署立醫院營運成效衡量與時間序列效率變動 模式分析

Measuring Operational Performance and Time-Series Efficiency Change Model on Hospitals of Department of Health

陳素幸(Shu-Hsing Chen)

指導教授 ： 陳弘信

元智大學/管理學院/管理研究所/碩士(2009年)

摘要

隨著全民健保給付方式及醫療產業經營模式之改變，醫療院所面對健保總額預算收入點值浮動核減之衝擊，醫務收入減少，公立醫院除提供醫療服務之外，需肩負國家賦予之社會責任與政策責任，並落實衛生政策及預防保健。署立醫院為公立醫院體系中分布最廣，自全民健保實施，民眾就醫行為改變，政府公務預算逐年刪減，署立醫院自民國90年實施區域聯盟，醫療網絡健全，希藉由資源共享、技術交流、聯合行銷及採購等方式，期達到降低經營管理成本，並提升服務品質與營運效率
本研究運用資料包絡分析法，以衛生署所署22所急性醫院為研究對象，運用投入及產出變項，評估96年營運成效及94-96年時間序列效率分析。
本研究的DEA模式，以病床數、醫師、護理人員、非醫事人員、行政人員為投入項目，以住院人日、手術人次、門急診人次為產出項目，經DEA實證結果發現，在96年度署立醫院與外在環境比較(其他公立醫院、財團法人醫院、私立醫院)，效率值分析結果為整體效率位第3名、技術效率表現最不佳、規模效率位第2名，由署立醫院與其他醫院相比較應仍有進步的空間，尤其是在技術效率方面更應有改善，如此對整體效率的提升有較大的幫助。在內在環境比較(22所急性署立醫院)上，整體效率分析結果有12所醫院為相對有效率（CCR＝1），技術效率分析結果有16所相對有效率（BCC＝1），規模效率結果與整體效率分析結果相同共有12所相對有效率醫院（Scale＝1）。由Super-Efficiency分析表現最佳為台東醫院。
行政院衛生署所署22所急性醫院從長期跨年度效率分析上則發現除了恆春旅遊醫院醫院外，其餘21所醫院96年度效率都較94年成長進步，這表示署立醫院在實施區域聯盟，希望能經由資源共享、技術交流、聯合行銷模式，提升醫院服務層級與經營績效，並降低成本與提高競爭力上有了很好的成果。

關鍵字

署立醫院 ； 績效評估 ； 資料包絡分析法

並列摘要

With the change of payment methods of National Health Insurance (NHI) and the change of operational modes in medical industry, medical care institutions are facing the impact of reduction in global budget floating values of NHI and the reduction in medical income. However, public hospitals still have to offer medical care services, undertake the social responsibility and policy responsibility endowed by the government, and put the health policy of disease prevention and health promotion into practice. Affiliated hospitals of Department of Health (DOH) are the most widely distributed hospitals among the public hospital system. Ever since the NHI policy was put into practice, the medical care seeking behaviors of people have changed. With the gradual decrease in official budget of the government, affiliated hospitals of DOH started to implement the policy of regional alliance to make medical network more complete. It is hoped that the regional alliance among hospitals can reduce the management costs and improve service quality and operational efficiency through methods, such as resources sharing, techniques exchange, joint marketing and joint procurement.
The subjects of this study were 22 acute care affiliated hospitals of DOH. This study used Data Envelopment Analysis and chose proper variables of inputs and outputs to evaluate the operational efficiency of year 2007 and analyze the efficiency of time-series from 2005 to 2007.
The DEA model in this study used the number of hospital beds, doctors, nurses, non-medical staffs, and administrative staffs as inputs and used the number of inpatients, surgeries, and both outpatient and emergency visits as outputs. The empirical results of DEA found that when comparing the analytical results of efficiency of affiliated hospitals of DOH with external environments (i.e. other public hospitals, Non-Profit Proprietary Hospitals, and private hospitals), the overall efficiency of affiliated hospitals of DOH in 2007 ranked the third, the technical performance was poor, and the scale efficiency ranked the second. It could be inferred that when comparing affiliated hospitals of DOH with other hospitals, many aspects in affiliated hospitals of DOH were still left to be improved, especially the aspect of technical efficiency. Also, the improvement in technical efficiency would help improving the overall efficiency. When comparing the internal environments (i.e. the 22 acute care affiliated hospitals of DOH), the analytic results of overall efficiency of 12 hospitals was relatively high (CCR＝1), the technical efficiency of 16 hospitals was relatively high, and the scale efficiency of 12 hospitals was relatively high, which was the same with that of overall efficiency (Scale=1). The analytical results of Super-Efficiency indicated that the performance of Taitung Hospital was the best.
The long term year-span analysis of efficiency of 22 acute care affiliated hospitals of DOH found that except for Heng-chun Tourism Hospital, the efficiency of other 21 hospitals in 2007 improved much better than that in 2005. It could be concluded that the implementation of regional alliance among hospitals by resources sharing, techniques exchange, and joint marketing did improve the service quality and operational performance of hospitals, reduce the management costs, and achieve great performance in increasing competitiveness.

Keywords: Affiliated hospitals of Department of Health, Performance evaluation, Data Envelopment Analysis

並列關鍵字

Hospitals of Department of Health ； Performance evaluation ； Data Envelopment Analysis，DEA

參考文獻

李文福、王媛慧（1998）•台灣地區公私立醫學中心與區域醫院生產力變動之研究-無母數Malmquist指數之應用•經濟論文，26（3），243-269。

Ozcan,Y.A.,Roice,D.L,& Cengiz,H.,（1992）.Owner and Organizational performance A comparison of Technical Efficiency Across Hospital Types.Medical Care,30（9）, 781-194

梁惠玉、吳秋鳳、章淑娟（2005）•醫療機構之績效評估－以平衡計分卡爲例•慈濟護理雜誌，4（3），26-32。

彭雅惠(2002) •醫療產業實施平衡計分卡的問題探討•醫務管理雜誌， 3(1)，26-35。

徐享達（2001）臺灣醫務管理學會，公立（營）機構績效不振因素分析兼論署立醫院突破困境因應之道，Vol.2No.3，p47-59。