成本管理與品質績效之關聯性研究:以醫療財團法人為例

台灣醫療產業為受總額預算分配之管制產業，在2010年逐步併行台灣版住院診斷關聯群支付（Tw-DRGs, Taiwan Diglossie Related Groups）制度後，導致醫院健保收入來源更為受限，管理當局進行成本管理的動機提升，包括裁量醫務成本中人事、藥品、醫材與教育研究發展等支出。與企業不同，醫院財務績效的重要性遠不及其品質績效的關鍵性，後者攸關民眾的健康與社會的安定。由此，本研究以醫療服務量居首的醫療財團法人為樣本，研究期間為2005至2017年。實證結果發現，多數成本習性在導入Tw-DRGs後明顯改變；而整體成本習性最顯著改變的宗教型醫療財團法人，其品質績效整體偏低。可見導入Tw-DRGs後雖使得醫院整體醫療效率提升，但可能導致醫療成本與醫療品質同步降低。本研究探討醫院的成本習性、管理取向與醫療品質，可幫助大眾與財務報表使用者判讀與監督，有助於主管機關規畫與協調臺灣醫療資源分配之問題。

關鍵字

醫療財團法人；成本；品質績效； Tw-DRGs ；醫療服務量

並列摘要

Taiwan's medical industry is a regulated industry which is subject to the allocation of the global budget system. After the Tw-DRGs payment system implementation in 2010, hospital’s health insurance income became more limited, and hospital management accordingly had more incentives to manage costs, including labor, medical materials, and educational and research expenditures. In contrast to for-profit companies, the importance of hospital financial performance is far from being the key to its quality performance, which is related to the people’s health and the stability of society. Therefore, this study’s sample consisted of not-for-profit hospitals during the period from 2006 to 2017. The empirical results show that the cost behavior of not-for-profit hospitals have changed significantly after adopting Tw-DRGs; the medical quality performance of religious-based hospitals whose cost behavior have changed significantly is much lower than non-religious based hospitals. It can be seen that although the overall medical efficiency has improved after the implementation of Tw-DRGs, it may lead to a decrease in both medical costs and medical quality. This study investigates the hospital's cost management and medical quality, which can offer insights for the public and financial statement users, and also help the authorities coordinate the distribution of medical resources in Taiwan.