總額支付制度實施後地區醫院
經營策略之探討

目的：本研究透過問卷調查探討及歸納，總額後地區醫院的經營轉型策略方向，依地區醫院屬性、權屬別與經營轉型策略、營運狀況及醫院社區化程度作統計分析，期能提供地區醫院未來轉型策略的方向與方針，並能於轉型後產生較佳經營績效。方法：主要採用問卷調查研究法，以94年度地區醫院評鑑合格名單（含地區教學醫院）352家院長或其代理人為問卷發放對象。問卷內容涵蓋總額實施後醫院經營轉型策略之方向、總額實施後91年-95年地區醫院的營運狀況及總額實施後地區醫院對醫院社區化的認同程度調查。問卷邀請經營醫院實務的經營者及醫療相關學術界的專家共五位，進行專家效度審查，並先選取三十家地區醫院院長作為發放對象，進行問卷題目之信度估計。信度分析檢定後，其整份問卷的Cronbach’s Alpha值為0.909。統計分析採12.0版之統計套裝軟體利用SPSS12.0版之統計套裝軟體進行卡方檢定及Pearson相關分析。結果：地區醫院在總額實施時與實施後，其平均佔床率、平均自費比率、健保佔全院收入比例、平均人事費佔支出比例無達顯著的差異。在不同權屬別的地區醫院，公立地區醫院、法人地區醫院及私立地區醫院平均佔床率無顯著的差異；公立地區醫院、法人地區醫院及私立地區醫院的平均自費比率在94年度及95年度有顯著差異；公立地區醫院、法人地區醫院及私立地區醫院健保佔全院收入比率在94年度及95年度有顯著的差異；公立地區醫院、法人地區醫院及私立地區醫院的平均人事費佔支出比例有顯著的差異。地區醫院在總額實施後，醫院社區化程度與醫院的營運狀況（91年度-95年度）有正相關，在統計上平均佔床率，有達顯著的差異。地區醫院在總額實施後，主要以醫療品質提升及變更經營策略為經營轉型策略的方向。結論與建議：總額支付制度實施後，地區醫院轉型或尋找合適本身的經營策略為醫院生存勢在必行的路。雖然根據統計分析顯示，醫院社區化對地區醫院的營運狀況有顯著差異，但，醫院的經營及轉型策略應評估自身內部的條件及外在的醫療環境等影響因素，來擬定未來的經營方向，不可盲從。否則，就算轉型或改變經營方式，不见得對醫院的營運績效有太大的助益。

關鍵字

地區醫院；總額支付制度；地區醫院的經營策略；轉型；社區化

並列摘要

Objective: Through the collection and discussion of surveys, this research discusses and categorizes the direction of strategies undertaken by district hospitals following the implementation of Global Budget System. Their character hospital、ownerships, and strategyies of transformation has been statistically analyzed, and it is hoped that this research can be a useful guide to district hospitals for their transformation strategies in the future, which may help yield better results following their transformation. Methods: Surveys were distributed to 352 district hospital directors (or their proxies) whose hospital passed annual assessment in 2005 (including teaching hospitals). The survey encompassed questions such as: hospitals’ management and transformation strategy following Global Budget System, the operating status of hospital in 2002-2006, and the level of identification with hospital localization. this research invited 5 experts who specialized in practical hospital management and medical-related academic matters to participate in the examination of validity of this research. 30 directors of district hospitals were also given evaluation forms to rate the validity of the survey questions. After certificate of reliability anaysis, Cronbach’s Alpha score for the survey was 0.909. SPSS (Statistical Package of the Social sciences) 12.0 software was used for Chi-squared test and Pearson correlational analyses. Results: There is no significant different on average occupancy rate, average private medicine rate, rate of hospital income account for NHI, and the rate of average payload account for expenditure when the global budget system implemented and after implementation. Base on the different ownerships, there is no significant different on average occupancy rate within public district hospital, non-for-profit district hospital, and private hospital. But the average private medicine rate and rate of hospital income account for NHI had significant different on year 94 and year 95. And the rate of average payload account for expenditure had significant difference, too.After the implementation of global budget, the degree of communization of the distinct hospital has positive relation with the operation of hospital on year 91-95, and there war significant difference on the average occupancy rate.After the implementation of the global budget, the distinct hospital take the improving quality of care and change the operation strategy as the transformation method. Conclusion and suggestion: Following the implementation of Global Budget System, transformation or finding a suitable management strategy has become a necessity for distinct hospitals. Though the analyses showed that the level of hospital localization has an obvious impact on distinct hospitals, hospitals should set out their future management plan according to their own interior conditions, as well as exterior medical environmental factors, and not to follow these results blindly. Otherwise, the outcome may not be better even following transformation or a change in management strategy.