醫療財團法人公司治理之研究-以長庚、馬偕、高醫和北醫為例

中文摘要台灣醫療財團法人設立的醫院數量，雖僅占全台醫院11%，淨值卻達5,000多億元，提供的病床數占總病床數32％，申請醫療費用支出占比近41%。因此醫療財團法人的管理良善與否，對國民至關重要。台灣的醫療法立法，係為促進醫療事業之健全發展，合理分佈醫療資源，提高醫療品質，保障病人權益，增進國民健康。於2004年4月修法後，醫療機構新增「醫療社團法人」類型，自此醫院籠統來說就區分為公、私立醫療機構、醫療法人(醫療財團法人及醫療社團法人)等設立型態。其中，在醫療法改制下的醫療財團法人，在全民健保給付制度，及資金來源有限環境下，以及集團化發展的進程，導致非營利之公益性定位愈來愈模糊，而法令（醫療法）對於醫療財團法人經營及監督規範顯有不足，致使醫療財團法人弊端、醜聞時有所聞，例如挾其經營優勢獲取大量健保上百億資金，並以財團醫療法人之公益性享有各種減稅等優惠，但財報卻問題百出；最近更有急診科醫師集體請辭，已嚴重影響民眾權益。當醫療財團法人常成為特定團體（家族、企業或宗教）控制賺錢的組織，當中容易發生與所屬關係交易人交易及掏空公司等治理問題。本文擬以台灣具代表性的醫療財團法人近年爆發的案件，探討醫院公司化演進過程，其公司治理的制度及原則，應如何將病患安全及醫療品質委員會導入董事會架構；並進一步思考如何在因應AI智慧醫療時代兼顧醫院國際競爭力、醫療品質與病患安全、利害關係人與股東利益平衡，落實董監事會經營監督，財務資訊揭露。

關鍵字

醫療財團法人,公司治理,董事會,醫院發展

並列摘要

Abstract The number of Taiwan medical foundation is only 11% of the whole hospital, but the net value is about 500 billion, the number of sick beds is 32%, and the medical expense accounts for nearly 41%. Therefore, the management of medical foundation is very important to all the people. Taiwan's Medical Care Act legislation is to promote the sound development of medical services, to distribute medical resources rationally, to improve medical quality, to protect the rights and interests of the patients and to improve the health of the people. After the April 2004 Revision of the law, medical institutions added the type of “Medical Incorporation". Since the hospital, in general, divided into public, private medical institutions, medical legal persons (Medical Foundation and Medical Incorporation). Among them, the legal system of medical consortium under the reform of Medical Act is becoming more and more obscure in the process of the National Health Insurance payment system, the limited source of funds and the process of the group development, and the law (Medical Act) is insufficient in the management and supervision of the medical consortium, resulting in medical treatment. The corporate malpractices and scandals of the consortium have been heard, such as holding a large number of funds on a large amount of health insurance with its operating advantages, and enjoying various tax cuts for the public welfare of the consortium medical legal person, but there are many problems in the financial report. When a medical consortium is often a particular group (family, business or religion) to control the money making, it is easy to deal with the dealing with the affiliate and the hollowing out of the company. This paper, based on the recent cases of the representative medical consortium of Taiwan, discusses the process of the evolution of the hospital company, the system and principles of its corporate governance, how to introduce the Committee of the patient's safety and medical quality into the framework of the board of directors, and further consider how to give consideration to the international competitiveness of the hospital in the age of AI. The balance between medical quality and patient safety, interests of stakeholders and shareholders, implementation of supervision and management of the board of supervisors and disclosure of financial information.