- 學位論文
醫院非核心醫療業務委外經營之研究 -以中部某救護車營業機構為例
A Study of Outsourcing Hospital’s non-core Business－Case Study of Private Ambulance Company in Central Taiwan
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摘要
本研究之調查結果得知，全台灣之地區醫院、區域醫院及醫學中心現已將救護車業務委外之比率分別為90%、80%與95%，合計約88.3%，這結果顯示全台灣八成以上的醫院都已經將救護車業務委外給救護車公司經營。本文針對三間採取不同招標方式將救護車委外經營之醫院：公立醫院異質性最低標、私立醫院無公開招標與公立醫院適用最有利標，進行採購主管、護理人員及救護車業者之訪談、並分別對護理人員及病患與家屬實施滿意度調查；最後並針對三間醫院支付給救護車公司之費用及該公司所有成本支出，計算成本效益分析。 根據護理人員之滿意度調查顯示，回饋金的多寡對於救護人員之服裝儀容、到醫院的速度及緊急處置能力等三個專業表現的項目並沒有顯著影響。在服務態度、工作效率與溝通互動部分，顯現出減少醫院回饋的比例可以大幅提升救護人員的服務態度與工作效率。另外在家屬及病患之滿意度調查結果顯示，對於救護人員服務態度的部分，以公立醫院適用最有利標最高，私立醫院無公開招標次之，公立醫院異質性最低標最低。類似的結果也反映在救護人員整體形象及與救護車到達派遣醫院時間的滿意度部分，而救護人員與病患或家屬間溝通互動、服裝儀容、及緊急應變能力等部分，顯示回饋車資的多寡對於這三個表現的項目並沒有顯著影響。 現有的招標方式及回饋管理費制度，除了醫院在收入上是贏家外，救護車公司與搭乘救護車的病患是雙輸。根據本研究之損益表及護理人員訪談、家屬問卷調查等結果，都認為家屬或病患繳交的救護車費用就是要用來購買符合需求且專業度佳、服務品質好的救護車，不應該讓醫院賺取所謂的權利金；應該全部用在購買更多的救護車、聘用足夠且符合勞基法規定且具有專業證照的救護人員、改善救護車裝備等用途上。 因此本研究對於各醫院將救護車業務委外之招標方式，建議在不扣除任何回饋管理費(回饋金0%)的情況下採取「適用最有利標」的方式，讓醫院對於救護車公司在收取同樣費用的條件下，依據車輛狀況、醫療裝備、人員證照、緊急應變等條件設定評選標準，選取符合醫院需求的廠商，以強化各該救護車營業機構承攬醫院救護車委外勤務之完整運作及提升救護車駕駛及救護人員之執勤安全。
並列摘要
First of all, the results of the study showed that the rates of outsourcing for ambulance services were 90%, 80% and 95% of the total number of hospitals, district hospitals and medical centers in Taiwan, with a total of 88.3%, showing that more than 80% of hospitals in Taiwan have ambulance business ambulances to the company. In this study, three different ways of bidding for ambulance outside the hospital： public hospital price tag, private hospitals without bidding, public hospital selection criteria, procurement supervisors, nurses and ambulance industry interviews, and nursing staff and the satisfaction survey of patients and their families. Finally, the cost-benefit analysis was made for the expenses paid by the three hospitals to the ambulance companies and the cost of all the companies. According to the satisfaction survey of the nursing staff, the amount of the reward money has no significant effect on the three professional performance items such as the clothing appearance of the ambulance personnel, the speed of the hospital and the emergency handling capacity. But in the service attitude, efficiency and communication interaction part showed that a decrease in the proportion of hospital feedback can greatly enhance the attitude of ambulance staff and work efficiency. In addition, the results of satisfaction survey on family members and patients showed that the attitude towards the ambulance service was the highest, the public hospital was the highest, the private hospital had no public tender, the public hospital price was the lowest; the similar results were also reflected in the ambulance staff Overall image and satisfaction with the ambulance arriving to dispatch the hospital part of the time, and ambulance personnel and patients or family communication and interaction, clothing appearance, and emergency response capabilities and other parts, show the amount of feedback on the performance of these three performance projects and There was no significant effect. In addition to the hospital in the tender fee system is a winner, the ambulance company and ambulance patients is a double lose, according to the study of the income statement and nursing interviews, family survey and other results, all of the tendering and feedback management fee system That ambulances paid by family members or patients is to be used to purchase to meet the needs of professional and good, good quality ambulance, should not allow hospitals to earn the so-called royalties; should be used to buy more ambulance Vehicles, the employment of ambulance personnel who are adequate and in compliance with the Labor Standards Act and have professional licenses, and the improvement of ambulance equipment. Therefore, in this study, it is suggested that the hospital should adopt the method of "selecting the standard" without any deduction of the management fee (0% of the subsidy) for the ambulance companies. Under the same cost conditions, based on vehicle conditions, medical equipment, personnel licenses, emergency response and other conditions set criteria for selection, select the hospital in line with the needs of manufacturers. In order to enhance the ambulance operating agencies contract hospital ambulance extra work of the full operation and enhance ambulance driving and ambulance personnel on duty security.
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