全民健保特約醫療機構之財務報表績效評估

自民國八十四年實施全民健保以來，醫療服務支付制度由最初論件計酬演化至分階段實施總額支付，再至全面實施上限總額支付制度，改變醫療院所的經營模式甚巨，更進而帶動醫療產業轉型。醫療產業在總額分配有限的資源下經營，體制的演變使得醫療院所必須改為以控制成本為生存的手段，經營的型態更逐漸具企業化，希望藉此提升財務績效。自民國102年起因全民健康保險醫事服務機構提報財務報告辦法公布，已公布財務資料為民國102年至105年。本研究以實證分析四年度之財務資料和配合分群的非財務資料，評估醫事服務機構財務報表之財務比率分析，觀察財務比率變數之分群資料，建立假說以檢驗分群財務比率是否有顯著差異。結果顯示：在權屬別、特約層級別、隸屬轄區別、規模別之財務比率有顯著差異。權屬別之部分公立機構在毛利率顯著大於私立機構。特約層級部分，資產報酬率和稅息前利益率具特約層級財務差異，以Scheffe事後比較結果顯示，地區醫院的資產報酬率顯著大於區域醫院。在轄區別部分，資產報酬呈現轄區別財務差異，以Scheffe事後比較結果，南區資產報酬率顯著大於北區。在規模別部分，毛利率具規模別財務差異，以Scheffe事後比較結果，小型毛利率顯著大於中型。

關鍵字

全民健保；財務績效；醫事服務機構；財務報告

並列摘要

Since the implementation of the National Health Insurance in 1995, the medical service fee has evolved from the payment by case to the payment by total amount in stages and finally to the full implementation of the total payment with maximum limit. The business model of medical institutions has evolved drastically in the last couple of decades. The medical industry operates under limited resources. This evolution of the system made medical institutions to change their means of survival with strong emphasis on cost control. To improve financial performance various medical institutions have to adjust their operations more closer to for-profit organizations. The National Health Insurance Medical Service Institution Financial Reporting Method was published in 2013, and the data availability spans from 2013 to 2016. This study utilizes empirical analysis of the financial and non-financial information of grouping of data to assess the financial ratio of the financial statements of the medical institutions. We observe the clustering data of the financial ratio variables, and establish several hypotheses to test whether there is a significant difference between the groups .The results show that there are significant differences in the financial ratio of ownership, contract type, jurisdiction and scale. Certain public institutions have significantly higher gross profit margins than private institutions. As with contract type medical institutions, the ROA and the pre-tax interest rate exhibit financial differences. According to Scheffe's comparison, the ROA of local hospitals is significantly greater than that of regional hospitals. The ROA exhibit differences across various jurisdictions. According to Scheffe's comparison, the ROA in the Southern District is significantly higher than that of the North District. In terms of scale, the gross profit margin show financial differences. The gross profit margin of small scale institutions is significantly higher than the medium ones.