醫院財務績效與醫療訴訟風險之實證研究

近年來醫療訴訟案件不斷增加，不僅造成醫病關係的緊張，亦嚴重衝擊了醫療生態，且若干報導更指出醫療訴訟已成為導致內、外、兒、婦產科醫師人力不足或急重症人才流失的主因之一。且在醫師面臨險峻的醫療訴訟風險之時，醫院的經營管理階層亦同時面臨兩大嚴苛議題，一為全民健保為抑制醫療費用快速的增長，從論量計酬移至總額支付制度，使得醫院在總額預算制實施後，有限資源日益減縮其獲利空間；二為民眾高度關注醫療傷害事件，引發日益增加的醫療訴訟及賠償責任風險。獲利減少，風險增加，都直接衝擊到醫院的財務穩定，因此本研究欲探討醫院的財務績效與醫院面臨醫療訴訟風險兩者間的相關性。本研究以民國102年至104年的「醫事服務機構財報公開」與民國98 年至101年的「醫療財團法人歷年財務報告公開一覽表」中所取得完整財報之醫院為研究對象，以及於司法院法學資料檢索系統中，篩檢出的醫療糾紛涉訟案件來進行敘述性統計、相關係數統計與羅吉斯迴歸分析等統計方法，以驗證研究假設。本文之研究結果顯示：(1)一般情況下，醫院的財務績效表現與醫院面臨的醫療訴訟風險兩者間呈顯著正相關；(2)二代健保的實施使得本文的獲利動機假說之效果下降；(3)醫院前一年的財務績效與醫院面臨的醫療訴訟風險間呈現正相關，但並未達顯著水準，因此兩者間可能不存在延遲的效果；(4)在醫院具有潛在的獲利動機下，醫院的財務績效與醫院的醫療訴訟風險間兩者間呈正相關，但未達顯著，推測可能兩者間存在反因果關係，惟此仍待未來相關的研究再做進一步的證實；(5)以ROA作為醫院財務績效衡量之指標，測試結果與本文主要測試一致。

關鍵字

財務績效；醫療訴訟；醫療品質；訴訟風險；醫院管理

並列摘要

The increase in medical malpractice claims these days, not only deteriorates the doctor-patient relationship but also crashes the medical practice system. The several reports even indicate that the medical malpractice lawsuits are the main reasons of the brain drain among the division of general medicine, general surgery, obstetrics and gynecology, pediatrics and acute and critical care medicine. Furthermore, when the doctors are facing the tough time regarding the medical malpractice claims, the top management teams of the hospitals also face two difficult issues. One is the changing National Health Insurance policies, the calculation base of the insurance fees allocated to the hospitals changes from the amount of the individual cases to the fixed total amount. After the enactment of the new policy, the limited resources possessed by the hospitals reduce the potential profits that the hospitals intend to have. The other is the increase in the risk of the medical malpractice lawsuits and huge amount of the compensation that the hospitals have to pay after losing the cases. The decrease of the profits with the increase of the risk nowadays threaten the financial stability of the hospitals. Therefore, this study aims to investigate the relationship between hospital financial performance and the medical malpractice lawsuit risk. This is a panel study of hospital financial performance and the medical malpractice lawsuit risk of the hospitals in Taiwan from 2009 to 2015. This research found that (1) In general, there is a statistically significant positive relationship between hospital financial performance and the medical malpractice lawsuit risk. (2) After the implementation of the second generation of National Health Insurance decreases the effect of the motivation hypothesis. (3) There is a positive relationship between the hospital financial performance from last year and the medical malpractice lawsuit risk yet does not reach the statistically significant level, which means the delayed effect may not exist. (4) Under the circumstances that hospitals possess the motivation of pursuing profits, there’s positive relationship between the hospital financial performance and the medical malpractice lawsuit risk but does not reach the statistically significant level, this may imply there’s reverse cause-effect relation between these two factors which needed further research to confirm. (5) Using ROA as the measurement of hospital financial performance, the testing results are aligned with the main testing.