全民建保總額預算實施前後榮民醫院經營效率比較

摘要研究目的本研究以「全民健保總額預算實施前後榮民醫院經營效率比較」為研究主題，針對榮民醫療體系內之12家榮民醫院於醫院總額預算實施前後經營效率進行評估，期能提供相關單位建立有效率的經營管理參考。本研究之目的有三：1﹚瞭解總額預算實施前後，榮民醫院整體之經營效率。 2﹚探討總額預算實施前後，不同規模榮民醫院之經營效率。 3﹚比較總額預算實施前後，不同區域榮民醫院之經營效率。研究方法本研究是採回溯性的研究設計，利用「資料包絡分析法」分析各受評醫院的相對效率值，資料來源係由各樣本醫院提供醫院總額預算實施前一年（2001年7月-2002年6月），醫院總額實施後一年（2002年7月-2003年6月）之醫療服務量統計及人力資源月報表加以整理，共有24個DMUs進行分析比較。研究結果總額預算實施前後榮民醫院整體經營效率；在單一年度CCR模式分析中，共有12個決策單位，總額前相對有效率的醫院有7家（58.33%），相對無效率醫院有5家（41.67%）。總額後相對有效率的醫院有4家（33.33%），相對無效率醫院有8家（66.67%），在BCC模式分析中，相對有效率的醫院有9家（75%），相對無效率醫院有3家（25%）。在跨年度的CCR投入及產出導向中，共有24個決策單位，相對有效率的決策單位有9個（37.5％），相對無效率的決策單位有15個（62.5％）。在跨年度的BCC模式分析中，相對有效率的決策單位有14個（58.33％），相對無效率的決策單位有10個（41.67%）。不同規模及不同區域的榮民醫院於總額預算實施前、後之經營效率均無顯著的差異。討論與建議本研究是以CCR及BCC模式來進行分析，總額預算實施前後榮民醫院之整體經營效率無顯著差異，顯示榮民醫院系統制度化的經營管理是有成效的。不同規模、不同區域的榮民醫院於總額預算實施前、後，因榮民醫療體系三級醫療照護網運作順利，投入資源的多寡或地理因素並未造成整體經營效率的影響。建議後續研究者能收集醫院總額預算實施前一年及後三年以上的資料作對照，加入財務指標相關變項，並納入不同權屬之公立醫院進行DEA效率分析比較，較能獲得客觀的研究結果。

關鍵字

總額預算

並列摘要

Abstract Objective: The study is on the evaluation of the management efficiency of the 12 veteran hospitals of the veteran medical system around the implementation of the Global Budget of National Health Insurance. To expect to supply the build-up of efficient management reference with the veteran hospital medical system around the implementation of the Global Budget. The objectives of the study were three-fold: 1) to realize the management efficiency of the whole veteran hospitals, around the implementation of the Global Budget; 2) to study the management efficiency of different scales of veteran hospitals around the implementation of the Global Budget; 3) to compare the management efficiency of different regions of veteran hospitals around the implementation of the Global Budget. Method: The study is based on backtracking method research devise calculated by Data Envelopment Analysis (DEA) to analyze the opposite efficiency value of the accredited hospitals. The source of the data was supplied with every model hospital’s medical service amount statistics and human resource monthly report (2001/07~2002/06&2002/07~2003/06). Analyze and compare the 12 & 24 DMUS in single-year & cross-year traverse and longitudinal analysis. Result: The management efficiency of the general Veteran Hospitals around the implementation of the Global Budget: There are 12 decision-making units (DMUs) in the single-year CCR(Charnes、 Cooper 、Rhodes) input and output models. There were 7 DMUs were related efficient (58.33%); however, 5 DMUs (41.67%) were related inefficient before the implementation of the Global Budget. But after the implementation of the Global Budget, there were 4 related efficient DMUs (33.33%) while 8 related inefficient DMUs (66.67%). For BCC models, there were 9 DMUs were related efficient (75%); however, 3 DMUs were related inefficient (25%). There were 24 DMUs in the cross-year CCR input and output models. The related inefficient DMUs were 15(62.5%). For BCC models, there were 14 DMUs were related efficient (58.33%); however, 10 DMUs were related inefficient (41.67%). The different scales and regions of veteran hospitals management efficiency around the implementation of the Global Budget are not obviously different. Discussion and Suggestion: There was no significant difference in the single-year & cross-year analysis of veteran hospital’s general management around the implementation of the Global Budget. It appeals that systematized management of the veteran hospital system is efficient. Different scale and regional veteran hospitals operate well around the implementation of the Global Budget because of the three-level medical web of the veteran medical system. The volume of input resource or the geographic element did not affect the whole management efficiency. Suggest the following researchers compare the data of the hospital’s Global Budget (pre-year & three-year afterwards). Add the related items of financial indicator, and compare the different authorized public hospitals with DEA efficiency to obtain objective results.