- 學位論文
醫院醫療品質與財務績效關聯性研究
The Association Between Hospital Quality of Care and Financial Performance of Hospitals in Taiwan
摘要
背景：隨著醫療機構逐漸朝向集團化、連鎖化趨勢大幅擴張，醫院競爭愈發白熱化，且為達到永續經營的願景，近年來全世界各醫療機構皆致力於以提升醫療服務的可近性、降低成本與提供更高品質的服務為目標，在醫院管理上，醫療品質與財務績效在醫療機構營運中扮演了關鍵角色，許多研究者對兩者之間的關聯感到好奇，因此做了許多該方面的研究，但目前尚不清楚台灣醫療品質與財務績效的真正關聯為何。 目的：探討臺灣醫院醫療品質與財務績效之關聯性，以利後續給予醫院管理決策與資源分配相關建議。 方法：本研究資料收集的對象為107-109年度皆有公佈財報之醫院，因此研究將採用107-109年醫院財報，並且以107-109年之財報公布醫院為對象，收集當年度與前兩年之指標，亦即本研究也預期採用105-109年度之品質指標資料用於分析。本研究為縱貫面研究，將建構複迴歸與GEE模型了解影響財務績效之品質因素。 結果：共202家醫院三年度樣本，因此樣本數共計606份，根據描述性統計結果可知，結果面總分平均值為1.639分，過程面總分0.2031分，結構面總分為0.6738分，醫務利益率平均值為1.9%，資產報酬率為3.03%，淨利率為3.73%；結果面與淨利率(r=0.19)、資產報酬率(r=0.1)正相關，結構面與淨利率(r=0.15)、資產報酬率(r=0.1)正相關，過程面與淨利率(r=0.14)正相關；控制醫院層級、權屬別和所屬健保分區後，透過GEE模型分析後發現，醫院品質結構面與醫務利益率、資產報酬率有關，且過程面與醫務利益率有關。 結論與建議：醫院主管機關應建立積極鼓勵醫院參加認證之政策，建立相關法規條例，政策執行機關應鼓勵醫院參加認證，建議可舉辦或設立工作坊輔導醫院參與認證，應關注認證後的持續性效果，建立持續性追蹤之制度；建議醫院應該致力於提升醫療品質結構面與過程面，對外積極參加相關認證，即使認證通過，仍應持續進行相關品質改善制度與政策，對內主動提升急診、住院與門診的照護品質，重視口碑效應，了解提高每位病患的醫療品質重要性；建議後續研究者，除可採用更多年度資料的樣本外；另外，也建議如進行AHP調查，期能提升樣本數，以獲得更可信的權重，同時在研究過程中，會發現指標選擇的不一致，會導致不同的結果，因此在選擇指標時，應審慎考量。
並列摘要
Background: With the expansion of hospitals, the competition among hospitals has become increasingly fierce. In order to achieve the goal of sustainable development, in recent years, all hospitals around the world have been committed to improving the accessibility of medical services and reducing costs. With the goal of providing higher quality services, quality of care and financial performance play a key role in the operation of hospitals. Many researchers are interested in the relationship between quality of care and financial performance, so they have done a lot of research about the topic, but there is currently no clear association between quality of care and financial performance. Objective: To explore the correlation between the medical quality and financial performance of hospitals in Taiwan, so as to suggest for hospital management decision-making and resource allocation. Method: The objects of this study were hospitals that had published financial reports from 2018 to 2020. Therefore, the research used hospital financial reports from 2018 to 2020, and took the hospitals that released their financial reports from 2018 to 2020 as objects to collect data from the current year and the previous two years. That is, this study was also expected to use the quality of care data of 2016-2020 for analysis. A longitudinal study was used. Results: A total of 202 hospitals had three year samples(n= 606). According to the descriptive statistics, the average total score of the dimension of outcome was 1.639. The total score of the dimension of process was 0.2031, and the total score of the dimension of structure was 0.6738. The average medical profit ratio was 1.9%. The return on assets was 3.03%. The net profit margin was 3.73%. The dimension of outcome was positively correlated with the net profit margin(r=0.19) and the return on assets (r=0.1). The dimension of structure was positively correlated with the net profit margin(r =0.15) and the return on assets (r=0.1) . The dimension of process was positively correlated with the net profit margin (r=0.14). The dimension of structure was related to the medical profit ratio and the return on Assets. The dimension of process was related to the medical profit ratio. Conclusions: Hospital authorities should establish policies to actively encourage hospitals to participate in accreditation, and establish relevant laws and regulations. Policy executive agencies should encourage hospitals to participate in accreditation. It is recommended to set up workshops to guide hospitals to participate in accreditation. We not only pay attention to the continuity after accreditation effect, but also establish a continuous tracking system. It is recommended that hospitals should be committed to improving the dimension of structure and process, and actively participate in relevant accreditation externally. Even if the accreditation is passed, they should continue to implement relevant quality improvement systems and policies. The hospital managers should pay attention to word-of-mouth effect, and understand the importance of improving the quality of care of each patient. There are some suggestions to other follow-up researchers. First, the researchers should increase the number of samples to obtain more credible weights. At the same time, in the process of research, careful consideration should be given when selecting indicators.