摘要
台灣的健保支付制度已從民國九十九年一月一日起正式走向「診斷關聯群」(DRG)時代，DRG主要的精神就是減少醫療給付，亦即減少住院病人的支付率及醫院不停膨脹的成本支出，過去文獻也指出應用 DRG在醫療費用支付制度上，主要是希望能抑制醫療費用快速成長，促使醫療供給者有較高經濟誘因提供更具成本效益的服務。因此，在DRG實施後，控制或抑減成本已經是台灣的醫院迫在眉睫的生存危機問題，本研究以複迴歸模型、資料包絡分析法及Tobit迴歸模型，分析醫院的成本結構對於醫院財務績效以及經營效率之影響。 本研究結果顯示人事費用比率、藥品及醫材費用比率、折舊費用比率、教育研究發展費用比率、及管理費用比率等五項實驗變數與營業淨利率（代表財務績效）均呈現顯著負相關。人事費用比率與醫院相對效率值（代表經營績效）呈顯著正相關，藥品及醫材費用比率、教育研究發展費用比率與醫院相對效率值（代表經營績效）呈顯著負相關。醫院管理者透過成本控制策略的改變，可以達到控制成本提升財務績效或增進經營效率，最終提升在醫療市場上的競爭能力，達成永續發展的目標。本研究結果除可提供國內外醫療機構管理者在決定經營策略時之參考外，亦可提供政府機構在制定健保支付標準時之參考。
並列摘要
The health care payment system in Taiwan has moved on to the era of Diagnosis Related Groups (DRG) since January 1, 2010. The main purpose of DRG is to reduce medical care payment, to lower the percentage patients have to pay and to decrease the never-ending inflation of cost of hospitals. The literature also indicated that DRG was used on medical care payment system in order to hopefully restrain the fast-growing medical care expenses and encourage medical care providers with higher economical incentives to provide services with more cost efficiency. As a result, controlling or decreasing cost has been the most urgent surviving matter for hospitals in Taiwan after the implementation of DRG. We used Multiple regression, DEA model and Tobit regression to analyze the effects of cost structure on hospitals’ financial performances and management efficiency. The results indicated that total labor expense as a percentage of total net operating revenues, medicine and material expense as a percentage of total net operating revenues, depreciation expense of property, plant and equipment as a percentage of total net operating revenues, educational and research expense as a percentage of total net operating revenues, and administrative expense as a percentage of total net operating revenues, all the above 6 empirical variables had significant negative correlations with profit ratio, which stands for financial performance. Total labor expense as a percentage of total net operating revenues had significant positive correlation with hospital’s DEA efficiency, which stands for management efficiency; while medicine and material expense as a percentage of total net operating revenues, educational and research expense as a percentage of total net operating revenues had significant negative correlations with hospital’s DEA efficiency, which stands for management efficiency. Hospital management could control cost and increase financial performances or management efficiency by changing cost control strategies and eventually promote the competency in medical care market, reaching the goal of continuous development. The study results not only can serve as references for medical care provider management while making management strategies, but also can serve as references for governments while establishing health care payment policies.
參考文獻
延伸閱讀
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