衛生署所屬醫院成立區域聯盟的成效評估

Evaluation of the Effectiveness of the Formation of Regional Health Alliance Among the Department of Health Hospitals

張世明(Shih-Ming Chang)

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(2005年)

摘要

研究目的：
由主客觀層面來探討衛生署所屬醫院區域聯盟成立（92年12月）一年來的成效及進展，並做為往後經營的參考，研究的主要問題有：
1、 瞭解區域聯盟成立後，署立醫院經營績效改善情形。
2、 瞭解區域聯盟成立後，署立醫院主管對經營績效的看法。
3、 瞭解區域聯盟成立後主客觀數據是否一致性。

研究方法：
客觀設計：回溯性次級資料分析（以91年、93年署立醫院生產力分析表）
為基準，並以人員病床數、財務、服務量、經營指標為研究構
面。
主觀設計：問卷調查法。
以衛生署所屬醫院之院長、副院長、秘書、人事主任、會計主任、
總務主任為對象，並以人力資源管理、財務管理、採購管理、資訊管理、聯合行銷、教育訓練、組織經營、整體評估八大構面來探討。

研究結果：
客觀設計： ○1住院人日、醫療收入、醫療成本、醫療折讓、醫師人數、全
院員工人數、病床數、政府補助創造的醫療收入（倍），政
府補助創造之獎前業務剩餘（倍）及單位住院人日費用…顯
著偏向增加。
○2政府補助人事費、業務剩餘…顯著偏向減少。
○3就聯盟區別而言：業務剩餘南區與北區有顯著差別，政府補
助創造之獎前業務剩餘南區與北區、南區與中區亦有顯著差
別。

主觀設計： ○1人力資源管理、財務管理偏向不同意，採購管理、資訊管理、聯合行銷、教育訓練、組織經營、整體評估偏向同意。
○2就性別而言，提高資通安全，男性比女性更顯著同意。
○3就聯盟區別而言，國際認證有助於提升醫院形象，中區比南區更顯著同意，在降低營運成本中區與南區、北區看法也有顯著差別，中區傾向於同意，南區、北區傾向不同意。

討論與建議：
1、 降低成本、提高效率仍是衛生署所屬醫院需繼續努力的目標。
2、 區域聯盟運作已有部分成效，這種運作模式是可以繼續努力的。
3、 對於競爭力較差地區的衛生署所屬醫院可以朝專科化或特殊化來處理。

關鍵字

區域聯盟 ； 策略聯盟

並列摘要

Purpose:

This study is to evaluate the effectiveness and the progress of the regional health alliance since its establishment in Dec, 2003. The results may be used for future reference in hospital management. This study focuses on three main subjects:
1. To understand the improvement of management among the Department of Health
hospitals after the formation of regional health alliance.
2. To understand the opinion of management among each of the Department of Health Hospital president, vice president, executive assistant, personnel chair, accounting chair, and general affair chair after the formation of regional health alliance.
3. To understand whether the result of objective data is in accordance with subjective data.

Methods:

Objective Design:
The published retrospective data (2002-2004 Department of Health Hospitals
production data analysis) forms the basis, and the study topics include personnel-numbers of beds, finance, service volume, and management indicators.

Subjective Design:
Questionnaire is distributed to the study subjects who include each of the Department of Health hospital president, vice president, executive assistant, personnel chair, accounting chair, and general affair chair. Questionnaire topics include human resource management, financial management, purchasing management, information system management, marketing alliance, educational training, organizational management, and overall assessment.

Results:
Objective design:
1. Numbers of admission and length of stay, medical care revenue, medical care cost, medical care unreceivable , numbers of physicians, numbers of hospital employee, numbers of beds, medical care supplement income from government, and the award from government in accordance with the increasing operational profits and unit of numbers and days of admission cost: significantly increase.
2. Personnel fee from government supplement and business profit: significantly decrease.
3. For regional health alliance: the southern and the northern regions have significant difference in business profit. For the award from government in accordance to the business profit , the south region shows significant difference from the central and the northern regions.

Subjective design:
1. Hunan resource management and financial management: disagree.
2. purchasing management, information system management, marketing alliance,
educational training, organizational management and overall assessment: agree.
3. For the different genders, more male agree to the improvement of security in transferring information than the female.
4. For the different regional health alliance, the international recognition can improve the hospital image, the central region agrees to that, but the southern region disagrees. For the reduction of the operation cost, the central, the southern, and the northern regions have significantly different views. The central region agrees to that, but the southern and the northern regions disagree.

Discussion and Suggestion:
1. The reduction of cost and improvement of efficiency is the main goal for the regional health alliance.
2. Since the operation of regional health alliance has made some progress, this kind of operational model can continue making strive.
3. The hospitals in less competitive areas may develop specialty care or using special treatment.

並列關鍵字

Regional alliance ； Strategy alliance

參考文獻

一、中文部分：

1、 白佳昇、張錦文,(1994),面對全民健保，醫院經營管理之因應策略,醫院雜誌。

2、 朱永昌,(2000),組織網路之結構性影響因素的探討,以台灣醫療組織為例。台灣大學社會學研究所碩士論文.。

3、 朱日僑、李淑宜(1992)，由醫院的組織互動談合作經營，醫院，第25卷第4期，247-254。

4、 呂鴻德（1996）。Q＆A企業策略聯盟。商周文化事業股份有限公司出版。