醫院因應總額支付制度之策略方案及其相關因素探討

Factors Associated with Strategic Choices of Hospitals in Response to the Global Budget System

莊念慈(Nien-Tzu Chuang) ； 黃國哲(Kuo-Chearh Huang) ； 許怡欣(Yi-Hsin Elsa Hsu) ； 郭乃文(Nai-Wen Kuo) ； 魏中仁(Zhong-Ren Wei)

《台灣公共衛生雜誌》 23卷2期 (2004/04) Pp. 150-158

https://doi.org/10.6288/TJPH2004-23-02-07

摘要

目標；有鑒於健保支付制度之改變，對醫院經營管理之影響甚鉅，因此各醫院莫不積極採取因應策略。本研究及探討醫院對於總額支付制度之實施，所採取因應策略之類型，並分析影響其策略選擇的相關因素。方法；本研究依據Shortell的理論架構，將醫院的策略類型氛圍機構層面、管理層面、及技術層面等三類。研究設計採橫斷性研究，使用結構式問卷，於總額支付制度實施九個月後，針對我國地區教學醫院(含)以上的127家醫院進行郵寄問券調查，最後回收之有效問卷共計75分，回收率為59.7%。結果：為了因應醫院總額支付制度的實施，樣本醫院在機構層面上採用最多的策略為教育院內同仁瞭解高制度之情形及其影響；在管理層面上採用最多的策略為加強內部財務管理，及建立完善成本會計制度；在技術層面上，採用最多的策略則為建立院際間轉診或轉檢之機制。研究結果亦顯示，醫院權屬別及醫院在總額支付制度實施後住院服務量的變化情形兩個變項，對於樣本醫院在機構層面所採取的策略有險著性的影響力。而醫院評鑑等級、醫院所處市場的競爭程度、及醫院在總額支付制度實施後總營運收入的變化情形等三個變項，則會影響樣本醫院在管理層面所採取的策略。結論；本研究發現醫院特性、醫院所處市場之競爭程度對於醫院因應總額支付制度所採取之策略有影響力。本研究的研究發現對於醫院經營管理者採取適當的策略，以因應環境的變動壓力當有所助益。

關鍵字

總額支付制度 ； 策略方案

並列摘要

Objectives: Due to the continuous revolutions in the national health insurance payment system the management of hospitals have been seeking a better strategy to cope with these changes. The purpose of this study was to explore the factors associated with strategic choices of hospitals in response to the global budget payment system. Methods: This study employed Shortell’s model by dividing strategies into three types; institutional-level response managerial-level response, and technical-level response. This cross-sectional study investigated 127 hospitals in Taiwan (including district teaching hospitals and higher levels) by sending them structured questionnaires. The response rate was 59.1% with 75 hospitals returning the questionnaires. Results: The results of the study indicated that in respect to institutional-level response to the global budget payment system, most hospitals adopted the strategy of further educating their staff about the major changes in the global budget payment system. In regard to managerial-level response, the majority of hospitals adopted the strategy of enhancing their financial management and constructing a better cost accounting system. Finally, for the technical-level response, most hospitals employed the strategy of establishing a referral system. The results of the study also showed that strategies at the institutional-level were influenced by hospital ownership and service volume following the implementation of the global budget payment system. Hospital level, degree of market competition, and change in operating income after the after the implementation of global budget payment system were significant indicators of the strategies at the managerial-level that the hospitals would adopt. Conclusions: The results demonstrated that the characteristics of the hospital and degree of market competition were significant indicators of strategies that hospitals would adopt in response to the global budget payment system.

並列關鍵字

global budget payment system ； strategic choices

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