養護型長期照顧機構經營績效與環境因素相關性探討

The Relationship between Environmental Factors and Operational Performance among Nursing Institutions of Residential Care

古永瑋(Yung-Wei Ku)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00206

摘要

背景： 由於老年人口數之快速成長，引發更多的長期照顧需求，長期照顧服務產業也應運而生且快速發展。民國87年前我國長期照顧機構僅237家，民國98年底已增至1,080家，其中又以養護型機構為數最多（969家），占總機構數89.7%。 然而，快速發展也引發了競爭劇增之效應。除此之外，長期照顧機構經營者更面臨政府政策轉變及民眾觀感不佳等威脅，使其經營環境逐漸趨為惡劣。
目的： 藉由投入與產出變項做資源配置模式之分類，瞭解各環境適用的資源配置方式為何，進而提供機構績效改善的參考建議。
研究方法： 針對台灣本島地區養護型長期照顧機構969家機構為研究對象，蒐集樣本數為202家機構（回收率為20.8％）。利用各機構之投入（直接人力、非直接人力、規模）與產出（進住人數、評鑑結果）進行資料包絡分析法之效率計算。透過集群分析分別將經營環境與資源配置模式加以分類，經營環境可分為高需求高競爭、中需求中競爭、中需求低競爭、低需求低競爭等四類經營環境；資源配置模式可分成三類資源配置模式，分別為大規模效率型、中等規模效率型、小規模精緻型機構。藉此分析各種資源配置模式在不同經營環境的績效表現狀況，並利用複迴歸分析瞭解提升績效表現之關鍵變項。所得資料除透過DEA計算績效分數外，並透過SPSS統計軟體進行資料描述、ANOVA、卡方及複迴歸分析。
結果： 三種資源配置模式在不同經營環境的績效表現呈現差異性，大規模效率型與小規模精緻型的機構在各類經營環境中績效表現相對較佳，反觀中等規模效率型的機構則僅在低需求低競爭的經營環境有較佳的表現。
根據複迴歸分析之結果，財團法人機構在效率的改善上，主要以降低直接人力的投入及提升進住人數的數量，同時以獲得較佳的評鑑結果為佳。私立小型機構在高需求高競爭經營環境中，若要有效率的提升績效表現，以降低規模或提升進住人數為主，評鑑結果則以優等成績為較佳選擇；在中需求中競爭經營環境中，以降低非直接人力的投入為優先，同時以獲得評鑑甲等成績為較佳選擇；在中需求低競爭與低需求低競爭經營環境中，以降低直接人力的投入及提升進住人數的數量為優先，並以獲得甲等成績為較佳選擇。
根據整體迴歸結果，權屬性以財團法人機構對於績效有正向影響，經營環境以低需求低競爭環境對績效有較佳的正向幫助，直接人力、非直接人力、規模呈現負向影響，進住人數及評鑑結果則是正向影響，評鑑結果以優等成績為較佳選擇。
討論與建議： 經營環境以低需求低競爭環境最適合機構生存，高需求高競爭經營環境競爭程度相對較高。對於管理者而言，在競爭程度越高的地區應設法更有效率的運用資源，位於競爭性較低的地區則有更充裕的空間考慮不同的經營策略及運用。由於我國政策未來走向以社區化照顧服務為主，未來應以小規模精緻型機構為理想的組織形式，管理者應設法提升評鑑成績，對於績效表現有相當程度的正向幫助，長期照顧產業發展越臻成熟，消費者對於服務品質的重視程度也逐漸提高，顯示服務品質在未來應是管理者必須重視及面對的一環。

關鍵字

資料包絡分析法 ； 養護型長期照顧機構 ； 經營績效 ； 經營環境

並列摘要

Objectives The rapid increase of ageing population has led to a higher demand for long-term care service, which subsequently entails a prosperous growth of long-term care industry. In 1998, there were only 237 long-term nursing institutions in Taiwan, but in 2009 the number climbed up to 1,080, of which 969 (89.7%) were nursing institutions of residential care. The rapid growth of nursing institutions has caused a fierce competition which calls for better resource allocation decisions for the managers of nursing institutions. Therefore, the main purpose of this study was to explore pertinent resource allocation strategies contingent upon environmental characteristics to help enhance operational performance for institutions.
Methods The 969 nursing institutions of residential care in Taiwan were the targeted research subjects. Through a series of data collection activities, 202 (a 20.8% response rate) institutions were retained for further analysis. The efficiency scores for operational performance were calculated based on the data envelopment analysis. The operational environments and resource allocation modes were classified by the cluster analysis into four environment types and three resource allocation modes, respectively. In addition to ANOVA and Chi-square statistical testing, multiple regression modeling was also conducted to examine the predictive power of independent variables.
Results The efficiency scores differ among the three resource allocation strategies in four operating environments. Relatively speaking, large-scale institutions showed better performance in every operational environment than small-scale institutions; the medium-scale institutions could only perform better in the operational environment of low development. According to the results of multiple regression analysis, the foundation-typed institutions could improve their operational performance by either reducing direct labors or increasing the number of institutional residents. For the private small-scale institutions, they could achieve better performance efficiency scores by lowering their size, increasing the number of institutional residents or trying to be accredited as Grade A+ in the highly-developed operating environments; and, by reducing indirect labors or trying to be accredited as Grade A in the sub highly-developed operating environments. In the mid-developed or low-developed operating environments, reducing direct labors, increasing the number of accommodation, or trying to be accredited as Grade A would help improve the operational performance. The multiple regression modeling shows that the ownership, foundation-typed status, and the low-developed environment had positive influence on the operational performance. Specifically, variables related to direct labor, indirect labor, and institutional size showed negative effect, but the number of institutional residents and accreditation grade had positive impact with the Grade A+ being the best target.
Conclusions Low-developed environments are most suitable for the institutions to survive and highly-developed environments are relatively competitive. Consequently, it is suggested that managers dedicate their efforts to using resources more efficiently in the more competitive regions; and more operating strategies could be considered in the less competitive regions. In consideration of the national policy of community nursing care service, small-scale organizations might be the trend in the future. Managers should endeavor to improve the accreditation grade, which would have a positive influence on operational performance. As the long-term nursing care industry gets more mature, consumers would pay more attention to the service quality. Therefore, quality service is the key aspect that managers should emphasize in the future.

並列關鍵字

Data Envelopment Analysis ； Nursing institutions of residential care ； Operational performance ； Operating environment

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