地區醫院於健保總額預算制度實施後經營策略與醫院產出表現之探討

摘要本研究主要採用問卷調查研究方法(Survey research)，透過相關文獻探討擬定研究概念架構，根據研究概念架構編製問卷，以達本研究的目的，探討及歸納實施健保總額制度後地區醫院經營策略是否與醫院產出相關。而醫院特性如權屬別、醫院屬性(地區或地區專科醫院)、病床數及醫師數，是否與目前地區醫院產出相關。市場競爭程度依衛生署資料以25縣市各層級總病床數為分母，樣本醫院佔床率平方為分子計算賀芬達指標是否也相對影響經營策略與醫院產出，經過SPSS統計方法分析，透過統計軟體得出研究結果。本研究共發出問卷363份，有效回收問卷指153份，有效回收率42.1%，但依健保局九十二及九十三年度地區醫院申報檔資料，扣除新設醫院未申報費用之地區醫院家數僅有356 家，若以實際兩個年度皆申報費用之地區醫院家數當母數則有效問卷回收率為42.9%。醫院特性為權屬別、屬性、床數、醫師數四個構面，可看出醫院特性不同經營策略會有差異，門、住診申報後收入金額與床數規模不同而有顯著性意義，在競爭程度即賀芬達指標於樣本醫院縣市別，對於資訊管理及品質管理策略構面與及醫院產出表現有顯著差異。本研究結果歸納出幾個方向，可提供給地區醫院經營者參考，論量計酬的時代醫院服務量的增加帶來的健保收入是可期待的。但從樣本醫院預測產生較佳醫院產出表現在經營策略時，發現總額支付制度來臨，醫院由健保支付的醫療收入已是上限制，若是選擇的經營策略是衝健保業務量則可能會走入死海；反之開發自費業務或業外收入是生存要件。因此由本研究結果得知選擇方向性調適性策略如(停止擴充、業務項目委外、採專科經營、附設長期照護服務、投入醫療相關產業、與非同業結盟調整組織架構)及財務管理策略如(設立並統合財會中心、設立物流中心，以減少屯積成本、設定營運指標並確實執行、與各層級醫院進行藥品採購聯合採購、院內儀器與醫院聯合外包或租賃)，是地區醫院面臨現行健保總額支付制度下取得健保收入最佳經營策略；面臨非健保業務之經營策略應如何運作，是有興趣者日後可研究的方向。醫院規模對醫院產出是重要的，地區醫院如何用連鎖或策略聯盟將規模限制問題降低，利用規模增加人力招募的容易度，著力開發自費相關產業是建議地區醫院可積極進行的方向。關鍵詞：地區醫院地區醫院的經營策略總額支付制度

關鍵字

地區醫院；地區醫院的經營策略；總額支付制度

並列摘要

Abstract This research chief adopt questionnaire survey research means, permeate relative to document inquire into draw up research concept's framework, ccording to research concept's framework's weave questionnaire, as reach what this research's aim, inquire into and generalize which practice Global Budget system behind the business of district hospital whether with hospital output relative. But hospital's characteristic be like belong to not, hospital's attribute (district or district’s special course's hospital), bed's and doctors, whether with at present district hospital's output relative. Market compete as 25 county's markets each's level's general sickbed numbers extent as Development of Health data for denominator, sample's hospital occupy bed rate square for molecule calculation congratulate fragrance reach target whether too relative to affect business principle with hospital output, pass through SPSS statistical method analysis, permeate statistical software reach findings. This research altogether give off questionaire 363, effective callback questionaire point 153, effective callback rate 42.1%, but depend on Chien protect bureau 92 and 93 year's area's hospital declare data, deduct new set up hospital not declare expense zhi area's hospital number only ens 356 Home, if as practicality's two years all declaration expense zhi area hospital number while parameter then effective questionaire callback rate for 42.9%.。 Hospital's characteristic for belong to not, attribute, bed number, doctor number four construct face, can see hospital's characteristic's different business principle can have difference, door, live examine income's amount with bed's number magnitudes different but have conspicuous sex meaning behind declaration, at compete extent that be congratulate fragrance reach target in sample's hospital's county's market not, towards information management and quality administer tactic construct with and hospital turn out behave have conspicuous difference. This' findings generalize come out several direction, can supply to area's hospital's operator referrence, discuss what quantity calculates compensation's era hospital serve quantity de increase bring de Chien protect income is can expect de. But from sample's hospital forecast bring forth compare good hospital turn out watch now business principle time, discover gross pay system coming, hospital by Chien protect pay de cure's income already is on confine, if elective business principle is rush Chien protect traffic volume then maybe walk enter dead sea; vice versa develop self-funded business or industry outside income is exist important item. So by this' findings hear of choose directivity transfer adaptability tactic be like (stop expand, outside business' project's Wei, pick up special course management, have as an attached institution long-term shine protect service, dive into cure relative to industry, with not fellow trader ally adjust organization's framework) come up to financial management's tactic be like (establish and lead equal to finance and accounting's center, establish logistic center, as decrease collect accumulate cost, set up operate target and actually execution, with each's level's hospital proceed medicine purchase association purchase, in institute apparatus with hospital associate outside wrap or lease) ,be area's hospital face active Chien protect gross pay acquire Chien protect income's best business principle under system; face not Chien protect business zhi business principle should how to operation, be have interest person in the future can research de direction. Hospital's magnitude to hospital turn out is important, area's hospital's how to use catenate or tactic federation will magnitude confine to problem debase, take advantage of magnitude increase what manpower recruit easily degree, put forth effort develop self-funded relative industry is suggestion area hospital can active proceed de direction. Key Words: District Hospital The Business Strategies of District Hospital Global Budget System