潤芝.(1987).醫院部門績效評估之研究, 中國醫藥學院醫務管理研究所未出版碩士論文.
王媛慧、李文福.(2004).我國地區醫院技術效率之研究--DEA 方法的應用. 經濟研究, 40(1), 61-95.
王媛慧、徐偉初、周麗芳.(2005).我國財團法人醫院經營績效之研究.
王銘杰、林永福.(1997).醫院經營績效評估模式: 北市衛生.

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