健保制度下人力精簡對國軍區域醫院影響之研究

The Influence of Manpower Trim on Military District Hospitals under the Health Insurance System

尹常晟(Chang-Cheng Yiin)

指導教授 ： 郭文忠

共同指導教授 ： 徐學忍(Hsueh-Jen Hsu)

元智大學/管理學院/管理研究所/碩士(2007年)

摘要

本研究係以國軍區域醫院為研究對象，以專家訪談進行質性研析，其主要目的在探討國軍區域醫院在功能與目的上與一般國立或署立醫院之差別、制度改變對其組織變革與營運績效之影響，以及因應方法。由訪查結果發現，受訪者均認為國軍區域醫院在功能與目的上與一般國立或署立醫院具顯著差別，其主要以軍事任務為優先考量，自不同於國立或署立醫院。多數認為制度改變對其組織與績效均具顯著影響，在組織變革上其人員素質與聘任受限制，組織承諾因人而異，薪資福利縮減與升遷管道窄化，工作態度及服務品質隨健保評鑑要求提昇；在營運績效上其病患員工滿足感降低，醫療品質及公共形象提昇，教研人力等資源減少，預算變少且執行難度高，成本節省計畫效益、單位效率及單位間的合作增加。
此外，多數認為制度改變對其營運績效指標亦具顯著影響，其財務、經營績效指標在健保給付縮減及醫療服務量下降下，大多數醫院除淨利變動率上昇外，其餘指標均下降，而品質績效指標在健保及醫院評鑑之要求下，大多數醫院除病人滿意度上昇外，其餘指標均呈上昇與下降各半之趨勢，並有一定水準比例。
針對未來之發展趨勢，各國軍區域醫院因應之道，依本研究結果發現可按下列各項具體作為參考運用：1.策訂目標，規劃策略，培養專才。2.開源節流，精進技術，發展社療。3.強化資訊效能。4.落實病安，建構醫療網，促進官兵醫療。5.健全醫療架構，引進企管，提昇績效。6.爭取法令鬆綁，增加靈活度。

關鍵字

健保制度；人力精簡；組織變革；營運績效

並列摘要

Proceeded in the characteristic research method, this research takes district army hospitals as research objects, interviewing experts to analyzing how the combination of the execution of the health insurance system and simplified manpower affect those hospitals’ organization and performance. Its main purpose is in inquiring into the difference between district army hospitals and national or official ones in aspect of function and purpose, and the influence of these two facts on district army hospitals’ organizational revolution and operational performance. And then discuss district army hospitals’ preparation for the coming challenge. As this research found, district army hospitals are different from the public ones in terms of function and purpose because of their destined military missions. In addition, the most thinks changed policies have notable influence on their organization and performance. In terms of organizational revolution, personnel quality goes down and recruiting are restricted, organize commitments vary from person to person, the increase in wages isn't easy, the welfare is cut, promotion is limited, and working attitude and service quality are promoted gradually by the health insurance request and the evaluation. With regard to operation performance, patients and employees are less satisfied, medical treatment quality and public image are getting better, teaching resources are grinded, more difficult to obtain budgets and carries out them, the cost-down plan is practiced more efficient, subunits are working more efficiently, and cooperate more frequently.
Besides, these changed policies have notable influence on their organizational constitutions and operation performance, and operation performance indices. And, their financial, operation performance indices had gone down because of the decreased payment from the health insurance and the descending medical service amount. Most hospitals have worse performance numbers except the net profit fluctuation rate. And, quality performance indices trend toward a certain level and most hospitals patients’ satisfaction runs high because of the request of the health insurance and the hospital review. Moreover, the rest index goes high and low in half.
Aiming at the future development, district military hospitals should: 1.Plan an ever-lasting development, adjust management strategy, and cultivate management professionals. 2. Earn more and reduce expenses, refine medical treatment techniques, develop a community medical treatment. 3. Enhance information system.4.Carry out a service practice with patients’ safety as center care, construct regional medical treatment net, and upgrade soldiers’ medical treatment. 5. Integrate medical treatment service structure, introducing business management concepts, promote performance. 6. Fight for ordinance relaxation, and increase management flexibility.

並列關鍵字

The health insurance system；manpower down-sizing；organizational revolution；operating performance

參考文獻

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