醫療業務委外影響股權涉入模式之實證研究

由於國內健保制度的影響，醫院面臨艱困的制度環境，加以同業間的競爭，導致國內醫療市場走向「高度競爭，低獲利率」的時代。在這種環境下，許多醫院選擇以策略聯盟來求取生存，且合作的範圍由以往非核心業務（例如清潔）擴大到醫療核心業務的合作。然而委外合作時可以選擇股權涉入的高控制模式，或無股權涉入的低控制模式。本研究欲探討醫療業務委外合作時，醫院選擇涉入股權與否，受到那些因素的影響？以中華民國九十二年十月中央健康保險局在約中之地區醫院級以上醫院為研究對象，發放問卷。42個醫院，63個科有醫療委外合作。分析這63個科顯示，醫院希望發揮範疇經濟時，傾向於選擇股權涉入的合作模式；如果希望快速進入市場而採取委外合作的醫院，則傾向於此無股權涉入的合作模式。

關鍵字

醫療產業；策略聯盟；委外合作；股權

並列摘要

In regard to the public health and insurance policies, most of the hospitals in Taiwan are faced with tough institutional environment. Besides, keen competition between hospitals deeply decreases the profit margin. Under these circumstances, many hospitals entered strategic alliances for survival. The range of collaboration extended from non-core services (ex. cleaning) to core clinic activities. However, a hospital can choose highly controlled (ex. equity control) vs. lowly controlled model (ex. non-equity control) when it entered a collaborative relationship. We examined the factors which would influence the control model choice when a hospital outsourced its medical activities and clinic service. We mailed questionnaire to those hospitals which still contracted with the Bureau of the National Health Insurance in 2003. After the followed up procedure, 63 effective respondents from 42 hospitals were received. The Logistic analysis showed that the higher the first-mover advantages a hospital thinks, the lower propensity of equity control can be chosen. The more a hospital wants to get more economy of scope through collaboration, the higher propensity of equity control it will choose.