衛生所業務委外之財政可行性研究─以新北市29區衛生所為例

A Study on the Financial Feasibility of Outsourcing Public Health Center Operations - Using New Taipei City's 29 Public Health Centers as an Example

洪琳凱(Lin-Kai Hung)

指導教授 ： 黃維民

國立中正大學/管理學院/會計與資訊科技學系/碩士(2015年)

摘要

目前各級政府財政普遍困窘，開源節流，相形重要。發掘各種開源節流的可行方案，便是政府財政永續的重要關鍵。導入民間資源用於公共事務，已是最重要的方法之一，惟促進民間參與成功的兩項因素，一要有利可圖，才能吸引民間投資；二要減輕財政，才能有效分配資源，如此，政府能永續，人民能受益。
作業基金主要係政府基於政策上的考量，由政府來做較適當，基於使用者付費，由受益者負擔一定的代價，使該基金自給自足並永續經營。各直轄市、縣（市）醫療作業基金大部分僅含衛生所，除對民眾辦理衛生預防保健的事務，又要提供民眾醫療服務，既要執行公共衛生政策，醫療服務任務因科技進步與醫療普及影響，形同與醫療院所爭利。再則，健保點值越來越小，人員的羅致越來越難，進而影響基層保健醫療服務及人民的權益。因此，衛生所的經營不論從財務面或人力面都愈來愈困難，為吸引更多人材留任只能繼續增加政府的補助。是以，此作業基金對民間參與者有利可圖又涉及財政負擔問題，似為較佳的促進民間參與標的。
本研究目的係以新北市衛生所為例，就法律與財務面向探討衛生所業務委外所吸引民間參與之利基與減輕財政負擔的可行性。惟因衛生所主要業務職掌為執行基層醫療照護及衛生預防保健，在評估委由民間參與之可行性，除法律與財務面向外，須就醫療、公共衛生政策、地域性、人口、人事、需求者、執行方式等面向綜合評估，故需結合各方面的專業人士共同研究，基於此，本研究雖無法對於衛生所業務委外之整體可行性作出結論，但先就財務可行性之面向評估，發揮抛磚引玉之效，再延伸其他面向之研究，期能完整呈現衛生所業務委外之架構及執行方式。
本研究主要採投資效益分析法，在所設定之各項基本假設下計算各項評估指標。研究結果發現因民間參與者未受限於現行績效獎金發放原則，在所得賸餘可自主分配情形下，其各項評估指標均指向財務面向係屬可行。

關鍵字

投資效益分析 ； 民間參與 ； 業務委外 ； 可行性 ； 衛生所

並列摘要

Currently, financial crises have resulted in cutting costs among all levels of government, and exploring a variety of cost-cutting options is the key to sustainable government finances. The utilization and application of private resources to the public sector is already one of the most important solutions to the problem. However, successfully promoting the involvement of the private sector depends on two factors. First, in order to attract private investment, there must be profit, and second, in order to effectively allocate resources, we must reduce finances, thus both benefiting the people, and sustaining the government.
Based on the user charge, policy considerations and considering the sustainable development of medical operation fund, it is suitable and suggested to operate and manage by government. Government funded medical operations in each city and township primarily consist of the department of public health. In addition to providing disease prevention and health promotion services, the department of public health must also provide medical services. However, having to carry out public health policy, while also still providing medical services has resulted in competition for funds between institutions. Moreover, dwindling health insurance reimbursements and increasingly difficult recruitment of medical personnel has unfortunately affected individuals’ rights to primary healthcare services. Therefore, whether from a financial or human resources aspect, operation and management of the department of public health is becoming increasingly difficult, and increased subsidies from the government are necessary for workforce retention. Therefore, having allocated medical operation funds will not only benefit the people, but will also decrease the government’s financial burden, thus promoting further civil participation from the people and from medical institutions.
Using New Taipei City as an example, this study aims to examine the legal and financial feasibility of outsourcing some of the department of public health’s duties to other institutions, in order to attract community institutions involvement and decrease financial burden of the department of public health. As the department of public health’s main objective is primary medical care and preventative health care. In evaluating the possibility of outsourcing to community institutions, in addition to legal and financial aspects, one must also combine experts from various fields to evaluate other aspects such as medical issues, public health policy, regional factors, population, human resources, community needs, and operational protocol. Although this study is unable to give a final conclusion regarding the overall feasibility of outsourcing to the community institutions, it was able to first consider the financial feasibility. Furthermore, through conducting the evaluation of financial feasibility aforementioned, it will be a good example to extend and evaluate other aspects.
By using investment benefit analysis and considering each evaluation index of possible assumptions, this study found that in various financial aspects, outsourcing to community institutions was feasible.

並列關鍵字

Community participation ； Outsourcing ； Feasibility ； Department of public health ； Investment benefit analysis

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