公立醫院以委託方式經營之評估研究

The Evaluation of Commission Management in Public Hospitals

曾淑芬(Shu-Fen Tseng)

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(2007年)

https://doi.org/10.6342/NTU.2007.10328

摘要

本研究主要是針對全國13家公立醫院以委託或BOT方式經營之政策面、法規面、執行面及財務面等議題進行探討，採用的研究方法是個案研究法，並同時採用文獻探討及針對主管機關之代表進行深度訪談，希望能提供一個全面性之建議及借鏡啟發之用。
本研究主要結果如下：
(一)政策面
1.公立醫院以委託方式經營從人事等支出面之減少，以及回饋金收入面之增加來看，有達到當初委託經營的目標。
2.目前12家以委託（租賃）方式經營之公立醫院在簽約到期後有91.7%（11家）醫院仍繼續以委託（租賃）方式經營。
(二)法規面：截至2007年5月止，13家以委託或BOT方式經營之公立醫院中，僅有1家係依據促進民間參與公共建設法辦理。
(三)執行面
1.執行面之問題
(1)對於新任與舊任受託經營者之交接，並無具體之規範。
(2)部分的履約管理未達實質之效果。
(3)12家公立醫院以委託方式經營中有9家是透過公開招標方式辦理，其中有8家經過多次流標或者僅有1家來投標。
(4)訪談結果僅有2家曾因契約規範內容窒礙難行或不合時宜而進行契約變更。
2.委託經營成功因素：（1）委託機關：主管支持、對受託經營者干預程度少、領導者之人際關係、適時協助受託經營者解決困難、誘因強；（2）受託機關：
優秀的受託經營團隊、董事會的支持、配合度佳；（3）溝通：溝通管道暢通及雙方互動良好；（4）契約規範：事前規劃周全，契約規範完備、合理的契約年限、合理的回饋金；（5）醫院特色：如醫院地理位置、當地人口數、醫院附近人口結構。
(四)財務面：各家回饋金收取方式不一，並無統一之標準。

關鍵字

公立醫院 ； 委託方式經營 ； BOT ； 組織變革 ； 促進民間參與公共建設法

並列摘要

This study focused on the aspects of policies, legal, execution, and finance in the 13 public hospitals that are under commission management or BOT. The research method adopted was case study, literature discussions and in-depth interviews with representatives from the authorities were also, conducted in hopes of providing suggestions and reflections.
The main findings are as follows:
A.Policy Aspect
1.The fact that human resources cost was reduced and feedback fund was increased indicates that commission management of public hospitals has indeed reached its goals.
2.Among the 12 public hospitals under commission (or leased) management, 91.7% of them (11 hospitals) will continue to be managed under the same method.
B.Legal Aspect: As of the end of May 2007, only one out of the 13 public hospitals that are under commission management or BOT has followed the “Act for Promotion of Private Participation in Infrastructure Projects.”
C.Execution Aspect
1.Problems with the Execution Aspect
(1)There were no specific regulations regarding the transfer process between the old and new commissioned manager.
(2)A part of the contract management did not meet its expected goals.
(3)Among the 12 hospitals under commissioned management, 9 of them used public bidding. However, 8 of them had to go through several times of bidding or only one company participated in the bidding.
(4)The interviews suggest that only two companies amended the contract as the original content was too difficult or too outdated to be carried out.
2.Factors behind successful commission management include: (1) commission authority: support from the authorities, low interference for the commissioned manager, leaders’ interpersonal relationships, timely support for commissioned managers who face difficulties, and rewards; (2) commissioned organizations: excellent management teams of the commissioned party, support from the board of directors, and good teamwork; (3) communication: clear communication channels and good interactions; (4) contract and regulations: good plans, solid contracts, reasonable contract duration, and reasonable feedback amount; (5) hospital features: locations, local population size, and demographics structure around the hospital.
D.Financial Aspect: Feedback funds were acquired through different methods and there was no a unified standard.

並列關鍵字

Public Hospital ； Commission Management ； Build- Operate -Transfer ； Organizational Change ； Act for Promotion of Private Participation in Infrastructure Projects

參考文獻

台中市政府（2001）•台中市政府公有老人醫院設施租賃契約書。

台中市政府（2001）•台中市政府公有復健醫院設施租賃契約書。

台南市政府（2007）•台南市立醫院委託暫管經營契約書。

行政院衛生署（2002）•行政院衛生署宜蘭醫院委託台北榮民總醫院經營契約書。

行政院衛生署（2004）•台北醫學大學投資興建經營雙和醫院契約書。