探討醫療預算系統對醫療決策行為之影響

The Effect of Medical Budgeting System on Medical Decision Behaviors

陳鈺薇(Yu-Wei Chen)

指導教授 ： 盧正宗 ； 王春熙

國立臺中科技大學/商學院/會計資訊系會計與財稅碩士班/碩士(2013年)

https://doi.org/10.6826/NUTC.2013.00022

摘要

2002年七月健保局實施總額預算制度後，突顯出醫院對於資源爭取以及預算規劃之重要性。因此本研究主要探討在該制度之環境下，醫院之醫療預算系統所應具備之特性，並引用社會認知理論來探討該特性對個人認知因素和醫療決策行為之影響。本研究使用「問卷調查法」來進行實證分析，其實證結果顯示當醫療預算系統特性具備財務性控制與非財務性控制時，可正向影響預算主管對預算攸關性之認知；另一方面，醫療預算系統之財務性控制亦會對成本意識產生正向影響。針對認知因素部分，預算攸關性亦能強化對成本意識之認知，進一步再延伸後續行為之研究，成本意識之認知會直接影響醫療決策行為；預算攸關性則係透過成本意識間接影響醫療決策行為。綜上所述，顯示有效的醫療預算系統須具備財務性與非財務性控制，有助於預算主管執行與評估預算，亦可合理分配資源。最後，當主管具備成本意識的認知時，會正向影響其醫療決策行為，因此如何權衡醫療成本與醫療品質，亦是學術界與實務界所關心的課題之一。

關鍵字

醫療預算系統 ； 社會認知理論 ； 預算攸關性 ； 成本意識 ； 醫療決策行為

並列摘要

The importance of medical resource and budgeting planning of hospitals has been an important management issue since the implement of global budget system by Bureau of National Health Insurance in 2002. Therefore, this study introduces social cognitive theory to investigate the characteristics of the medical budgeting system of hospitals on personal cognitive factors and medical decision behaviors. The empirical analysis is applied by questionnaire survey in this study. The empirical results reveal that the medical budgeting system characterized by financial and non-financial control positively influences the budget director’s cognition of budget relevance. On the other hand, the results also show that cost-consciousness is positively affected by financial control of medical budgeting systems. In the aspect of cognitive factors, budget relevance reinforces the cognition of cost-consciousness. Through further research of the subsequent behaviors, it is found that the cognition of cost-consciousness has a direct effect on medical decision behaviors. Budget relevance has a indirect influences on medical decision behaviors via cost-consciousness. In summary, the effective medical budgeting system includes financial and non-financial control characteristics that contribute towards budget execution, evaluation and resource distribution by the budget directors. Finally, when the directors own cost-conscious, he/she would have a positive effect on medical decision behaviors. Thus, how to balance health care costs and the quality of medical care is one of the issues concerned by academia and practice circles.

並列關鍵字

Medical Budgeting System ； Social Cognitive Theory ； Budget Relevance ； Cost Consciousness ； Medical Decision Behaviors

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