疾病複雜度、醫療品質與市場區隔變數對台灣醫院效率之影響 -資料包絡分析法之運用

The Effect of Disease Complexity, Medical Quality and Market Segmentation on Taiwan Hospital Efficiency- An Application of Data Envelopment Analysis Approach

黃軍浩(Haung Chun-Hao)

指導教授 ： 李佳玲

國立政治大學/商學院/會計學系/碩士(2020年)

https://doi.org/10.6814/NCCU202000909

摘要

本研究之主要目的在於探討疾病複雜度、醫療品質與市場區隔變數對於台灣醫院效率之影響，以台灣之地區醫院以上等級之醫院為樣本，手工方式收集其營運資料，本文運用資料包絡分析法計算各醫院之相對效率，再進一步分析疾病複雜度、醫療品質及市場區隔變數對於醫院相對效率之影響。
本研究將疾病複雜度分為門診之疾病複雜度與住院之疾病複雜度，研究結果顯示由於台灣醫療體系下有分級醫療之作法，醫學中心及區域醫院往往負責較嚴重之病人，因此其住院之疾病複雜度與效率有顯著之負向關係；相反地，地區醫院門診之疾病複雜度與效率才有顯著之負向關係。本文進一步發現醫學中心及區域醫院在門診之疾病複雜度，若複雜度愈高，有更好的效率。而醫療品質部分，研究結果顯示地區醫院相較醫學中心及區域醫院更應注意結構品質的調整；而醫學中心及區域醫院在流程品質變數與效率之間有互補關係，但在地區醫院則無此情況；地區醫院則在結果品質變數上與效率有互相替代之關係。最後市場區隔變數中，我們分析地理性區隔變數以及人口統計變數與效率之關係，發現台灣各縣市扶養比在醫學中心及區域醫院中與效率之關係結果顯示顯著負相關、台灣各縣市人口密度在醫學中心及區域醫院或是地區醫院皆呈現顯著正相關以及台灣各縣市平均家戶儲蓄率在全部醫院當中呈現顯著負相關。上述結果也說明醫院除了營運特性外，人口之因素亦會影響醫院營運效率。

關鍵字

資料包絡分析法 ； 醫療品質 ； 疾病複雜度 ； 市場區隔

並列摘要

The main purpose of this study is to explore the effect of disease complexity, medical quality and the market segmentation on the efficiency of hospitals in Taiwan. In this study, our samples are taken in the hospitals which level above the district hospitals throughout Taiwan and keyed in by handmade. This study employed Data Envelopment Analysis to assess the relative efficiency of all sample hospitals, then we further analyze the effect of disease complexity, medical quality, and the market segmentation on samples’ relative efficiency.
In this study, the complexity of disease is divided into outpatient disease complexity and inpatient disease complexity. And the result shows that medical centers and regional hospitals are often responsible for more serious patients because of the practice of graded medical care in Taiwan's medical system, therefore, it has a significant negative correlation between efficiency and the inpatients disease complexity. In contrast, district hospitals have a significant negative correlation between efficiency and the outpatient disease complexity because they mainly treat outpatients. One particular thing is that medical center and regional hospitals have better efficiency when the outpatients’ disease they treat are more complex. In the mention of medical quality, we show that district hospital should pay more attention to structure quality adjustment than medical centers and regional hospitals. In addition, medical centers and regional hospitals have a complementary correlation between process quality and efficiency, but not in district hospitals. On the other hand, district hospitals have a trade-off correlation between outcome quality and efficiency. At last, in market segmentation, we analyzed the correlation between geographic segmentation and demographic segmentation variables with efficiency. We found that in medical center and regional hospitals, dependency ratio of counties and cities in Taiwan has a significant negative correlation with efficiency, Population density of counties and cities in Taiwan has a significant positive correlation with medical center, regional hospitals and district hospitals’ efficiency, and average household savings rate of counties and cities in Taiwan has a significant negative correlation with all Taiwan hospitals’ efficiency. To sum up, not only the operating property, but also the population factors will affect the efficiency of hospital operation.

並列關鍵字

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