醫院醫療服務面經營績效及品質績效相關性研究-以新制醫院評鑑受評醫院為例

The Relationship Between the Operating Performance and Quality Performance of Medical Services of Hospitals Accredited with the New Accreditation Model

郭蘊慧(Yun-Hui Kuo)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.00532

摘要

在醫療資源有限、醫療服務利用情形又持續增加的情形，醫院若能完全發揮其效率則可為醫療資源做更有效的運用及配置。因此醫院之經營績效及服務品質之提升亦成為主管機關、醫院管理者相當重視之議題。為瞭解目前醫院績效情形及其相關因素，本研究之主要目的在探討國內接受新制醫院評鑑之受評醫院，其不同特性（權屬別、評鑑結果）在醫療服務面之經營績效及品質績效表現情形，並欲進一步探究其經營績效與品質績效間是否具有相關性。
除分析受評醫院經營績效外，本研究亦希望透過文獻探討蒐集相關品質指標以探討醫院之品質績效，研究材料係採用國內「新制醫院評鑑資訊系統資料庫」資料，探討2005至2007年申請並接受新制醫院評鑑之125家受評醫院之經營績效及106家受評醫院之品質績效，惟因採用次級資料分析，故研究變項之選定亦較受限，最終選定經營績效有4項投入變項及5項產出變項；品質變項有4項投入變項及2項產出變項。
本研究採以資料包絡分析法（Data Envelopment Analysis，DEA）進行醫院經營績效與品質績效之效率值分析，並以Mann-Whitney U及Kruskal-Wallis等方法進行無母數檢定，研究結果發現在經營績效或品質績效部分，公立醫院較非公立醫院相對無效率，與國內大多文獻結果相同；在評鑑結果別，優等以上醫院部分經營績效之效率值平均小於合格醫院及未合格醫院；而在品質績效部分效率中，特優醫院效率值平均小於優等、合格醫院，優等醫院、優等以上醫院之效率值平均又小於合格醫院。上開結果發現評鑑結果越高者並未較評鑑結果越低者有效率。而在經營績效與品質績效相關性，研究發現經營績效純技術效率及規模效率較高者，有較高之品質績效純技術效率及規模效率，且達顯著相關。本研究之限制在於研究對象篩除較小規模及未提供生產服務之醫院，故外推性受限；另因變項數設定有限及使用次級資料分析，未能於研究中一併探討或針對研究變項（如：產出變項）進行合理之調整，亦可能影響研究結果。
關鍵詞：醫院經營績效、品質績效、新制醫院評鑑、資料包絡分析

關鍵字

醫院經營績效 ； 品質績效 ； 新制醫院評鑑 ； 資料包絡分析

並列摘要

In the condition of limited medical resources and increasing medical care utilization, those hospitals improve their efficiency could make more effective application and disposition for medical resources. Therefore, improving the operating performance and the quality of hospitals become important issues that the competent authority and top managers of the hospitals pay more attention to. In order to examine hospitals’ performance in medical services and its related factors, the main purposes of this study were to probe into the operating performance and quality performance of medical services of hospitals accredited with the new accreditation model and to examine the association with hospital characteristics (i.e. ownership and level of hospital accreditation). Further more, this study will look into the relationship between the operating performance and quality performance.
This study identified indicators of operating and quality performance of hospitals through literature review. The study materials were extracted from the database of new accreditation model information system. All of the hospitals accredited in 2005 to 2007 were included as study samples. Because the research used secondary data analysis, study variables were relatively limited. Therefore, 4 input and 5 output variables were identified to analyze the operating performance; 4 input and 2 output variables for the quality performance were selected. Totally 125 hospitals had enough information to evaluate their operating performance and 106 for quality performance. We analyzed the efficiency value of the 2 performances by Data Envelopment Analysis (DEA), and tested the hypotheses with Mann-Whitney U test and Kruskal-Wallis test.
Results show that public hospitals were relatively inefficient in terms of the operating and quality performance. By level of hospital accreditation, hospitals graded good or excellent were less efficient than those graded pass or non-pass in terms of operating performance. In some efficiency of quality performance, hospitals graded excellent were less efficient than those graded good or pass. Hospitals graded good or excellent were less efficient than those graded pass. Hospitals with higher level of hospital accreditation were not necessarily more efficient than those with lower level. In addition, the operating performance and quality performance were significantly positively correlated in pure technical efficiency and scale efficiency. The limitations of this study include limited generalization caused by excluding hospitals of smaller scale and those did not provide child delivery services. Also the results might be affected because the output variables couldn’t be appropriately adjusted from the secondary data.

Keywords: operating performance of hospital, quality performance, new accreditation model, data envelopment analysis

並列關鍵字

operating performance of hospital ； quality performance ； new accreditation model ； data envelopment analysis

參考文獻

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