不同營運策略對醫院績效之影響 -以台灣公立醫院為例

The Effects of Different Operation Strategies on Hospital Efficiency -Evidence from Public Hospitals in Taiwan

徐鈺羚(Yu-Ling Hsu)

指導教授 ： 朱炫璉

國立臺北大學/商學院/會計學系/碩士(2008年)

摘要

在面臨全民健保、總額預算制度的實施以及政府補助逐年減少的政策下，台灣公立醫院面臨前所未有的競爭壓力，也致使公立醫院必須推行新的「營運策略」力求突破，才具備繼續生存的能力；因而有了「委外經營」和「策略聯盟」兩種策略的應用，這兩種營運策略也是本研究發展的主軸，探討營運策略是否能提升公立醫院在競爭醫療環境下的效率和競爭力；本研究除彌補過去文獻的不足，比較兩種不同營運策略對台灣公立醫院的影響外，亦提供政府當局重要的參考依據。
本研究以資料包絡分析法和Tobit迴歸模型分析「委外經營」和「策略聯盟」這兩種營運策略的推行對公立醫院效率的影響；研究結果也發現委外經營的公立醫院比其他沒有委外的公立醫院更有效率，而署立醫院成立區域聯盟後也較區域聯盟成立前有效率，最後比較兩種不同營運策略對公立醫院效率影響之差異，研究結果顯示委外經營之公立醫院較成立區域聯盟的署立醫院有效率，故署立醫院為提升績效而成立區域聯盟的策略較委外經營的公立醫院仍有一段差距，因此政府當局仍須努力提升區域聯盟之績效，才能在政府補助銳減及健保政策的壓力下有繼續生存的能力。

關鍵字

營運策略、委外經營、策略聯盟、資料包絡分析法、Tobit迴歸分析

並列摘要

The National Health Insurance (NHI) Program and Global Budget System changed the method payment for hospital finances. The effect of the program has been one of the major threats to the finance of public hospitals. In recent years, adopting operating strategies to improve efficiency has been very popular for public hospitals. Total contract management and strategy alliance are by far the most popular operating strategies and have been adopted by public hospitals to reduce cost and improve the financial survivability. The main purpose of this study is to examine the effect of total contract management and strategy alliance on public hospital performance.
The Data Envelopment Analysis model (DEA) is applied to measure public hospital efficiency. In addition, Tobit regression analysis is used to estimate the effects of the operating strategies and provide better control for the effect of other factors (eg, size, degree of competition and the change in regulatory regime) that may also affect hospital efficiency.
Results indicate that public hospitals which adopted total contract management are more efficient than hospitals that did not. And the inception of the strategy alliance does improve public hospital efficiency. But hospitals which adopted total contract management are more efficient than hospitals which adopted strategy alliance. It showed that public hospitals which adopted strategy alliance should continue to improve their efficiency.

並列關鍵字

operating strategy, total management contract, strategy alliance, data envelopment analysis (DEA),tobit regression

參考文獻

4. 魏誠佑、祝道松、潘奇、侯勝茂，2006，總額預算實施前後署立醫院營運績效之評估。醫務管理期刊。

1. 陳金哲，2006，準市場機制與區域治理--以秀傳醫院、署立醫院及臺北市立醫院之執行經驗為例。公共行政學報(政大)。

2. 張世明，2005，衛生署所屬醫院成立區域聯盟的成效評估。高雄醫學大學公共衛生學研究所碩士論文。

2. Banker, R. D., A. Charnes, and W. W. Cooper.1984.“Some Models for Estimating Technical and Scale Inefficiency in Data Envelopment Analysis,”Management Science 30:1078-1092.

3. Banker, R.D.1996. Hypothesis test using data envelopment analysis, Journal of Productivity Analysis 7: 139-159.