醫院各臨床科長期經營效率評估－以某二家醫學中心為例

面對醫療環境不斷變遷，醫院過去以量取勝之經營策略，非但不能使醫院度過此一險境，在健保總額之下，反而為醫院帶來危機。要化解此種變革，首要改善醫院經營體質，如提高醫療品質、降低醫療成本、提升醫院管理及經營效率等。由於醫院內部各臨床科為各醫院之主力生產部門，欲提升醫院經營效率，必須先從各臨床科做起，對於各臨床科過去及現狀營運狀況，透過效率衡量與評估方法，以便於了解各臨床科長期醫療資源耗用及產出情形，掌握各臨床科的內部優勢(Strengths)與劣勢(Weaknesses)，外部環境的機會(Opportunities)與威脅(Threats)，進而對各項醫療資源做最有效率之分配，以提升醫院整體之生產力與競爭力。本研究資料為同一醫療體系某二家醫學中心回溯性資料，跨越之時間點為83年、87年及91年，即從勞保時期，健保時代，至健保總額預算實施，剛好穿越健保實施前、後及總額預算三個台灣醫療史上的重要紀元。以各臨床科為主軸，兼具縱貫性及橫斷性研究設計。其樣本數，內科組有13個臨床科，外科組有12個臨床科，三個年度則分別有39個決策分析單位(Decision Making Units, DMUs)及36個決策分析單位。利用資料包絡分析法(Data Envelopment Analysis；DEA)，就同一院區內科組、外科組及合併組與不同院區內科併組、外科併組，評估各臨床科之長期經營效率。研究結果發現： 1.同一院區A院區，內科組相對有效率者有17個，佔43.6%，相對無效率者有22個，佔56.4%；外科組相對有效率者有18個，佔50.0%，相對無效率者有18個，佔50.0%；就內、外科併組分析，其中內科組相對有效率者有17個，佔22.7%，相對無效率者有22個，佔29.3%，而外科組相對有效率者有1個，佔1.3%，相對無效率者有35個，佔46.7%。 2.同一院區B院區，內科組相對有效率者15個，佔38.5%，相對無效率者有24個，佔61.5%；外科組相對有效率者有24個，佔67.7%，相對無效率者有12個，佔33.3%；就內、外科併組分析，其中內科組相對有效率者有15個，佔20.0%，相對無效率者有24個，佔32.0%，而外科組相對有效率者4個，佔5.3%，相對無效率者32個，佔42.7%。 3.不同院區內科併組，相對有效率者26個，佔33.3%，相對無效率者有52個，佔66.7%；其中A院區相對有效率者15個，佔19.2%，相對無效率者有24個，佔30.8%，B院區相對有效率者11個，佔14.1%，相對無效率者有28個，佔35.9%。不同院區外科併組，相對有效率者37個，佔51.4%，相對無效率者有35個，佔48.6%；其中A院區相對有效率者14個，佔19.4%，相對無效率者有22個，佔30.6%，B院區相對有效率者23個，佔31.9%，相對無效率者有13個，佔18.1%。就A院區長期經營效率而言，內科組、外科組及內外科併組各臨床科，並無顯著性有差異；B院區長期經營效率而言，內科組及內外科併組各臨床科，有顯著性有差異，外科組各臨床科，並無顯著性有差異；另就不同院區內科併組，其長期經營效率有顯著性有差異，外科併組其長期經營效率並無顯著性有差異。本研究顯示，同一院區之外科組及不同院區之外科併組，其長期經營效率並無顯著性差異，以及A院區其內科組、外科組及合併組其長期經營效率並無顯著性差異外，其餘各組則各有差異或無差異。

關鍵字

資料包絡分析法；決策分析單位；差額變數分析

並列摘要

In the face of constant changing of medical environment, the former quantity-based management policy in a hospital no longer helps. In contrast, under the global budget of NHI, it brings some crisis for the hospital. In order to solve the change, we first have to improve the management quality of a hospital, such as increasing the medical care quality, reducing the medical care cost, enhancing the hospital management and efficiency, etc. Clinical departments in hospital are the major productive parts. If we want enhance the hospital management efficiency, then we have to start improving each of the clinical departments. For the past and present management situation in each of the clinical department, we have to use the methods of efficiency measurement and evaluation so as to understand their long-term medical care resources consumption and producing, internal strength and weakness, as well as the opportunities and threats of external environment. Furthermore, we can distribute all kinds of medical resources in the most efficiency way, and then improve the hospital’s productive and competitive abilities at the same time. The data of this study are retrospective data in two medical center which are the same medical system, during the period of year 1994, 1998, and 2002, i.e. from the Labor Law age, National Health Insurance age, to the Global Budget of NHI, which just crosses the three important eras (pre-NHI, post NHI and Global Budget) in Taiwan medical history. This study design based on all clinical departments was longitudinal study design and cross-sectional study design. There were 13 samples of surgical departments, and 12 samples in division of internal medicine, it means there were 39 and 36 Decision Making Units in three years. Data environment Analysis was employed in the division of the internal medicine and surgery at the same hospitals, to evaluate the long-term management efficiency in the clinical departments. Result： 1.Hospital A：In the division of internal medicine, 17(43.6%) are relative efficient, and 22(56.4%) are relatively inefficient. In the division of surgery, 18(50%) are relatively efficient, and 18(50%) are relatively inefficient. For the combined group of internal medicine and surgery, 17(22.7%) of internal medicine are relatively efficient, and 22(29.3%) are relatively inefficient. One (1.3%) the surgery is relatively efficient, and 35(46.7%) are relatively inefficient. 2.Hospital B：In the division of internal medicine, 15(38.5%) are relative efficient, and 24(61.5%) are relatively inefficient. In the division of surgery, 24(67.7%) are relatively efficient, and 12(33.3%) are relatively inefficient. For the combined group of internal medicine and surgery, 15(20%) of internal medicine are relatively efficient, and 24(32%) are relatively inefficient. Four (5.3%) the surgery is relatively efficient, and 32(42.7%) are relatively inefficient. 3.Combined group of the internal medicine division from different hospital： 26(33.3%) are relative efficient, and 52(66.7%) are relatively inefficient. 15(19.2%) from hospital A are relative efficient, and 24(30.8%) are relatively inefficient. 11(14.1%) from hospital B are relative efficient, and 28(35.9%) are relatively inefficient. Combined group of the surgery division from different hospital： 37(51.4%) are relative efficient, and 35(48.6%) are relatively inefficient. 14(19.4%) from hospital A are relative efficient, and 22(30.6%) are relatively inefficient. 23(31.9%) from hospital B are relative efficient, and 13(18.1%) are relatively inefficient. In terms of long-term management efficiency in hospital A, there was no significant difference among the division internal medicine、 surgery and combined group. In terms of long-term management efficiency in hospital B, there was significant difference between the division internal medicine and combined group, however, there was no significant difference between the surgical departments. In combined group of internal medicine in different hospitals, there was significant difference in long-term management efficiency, however, there was no significant difference in combined group of surgery. This study shows that there were no significant difference in long-term management efficiency between the surgical departments at the same hospital and the combined group at different hospitals. And in hospital A, there was no significant difference among the division of internal medicine、 surgery and combined group, and there was some difference or no difference in the rest of the division.