署立醫院經營績效之評估---應用資料包絡分析法

Efficiency Evaluation of Department of Health Hospitals：An Application of Data Envelopment Analysis

洪錫明(Hsi-Ming Hung)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/公共衛生學研究所碩士在職專班/碩士(2004年)

摘要

中文摘要
背景與目的
隨著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。署立醫院必須站在政府的立場，均衡醫療資源的使用，又要處於市場的競爭。因此，站在醫院經營管理者之立場，必須瞭解自身之營運狀況，作為設備資源投入及人員規模運用創造盈餘決策的參考。
本研究之主要目的包括：
一、評估署立醫院在不同年度(89,90,91)長期經營之相對經營績效。
二、瞭解署立醫院不同經濟規模長期經營之相對經營效率。
三、探討署立醫院在區域聯盟經營型態下之相對經營效率。
四、瞭解署立醫院經營績效最適之投入與產出。
研究方法
本研究採用資料包絡分析法，運用行政院衛生署中部辦公室統計之89-91年署立醫院營運相關資料為分析研究對象，係以22家署立綜合醫院，11家評鑑為區域醫院，其餘11家為地區醫院，並以中部辦公室規劃之四個區域聯盟來進行評估。

研究結果
來分析其投入變項為「總病床數」、「醫師人數」、「護理人數」、「其他醫事及行政人員數」；產出變項為「門診人次」、「急診人次」、「住院人日」、「平均每醫師產值」、「平均每日在所有22家樣本醫院中，連續三年之營運資料，以DEA門診費用」及「平均每日住院費用」。區域醫院組，在整體效率方面，33個DMU有22個是相對有效率佔樣本數的66.7%；地區醫院組，有15個DMU是相對有效率佔樣本數的45.4%；區域聯盟組，有5個DMU是相對有效率，佔樣本數的41.66%；依年度來比較，區域醫院組及地區醫院組，在90年度均呈現下降，而在91年度又再度提昇且比89年度要高出，區域聯盟組則在三年度持續上升。
結論和建議
就年度而言，署立綜合醫院之營運績效，在90年度均為顯著呈現下降，尤其地區醫院組為甚，效率值比區域醫院組低了許多。顯示地區醫院經營之規模，在政策改變時，更容易受到衝擊，造成營運績效不良，但在經營管理者能夠適時調整營運策略，資源投入及人力運用，績效亦能逐漸提昇。
就衛生主管機關之立場而言，除了考慮財務績效以外，建議能夠再強化署立醫院之功能，積極培養醫事人才，為政府醫療政策作後盾，在醫療投資時，更應考慮軟硬體之評估。對經營管理者而言，除了創造營運績效時，需考量經營型態之決策改變外，應注意內部之激勵誘因及分階段定期評量，同時更應提昇醫療品質之監測。
關鍵詞：績效評估、資料包絡分析法、DMU(Decision making unit)

關鍵字

決策單位 ； 資料包絡分析法 ； 績效評估

並列摘要

Abstract
Background and Purpose：
Along with enforcements of various medical institutuions, the medical environment of Taiwan produces the great changes. Limited medical resource reallocated. The hospital of DOH must stand position in government for the usage of the balanced medical resources and to be placed in the competition of the market again. Therefore, the station conducts the governor’s position at the hospital must understood the operation condition of the self. Be the equipment resource devotion and the personnel’s scale create the reference of the surplus decision.
The main purpose of this research are : (1) Evaluating efficiency of all hospitals of DOH pay the system in the aggregate of implement in front and back its whole operating efficiency; (2) understanding the hospitals of DOH in different year, opposite operating efficiency of the different layer class scale; (3) At inquire into the hospitals of DOH after government organization ,evaluating the efficiency of the alliance of the district decision for the consult of Health administration decision.
Method and Materials：
This research adopts the Data Envelopment Analysis, making use of the central office of Department of Health statisticses 2000-2002 the operation related data of the hospitals of DOH come to analytical research object. With 22 hsopitals of DOH, 11 hospital are regional and the another 11 hospitals are localized on the data bank of hospital accreditation and the total hospitals are devided to four alliances for valuation.
Result：
In all 22 sample hospitals, continuous operation data of the three years, analyze with DEA, the Input variable are “ Total number of bed”, “ Doctor’s number”, “ Nursing number”, the Output variable are “Out-patient service person-time”, “Emergency call person-time”, “Stay in the hospital person’s day”, “Equally pr.doctor’s production value”, “Average per diem out-patient service charge”, and “Average per diem stay in hospital charge per day”.
In regional hospital group, 22 DMUs are relative efficient in the whole aspect of efficiency, account for 66.7% of sample numbers; In local hospital group, 15 DMUs are opposite efficient, account for 45.4%; In Alliance group, 5 DMUs are opposite efficient, account for 41.66% of sample numbers. Compare according to the year, the regional group and local group are all present the slump in 2001, and once more again promote in 2002, want the high proptosis than 2000, but the all alliance group had improved by year progressively.

Conclusion and Discussion：
In regard to year, the operation results of hospital of DOH, all are obvious to present the slump in 2001, particularly in the local hospital group. The efficiency value are lower than the hospital set of the district many. Show the scale of the hospital management of the local hospital group was subjected to the impact easily and cause operate the result badly at the policy transform.. But they can adjust the operation strategy in good time in the operating management, resource invest and usage of manpower. The results also can promote gradually.
In addition to respect results of finance outside from the health agency, we suggest to enhance again the function of the hospitals of DOH. The aggressive development sures the matter talented person to make the backing for the government medical policy. At the medical invest, the appraisal of the software and hardware should be considered on the same time. In the operating management, in addition to creat the operation results for hour, needing the decision making of consideration management type of transforms outside, we should notice the inducement of motivate of the inner part,even should promote the medical quality meanwhile.

並列關鍵字

DOH (Department of Health) ； DMU (Decision Maker Unit) ； Efficiency evaluation ； DEA (Data Envelopment Analysis)

參考文獻

參考文獻

一、中文部分

1. 省市立醫院生產力之研究---以DEA方法研究醫院生產力之運用,行政院衛生署委託計 畫 藍忠孚、錢慶文 1991

2. 國軍醫院經營效率之實證研究　張石柱、廖哲聖　　 國防管理學院學報　 89.05

3. 公私立綜合醫院服務層面效率差異之探討　石淦生、羅紀瓊　 中華公共衛生雜 誌 85.10