管理式私人醫療保險病患占比對加州地區營利性醫院財務困境的影響

Impact of the Patients’ Proportion with Managed Private Healthcare Insurance on the Financial Constraint of For-Profit Hospitals in California

張軒慈(Shuan-Tzu Chang)

指導教授 ： 林修葳

國立臺灣大學/管理學院/國際企業學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202101155

摘要

本文使用2003年至2018年加州政府網站(California Office of Health Planning and Development)資料做醫院財務狀況之系統性研究，探討管理式私人醫療保險病患占比與加州地區營利性醫院財務狀況的關係。在控制占床率以及成本比率後，本研究依序檢測不同醫院類型的財務表現差異、未投保貧困病患比率以及管理式私人醫療保險病患占比對醫院財務受限制指標的影響。實證結果顯示，短期綜合醫院及短期精神醫院在財務受限制指標有顯著的表現差異。其次，人均所得對該地區平均未投保貧困病患門診占比有顯著的負向影響，而醫院之未投保貧困病患門診占比的上升使醫院財務受限制程度顯著增加，且於多變數回歸結果顯示此影響力隨著分位數上升嚴格遞增。最後，除短期精神醫院外，管理式私人醫療保險病患占比的增加使醫院財務受限制程度顯著下降，分位數回歸結果顯示，其於0.3、0.4至0.8、0.9分位數中，此改善效果大致隨著分位數上升而遞增。
　　綜合上述，實證結果支持管理式私人醫療保險病患占比在一般的情況下與醫院財務健全度有顯著的正向關係。

關鍵字

管理式私人醫療保險 ； 醫院財務健全度 ； WWI財務受限制指標

並列摘要

On a broad base, this paper explores the relationship between the proportion of patients with private managed healthcare insurance and financial constraint status (Whited-Wu Index for financial constraints, hereafter also referred to as WWI.) Specifically, it retrieves data from the California Office of Health Planning and Development for the test period from 2003 to 2018 for for-profit hospitals in California. After controlling the available beds occupancy rate and the cost-to-charge ratio, this paper analyses (1) the financial performance differences between different types of hospital, (2) the influence of uninsured patients and patients with private managed healthcare insurance, and (3) whether and the extent to which WWI change with the proportion of patients with private managed healthcare insurance. The results show the following findings. First, there is significant difference in financial soundness between short-term general hospitals and short-term psychiatric hospitals. Second, income per capita has a significant negative impact on the average proportion of uninsured outpatient visits of the region, while the Whited-Wu Index of hospital increases with the individual proportion of uninsured outpatient visits. Regarding such relationship, the results of quantile regression analysis show that the slope coefficient is strictly increasing as the quantile rises. Finally, not only the dummy variable for the short-term psychiatric hospitals, but also the proportion of patients with private managed healthcare insurance has a significant negative impact on the WWI, and the results of quantile regression show that such effect of strengthening the financial soundness roughly increases as the quantile increases from 0.3, 0.4 to 0.8, 0.9.
　　In conclusion, the empirical results support that the proportion of patients with private managed healthcare insurance has a significant positive impact on the financial constraints of the sample hospitals.

並列關鍵字

Private Managed Healthcare Insurance ； Hospital Financial Soundness ； Whited-Wu Index

參考文獻

Arrow, K. J. (1978). Uncertainty and the welfare economics of medical care. Uncertainty in Economics, 345-375.

Bazzoli, G. J., Chan, B., Shortell, S. M., D'Aunno, T. (2000). The financial performance of hospitals belonging to health networks and systems. Inquiry, 234-252.

Carr, W. J., Feldstein, P. J. (1967). The relationship of cost to hospital size. Inquiry, 45-65.

Chung, K. and Mullner, Ross M. (2016, May 5). Managed care. Encyclopedia Britannica. https://www.britannica.com/topic/managed-care

Clement, J. P., McCue, M. J., Luke, R. D., Bramble, J. D., Rossiter, L., Ozcan, Y. A., Pai, C. W. (1997). Strategic hospital alliances: impact on financial performance. Health Affairs, 16(6), 193-203.