醫院與廠商之訂約模式及其契約執行績效評估：以昂貴醫療儀器投資為例

The Types and The Evaluation of Hospital-Supplier Contracting: The Case of The Investment of Expensive Medical Equipment

陳俐君(Ｌi-Chun Chen)

指導教授 ： 許玫玲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2004年)

摘要

中文摘要 論文名稱：醫院與廠商之訂約模式及其契約執行績效評估：以昂貴醫療儀器投資為例 研究所名稱：臺北醫學大學醫務管學研究所 研究生姓名：陳俐君 畢業時間；九十二學年度第二學期 指導教授：許玫玲 臺北醫學大學醫務管理學研究所助理教授 面對日益競爭與管制的醫療環境，越來越多醫院以不同的投資策略取得昂貴的醫療儀器，例如合作經營與外包。本研究有三個目的：醫院與儀器供應商之間有哪些訂約模式，醫院型態與儀器種類是否與訂約模式有關，以及醫院管理者如何評估其訂約決策。 本研究以五份結構式問卷調查五種儀器(準分子雷射角膜屈光儀、電腦斷層掃描儀、核磁共振攝影儀、體外震波碎石機、正子攝影儀)之訂約模式，並將之寄發給127所醫院。共有50家醫院回覆問卷，有效的儀器問卷共106份。 本研究以十個構面定義訂約模式，並詢問醫院管理者其各項醫療儀器在此十構面分別由誰負責，是醫院、是廠商，還是雙方共同負責。為了進一步統計分析，本研究將所有訂約模式組合分為兩組。A組共有66筆儀器，其訂約方式之特色為以下八個構面均由醫院負責，包括場地成本、水電空調成本、此儀器之專屬醫師費、病患來源、儀器之經營權、使用儀器所需專業人力之提供、空間設施裝修成本、儀器之所有權。B組包括其他所有非屬於A組者。 邏輯諦斯迴歸分析結果顯示不同儀器類型之訂約模式不同，但醫院型態則與訂約模式無顯著相關。複迴歸分析結果顯示管理者對其訂約模式的評估與訂約模式、儀器類型以及醫院型態有部分相關。尤其是A組的管理者普遍較B組管理者對訂約模式滿意，不過A組所承擔的財務壓力較大。 本研究的結論是當醫院尋求合作經營或者將醫療服務外包時，醫療品質不應當被犧牲。當醫院與供應商的訂約關係越來越複雜，很重要的是衛生主管機關能訂定恰當的規範並對醫療品質進行監測。 關鍵字：績效評估、醫療儀器、契約模式、合作經營

關鍵字

績效評估 ； 合作經營 ； 契約模式 ； 醫療儀器

並列摘要

Abstract Title of Thesis : The Types and The Evaluation of Hospital-Supplier Contracting: The Case of The Investment of Expensive Medical Equipment Author : Li-Chun Chen Thesis Advised by : Mei-Ling Sheu Assistant Professor As health care environment is becoming more competitive and regulated in Taiwan, hospitals are increasingly adopting various investment strategies, such as joint venture and outsourcing, to acquire expensive medical equipments. The goals of this research are to understand the types of contracting between the hospital and the equipment supplier, to explore whether or not different types of hospitals and equipments are associated with different types of contracting, and to investigate how hospital managers evaluate their contracting decisions. Five structured questionnaires for five types of medical equipments, LASIK, CT, MRI, ESWL and PET, were mailed to 127 hospitals. Fifty hospitals responded and 106 equipment questionnaires were valid for analysis. The study has defined contracting types in ten dimensions. Hospital managers were asked who is in charge of each one of the contracting dimensions for each type of equipment, either the hospital, the supplier or both. For further statistical analysis, this study has classified these combinations of contacting types into two groups. Group A consists of 66 equipments of which the hospital is in charge of eight contracting dimensions, including space cost, utility cost, physician fees, sources of patients, right to operate the health service, supply of professionals, space and equipment setup cost, and ownership. Group B consists of those not included in Group A. The result of the logistic regression model shows that different types of equipments, but not types of hospitals, are associated with different contracting types. The multiple regression results of managers’ evaluation of their equipment contracting show that contracting types, equipment types, and hospital characteristics are partially associated with different evaluations of the contracting. In particular, managers of group A are more satisfied with their contracting, although they recognize that they take more financial burdens. This study concludes that when hospitals seek joint ventures with suppliers or outsource some of their health services, quality of care should not be compromised. For government agencies, it is far more important to set proper regulations and monitor health care quality when hospital-supplier contracting becomes more complicated. Keywords: performance evaluation, medical equipment, contracting types,joint venture

並列關鍵字

performance evaluation ； joint venture ； contracting types ； medical equipment

參考文獻

彭朱如、王維元、張錦文、黃松共(1997)。從跨組織關係理論觀點探討醫院間的合作策略。中原學報，25(4)，1-16。

陳國嘉(2001)。績效管理。台北:書泉出版社。

蘇文秀(2001)。基層醫療院所策略聯盟之績效評估-以南部某眼科診所為例。國立中山大學人力資源管理研究所未出版碩士論文。 蘇勳璧、彭朱如、鄧振華(2001)。不同等級醫院其資源優勢、策略優勢與績效之關係。醫務管理，2(1)，93-109。

王福蘭(2001)。麻醉部護理人員品質促進團隊之績效評量。國防醫學院護理研究所碩士論文。 王銘杰、林永福(1997)。醫院經營績效評估模式。北市衛生，35，15-18。

朱美鳳(2003)。全民健保後高科技醫療利用之研究-以CT及MRI為例。台中健康暨管理學院健康管理研究所碩士論文。