公立教學醫院實施責任中心制度之初步成效及成本控制相關因素之個案研究

A Case Study on the Impact of Establishing Responsibility Centers in a Public Teaching Hospital

劉順仁(Shuen Z. Liu) ； 楊志良(Chih L. Yaung) ； 鄭旭然(Shiuh R. Cheng)

《管理評論》 16卷1期 (1997/01) Pp. 85-114

https://doi.org/10.6656/MR.1997.16.1.CHI.85

摘要

近年來國內醫療院所在日趨競爭的經營壓力下，紛紛引進企業界施行已久的責任中心制度。本文以個案研究方法探討某大型公立教學醫院實施責任中心制度之成效，並透過迴歸分析進一步瞭解成本中心、主治醫師群、醫療產品等三方面特性與成本控制的關係。本文主要發現如下：
(1)個案醫院實施責任中心制度初期，成本控制的成效並不顯著。可能原因在於績效評估系統尚未配合施行，或是研究期間內病患人數出現下降的趨勢所引起的規模不經濟。
(2)規模愈大、主治醫師群的平均年資愈高之責任中心，成本控制的成效愈差。相對的，主治醫師兼任醫學院教職比率愈高，醫療服務執行項目的分布愈分散，或醫療產品加權平均單價愈高之責任中心，其成本控制之成效愈佳。

關鍵字

責任中心制度 ； 公立教學醫院 ； 成本控制

並列摘要

The purposes of the study are to investigate the impact of establishing responsibility centers and examine factors which influence the cost control performance among different departments in a large public teaching hospital. Concerning the impact of establishing responsibility centers, we found that average cost and average controllable cost actually rised after implementing the system. The result may be because that no explicit performance evaluation is tied to the cost control outcome of the responsibility centers or because of the scale diseconomy resulting from a decline of patients during the sample period.
Concerning factors which influence the cost control performance among different departments, we found that larger responsibility centers or responsibility centers with higher percentage of senior physicians perform poorer in cost control. By contrast, responsibility centers with higher percentage of physicians who also serve as faculty in College of Medicine perform better in cost control. Finally, responsibility centers which have a less concentrated distribution of medical services or perform more expensive medical procedures also perform better in cost control.

並列關鍵字

Responsibility centers ； public teaching hospital ； cost control