以資料包絡分析法進行非營利宗教性財團法人醫院營運效率最佳化研究

Evaluation of the operational efficiency of a regional not-for-profit religion hospital by Data Envelopment Analysis (DEA) method

藍志堅(Chi -Kin Lan)

指導教授 ： 邱亨嘉

共同指導教授 ： 郝宏恕(Hong-Shu Hoa)

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2007年)

摘要

中文摘要
?? 背景與目的
隨著全民健保總額給付與各項醫療制度的施行，台灣的醫療環境產生莫大的變遷，有限的醫療資源重新分配。非營利宗教性財團法人所屬之教會醫院，一方面必須站在醫院設立的宗旨，以非營利慈善事工為目的，又要處於市場的競爭。因此，本研究之主要目的包括：一、評估屏東某區域級基督教醫院之長期經營效率在健保總額给付制度實施前後營運與績效；二、評估此醫院之長期經營效率在其他教會型區域醫院中相對績效成果；三、評估教會型區域醫院之長期經營效率在其它同類型之法人區域醫院的相對績效成果；四、研究在固定人事與預算成本之下，如要將此醫院營運最佳化，需要在哪些控制指標中修改。

?? 研究方法
本研究選取屏東某基督教區域醫院，以及其相同性質屬性之教會醫院與法人醫院做比較，並同樣比較教會型醫學中心與法人醫學中心之營運績效。本研究採用資料包絡分析法，運用投入變項(總樓板面積、急性(一般)病床總合數、醫師總數與護理人員數)與產出變項(門診平均每日人次、急診平均每日人次、急性(一般)病床平均佔床率)。各醫院之數據資料，來自於台灣醫院協會所製作「台灣地區醫院年鑑」之統計資料，本研究收集之資料自全民健保實施總額支付制度前後，從2002年至2004年連續三個年度之資料。

?? 研究結果
本研究共擷取擬研究之屏東某基督教區域醫院(n = 1)、教會型區域醫院(n =9)與法人區域醫院(n = 8)。本研究發現，研究醫院以2002年之營運效率最佳，2003年為最差。健保總額制度實施前後營運效率的比較中，在教會型區域醫院中，有4家總額制度實施前效率較佳，有4家在總額給付制度實施後，效率較佳，有2家醫院2002年與2004年之效率皆為1。在所有區域教會與法人醫院中，相對有效率(效率值為1)共有19個DMU，其中教會醫院有10個，法人醫院9家；無效率(效率值<0.8)中之醫院有8個DMU，其中教會醫院有5個，法人醫院有3個。綜合分析各醫院的表現，以2003年為最低，在調整佔床率數據以排除SARS的影響之後，2003年之表現仍為最差，表示總額給付制度的確造成衝擊。
?? 結論與建議
教會型區域醫院在與其他法人區域醫院比較時，教會型醫院普遍營運效率較差。顯然教會型醫院在經營上，仍有進步的空間。本研究也發現，各區域醫院普遍受到健保總額給付影響，在此制度實施後，2003年經營效率都變差，唯仍有一些醫院在2004年效率值又上升，表示各醫院能夠找出調適的方法。建議未來研究者，可以選取幾所營運良好的醫療院所，進行質性的個案研究，探討其營運成功的內部原因，提供給其他有志努力的醫院作參考。

關鍵字

資料包絡分析法 ； 營運效率 ； 宗教型區域醫院

並列摘要

Abstract
?? Background and Purpose:
The not-for-profit religious healthcare institutions face a great challenge today because of the new National Insurance Policy “Global Budget Cap” and various medical policies changes. These not-for-profit healthcare institutions not only need to continue their missionary services to the needy individuals, but also have to keep up with the competition from the private and public hospitals. Thus, it is important for the not-for-profit religious hospitals to evaluate their operating efficiency, based on their missions and goals, in order to optimize their investment in personnel and capital expenditures. The objectives of this study are: (1) to evaluate the Study Hospital, a Christian hospital, operating efficiency before and after the National Insurance “Global Budget Cap” policy, during 2002 – 2004; (2) to evaluate the Study Hospital’s operating efficiency against the selected religious hospitals within the same operating category; (3) to evaluate the Study Hospital’s operating efficiency against selected religious and private hospitals within the same operating category; (4) to determine how, if possible, to optimize the operating efficiency of the Study Hospital without laying off any personnel.

?? Materials and Methods:
A Christian religious regional hospital located in Pingtong City, was selected as “Study Hospital” for this study. Selected religious and private regional hospitals as well as medical centers were also included in the analysis. Data Envelopment Analysis (DEA) was used as the evaluation method. Four input variables (floor area, total beds, number of doctors, and number of nursing staff) and three output variables (daily outpatient visits, daily emergency room visits, and average bed occupied rate) were used for DEA. The hospital data was extracted from the “Taiwan Hospital Annual” between year 2002 – 2004 by Taiwan Hospital Association.

?? Results:
There are one Study Hospital (in Pingtong City), 9 religious regional hospitals, and 8 private regional hospitals. The results showed that the Study Hospital has the best operating efficiency in 2002 while 2003 yielded the worst efficiency. Among religious regional hospitals, 4 hospitals have better efficiency before the implementation of global budget cap policy. Four hospitals have better efficiency in 2004 which as after the implementation of global budget cap policy. Among regional hospitals which were relative efficient (Efficiency = 1), 10 DMUs were religious hospitals and 9 were private hospitals. Among hospitals which were relative non-efficient (Efficiency <0.8), 5 DMUs were religious hospitals and 3 were private hospitals. Most hospitals included in this study exhibited lowest operating efficiency in 2003. If the effect of SARS was considered as a cause of decrease of average bed occupied rate, the adjusted efficiency still demonstrate that 2003 yield the worst efficiency which suggest the influence of global budget cap.

?? Discussion and Conclusion
Based on our study, the Study Hospital exhibited “above average” operating efficiency against other religious regional hospitals. However, religious regional hospitals, in overall, did not perform better than private regional hospitals. Our results also indicate that the global budget cap policy has impact on most of the hospitals in 2003 which yielded the lowest operating efficiency. It is noteworthy that some hospitals regain their competitiveness where their efficiency increases in 2004. It is possible to design a prospective, qualitative study to determine the key aspects to achieve high operating efficiency in better performance hospitals in the future.

並列關鍵字

Data Envelopment Analysis (DEA) ； Operating Efficiency ； Non-for-profit Religious Hospitals

參考文獻

5. 翁興利、李艷玲、潘婉如（1996），相對效率之衡量DEA運用，中國行政評論，5（4）：63-106。

參考文獻

中文部份

1. 王信仁（1992），醫學中心與區域醫院之效率評估-資料包絡法之應用，高雄醫學院公共衛生研究所碩士論文。

2. 李玉春、蘇春蘭（1993），總額預算制度之設計，行政院衛生署研究報告。