本文嘗試就二○○三年以來,發生於都會區的公立醫院合併案例,就其發生的因素及發展輪廓,做一簡明的描繪。採取個案研究法,並透過深度訪談,分析北高兩市及臺北縣在公立醫院整併過程的發展,以及組織合併後所遭遇問題的配套作爲,從中釐清地方醫院合併所需的要件。三組幾乎在同一時期進行合併的案例,包括高雄市立聯合醫院、臺北縣立醫院及臺北市立聯合醫院等新醫院,均採取擴大規模經濟及提升醫療服務品質爲手段,來因應外在環境制度的變遷及市場的競爭。 透過分析,本文發現地方政府對於所屬醫院的改革,逐漸擺脫以往求助中央奧援,或僅採取委外經營的取向,而走出地方自治的彈性靈活空間。而且,都會區的地方公立醫院,採取合併並擴大規模經濟,有助於強化市場競爭能力,並提升公共醫療服務品質。但另一方面,高雄市政府及臺北縣政府所採取的「小規模漸進改革」模式,以及臺北市政府的「大規模漸進改革」模式,兩者不同策略選擇,所引發的不同組織整合問題,也提供決策者進行公共醫療組織改革時的寶貴經驗與比較基礎。本文認爲地方「公立醫院」透過創新及資源整合,已重新賦予老店新開的生命力。
This paper focuses on one of the major medical reforms-the public hospital mergers, that have been carried out in Taipei City, Kaohsiung City and Taipei County. Since 2003 the three merger cases emerged almost simultaneously, although the respective processes of decision-making differ and the modes of organizational restructuring also vary. Case studies and in-depth interviews are adopted as the methods by which empirical data was collected for this study. Based on the interviews, this study attempts to explain the variations between small-scale incremental changes and large-scale incremental changes. This series of local public hospital innovations occurred domestically and included Kaohsiung Municipal United Hospital, Taipei County Hospital and Taipei City Hospital. The mergers all point to the importance of economics of scale and medical quality improvements as a response to the institutional changes and market competition. This study suggests that the model of hospital merger could be an innovative alternative to the status quo. The local public hospital reform in this paper can be dubbed as ”New Wine in Old Bottles”.