台灣健保實施後地區醫院經營策略與績效探討

A Study of Strategic Management and Performance of District Hospitals in Taiwan after The Implementation of National Health Insurance

陳純慈(Chun-Tzu Chen)

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

雖說台灣健保實施後醫療環境對於地區醫院相當不利，但目前仍有倖存者，盼這些尚存之地區醫院能永續經營，且能有美好的未來，故本論文希望能歸納出台灣實施健保後地區醫院經營策略、地區醫院是否有因醫院特性或環境因素不同，而有經營策略之不同、探討經營績效較好之地區醫院之經營策略，期盼能對於地區醫院的經營有所助益。
本研究採用問卷調查研究方法(Survey research)，透過相關文獻探討後，根據研究架構編製問卷，以達到本研究目的，探討地區醫院經營策略如合作經營、垂直整合、醫療相關業務多角化經營等策略，是否與經營績效有直接關係，而醫院特性及環境特性是否也相對影響經營策略及經營績效，經過統計分析方法透過SPSS統計軟體得出研究結果。
本研究共發出問卷454份，有效回收問卷124份，有效回收率27.31%，但據衛生署公佈九十一年底地區醫院含地教僅有385家，若以實際地區醫院當母數則有效回收率應為32.21%。醫院特性即權屬別、評鑑別、規模、屬性四個構面，可看出因醫院特性不同醫院經營策略會有差異，門急診人次因規模不同而有顯著性意義，在環境特性即病床人口比、醫師人口比、人口密度、城鄉別上，對於經營策略及經營績效較無顯著性影響，至於經營策略與經營績效發現，RCW的經營對佔床率有顯著意義，復健中心的經營、PF計薪制度的實施、向外承包醫療相關業務會提升門急診人次達顯著意義。
綜合研究結果目前洗腎室、RCW、復健中心是地區醫院最多經營的項目，另外朝醫療相關多角化，擴大本身經營範圍，及與其他醫院或機構在經營項目、人力結合、專業共享、成本節省上合作，達到多贏的目標，是目前地區醫院經營的主流策略，也是本研究給於最衷心的建議。

關鍵字

經營績效 ； 經營策略 ； 地區醫院

並列摘要

Some district hospitals in Taiwan are surviving notwithstanding the inextricable difficulties due to the implementation of National Health Insurance. The aim of this study is to understand, firstly, how these district hospitals survived in such a circumstance and what the strategies of management these district hospitals have in response to change of market environment caused by implementation of compulsory national health insurance and reimbursement system. The influence of hospital characteristics and market environment on hospital strategy of management was also evaluated. Finally, crucial strategies of management that lead to success in terms of hospital performance were analyzed.
The study was an analytical survey research in design. A questionnaire based on results from literature review was developed to examine the relationship between hospital performance and strategy of management, such as strategic alliance, vertical integration, and diversifying service. The moderating effects of hospital characteristics and market environment on strategy and performance were also examined. SPSS statistical software was utilized to do all the statistical analyses in this study.
454 questionnaires were sent to all district hospitals listed in the Department of Health. There were 124 effective questionnaire returned, effective response rate was 27.31%. Nevertheless, there were only 385 district hospitals in Taiwan according to record of the Department of Health in 2002. The effective response rate, therefore, was 32.21% using 385 as denominator. Various strategies of management were observed in hospitals with different characteristics in terms of public sector or private sector or NPO, levels of accreditation teaching and non-teaching, aspects of hospital services and general or specialization. Total annual numbers of patients in outpatient department and Emergency showed significant difference between different sizes of hospitals. However, there were no significant influence on strategy of management and hospital performance regarding market environment, such as ratio of hospital beds and catchment’s population, ratio of physician number and catchment’s population, catchment’s population density, and location of hospital. In relationship of strategy and performance, the data showed that RCW service significantly influenced the annual average rates of patient occupied in hospital and running community rehabilitation center, PF physician salary system and strategic outsourcing medical service significantly increased total annual number of patients at outpatient clinics as well.
This study showed that haemodialysis, RCW, and community rehabilitation center are currently most common services in the district hospitals in Taiwan. The most common strategies employed among district hospitals to achieve multi-winner goal were expansion of service scales by providing diversified service types and vertical strategic alliance to achieve integration of services and manpower, expertise sharing, and cost reduction.

並列關鍵字

district hospitals ； strategic management ； performance

參考文獻

中文部份：

1. 王美芳，1994，我國地區醫院功能之研究。中國醫藥學院醫務管理學研究所碩士論文。

2. 王炳龍、徐淑芬、梁乃仁等，2000，醫院採用垂直整合策略之影響因素與績效評估，醫管雜誌，創刊號，17-25。

3. 王俊文，1999，健保新時代醫療產業之生態與因應 醫院 Vol.32，No2，P17-31。

4. 白佳昇、張錦文，1993，面對全民健保，醫院經營管理之因應策略。醫院，27(2)：25-31。