財團法人醫院組織特性、市場特性與其申報費用、財務績效關係之探討

研究背景與重要性近來財團法人醫院營利狀況被廣為探討，財團法人醫院屬非營利醫院，肩負永續經營的社會責任，如何在健保總額支付制度下，管控合理申報費用，維持醫院盈餘，為財團法人醫院經營重點。本研究試圖以組織特性、市場特性探討檢視財團法人醫院申報費用與財務績效。研究目的一、探討財團法人醫院不同組織特性間其申報費用、財務績效之差異二、探討財團法人醫院不同市場特性間其申報費用、財務績效之差異三、探討財團法人醫院申報費用與財務績效相關性。四、分析醫院申報費用、財務績效影響因素。研究方法本研究為回溯性次級資料分析，採用2010年~2014年衛生福利部公告財團法人醫院財務報表與中央健康保險署公告醫院總額各醫院醫療服務費用申報情形，研究樣本為財團法人登記為綜合醫院且2010年~2014年財報資料完整無闕漏者，共54間醫院，以線性迴歸、重複測量雙因子變異數分析、皮爾森相關、複迴歸分析進行研究分析。結果 2010年~2014年財團法人醫院就醫院組織特性方面，醫院規模(F=11.675,P<.005)、醫院層級(F=7.651,P=.001)稅後餘絀有顯著差異，大型醫院、醫學中心顯著高於其他規模、層級醫院，而醫院規模(F=1.990,P=.147)、醫院層級(F=0.647,P=.528)稅後純益率則無顯著差異；集團化醫院與非集團化醫院申報總費用(F=3.875,P=.054)、稅後餘絀(F=2.534,P=.131)與稅後純益率(F=0.103,P=.750)無顯著差異。在市場特性方面，醫院位於不同競爭度市場申報總費用(F=0.014,P=.986)、稅後餘絀(F=1.955,P=.152)與稅後純益率(F=0.914,P=.408)無顯著差異。另，研究結果交通便利性為影響申報總費用的重要正向因素(P=0.12,R2=0.806)。結論與建議大型醫院其獲利能力依規模經濟理論，應高於中小型醫院，結果顯示其獲利能力與中小型醫院無顯著差異，建議檢視管控成本費用，以增加獲利空間。另，交通便利性與門診申報件數、住院申報件數為正相關，且交通便利性為影響申報總費的正向因素，醫院可檢視醫院所在位置交通便利性，若所在位置缺乏大眾運輸工具或距離大眾運輸據點距離偏遠，建議增加接駁服務，應可增加醫院服務量。

關鍵字

組織特性；市場特性；申報費用；財務績效；財團法人醫院

並列摘要

Background：Recently the financial statement of non-profit hospitals has been widely discussed. Foundation Hospitals, also referred to as not-for-profit(NFP) hospitals, shoulder social responsibility to achieve sustainable development. For example, how to retain reasonable control over medical expenses declaration and maintain surplus under the global budget payment system are the core of hospital management. This study attempts to explore the impact of organizational and market characteristics on medical expenses declaration claimed by NFP hospitals and their financial performance. Objectives：(1) the difference of medical expenses declaration and financial performance from different organizational characteristics of NFP hospitals (2) the difference of medical expenses declaration and financial performance from different market characteristics of NFP hospitals (3) the correlation between medical expenses declaration and financial performance of NFP hospitals and (4) analyze the influential factors regarding medical expenses declaration and financial performance. Method：Retrospective studies are designed to analyze secondary data based on 2010-2014 financial statement of Foundation Hospitals released by the Ministry of Health and Welfare and the declaration of medical services claimed by each hospital in accordance with global budget payment system announced by the Department of National Health Insurance. In this study, a sample of 54 hospitals registered as General hospitals by NFP organizations has complete financial statement report between 2010 and 2014. The collected data was analyzed with linear regression, repeated measures two-way ANOVA, Pearson correlation, multiple regression analysis. Results：For organizational characteristics of NFP hospitals, profit after tax was significantly associated with hospital size (F = 11.675, P <.005) and hospital levels (F = 7.651, P = .001). It can be found that the performance of large hospitals and Medical Centers was significantly higher than other hospitals of different sizes and levels. However, net profit margin was not significantly associated with hospital size (F = 1.990, P = .147) and hospital levels (F = 0.647, P = .528); total medical expenses declaration (F = 3.875, P = .054), profit after tax (F = 2.534, P = .131) and net profit margin (F = 0.103, P = .750) were not significantly associated with hospital group & non-hospital group. For market characteristics, total medical expenses declaration (F = 0.014, P = .986), profit after tax (F = 1.955, P = .152) and net profit margin (F = 0.914, P = .408) were not significantly associated with different levels of competition in hospital market. In addition, the result findings show easy access to transportation can be perceived as an important positive factor to affect total medical expenses declaration. (P=0.12, R2=0.806) Conclusion and suggestions：In accordance with the theory of economics of scale, large hospitals should be more profitable than small and medium hospitals. However, the results indicated that the profitability was not significantly associated with small and medium hospitals. As such, it is recommended that cost should be checked and inspected in order to increase profit margin. Also, easy access to transportation has positive correlation with the number of outpatient cases and inpatient declaration cases. Meanwhile, easy access to transportation can be viewed as a positive factor to affect total medical expenses declaration. Therefore, hospitals can verify access to their facility. Provided that public transportation is not available or the location is too far from the route of public transportation, it is advisable that increasing pickup service should encourage more patients to visit the hospital.