台灣醫院歇業原因之探討

Factors Affecting the Closure of Hospital in Taiwan

吳翠屏(WU TSUI PING)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

本研究主旨在探討台灣地區醫院在民國83年至95年間歇業醫院之特性及歇業原因。台灣地區醫療環境在最近十數年劇烈變遷，新醫療法、全民健康保險的實施，加上整個社會環境、經濟變化及醫療消費者權利覺醒，醫療院所面臨前所未有的經營挑戰。台灣醫院家數，從719家減少至523家，減少196家幅度為27.3%，其間因有217家新設，實際歇業醫院有413家，本研究利用調查訪問法，分析影響台灣歇業醫院之特性及歇業原因。
研究結果發現：（1）民國83年至95年歇業醫院中，85%是規模在50床以下的私立小型醫院。（2）影響台灣地區私立小型醫院歇業主要原因是：小型醫院未達規模經濟，經營成本高且不善經營管理，又面臨各項法規如醫療機構設置標準、醫院評鑑的要求難以達成，在民眾就醫選擇自由病人減少、健保支付制度使醫院的財務收入狀況不穩定的情況之下容易歇業。（3）私立小型地區醫院之繼承問題也是造成醫院歇業重要原因之一。
結論：健保制度是影響醫院歇業的主要因素，但非唯一影響醫院歇業原因，尚有因政策實施後對醫院經營產生間接的影響，醫療服務體系的結構在全民健保實行12年來，已經產生極大的變化。

關鍵字

醫院歇業 ； 全民健保 ； 小型醫院

並列摘要

This study aims to discuss the characteristics and the factors of those hospitals closing out in Taiwan between 1994 - 2006. During past decades, the medical environment in Taiwan was severely impacted by several aspects. Due to the implement of new Medical Law, National Health Insurance as well as the influence of the society environment, economic deterioration and the awakening to the consumer’s rights, hospitals were facing an unprecedented challenge on operating their business. From 1994-2006, the total number of hospitals decreased by 27.3% from 719 to 523 in Taiwan. There were 413 hospitals closed and 207 new hospitals opened. This study analyzed the characteristics and the factors influencing those hospitals closing out by investigational questionnaires.
The major reasons of closing are: (1) most closed hospitals are small size less then 50 beds; (2) the major factors affecting the closure of hospitals include small economic scale, high operating cost, and inefficient management. Additionally, they face with regulation of national health insurance: the small district closed hospital could not meet the standard of medical staff and facilities requirement of hospital and hospital accreditation. Patients can free choice medical organization to get care, the amount of patients that visited small district hospitals, become less and less. According to the payment mechanisms of national health insurance, the small district hospital is likely closed under the condition of unstable financial status; (3) the controversial issue on inheritance of small private district hospitals is also one of the major factors resulting in the closure.
Conclusion: National Health Insurance policy is major factor, but not only one factor causing the closure of the hospitals. There are also some indirect impacts due to the implementation of new policy and the change of society environment.
Key words：Hospital Closure, National Health Insurance, Small Hospitals

並列關鍵字

Hospital Closure ； National Health Insurance ； Small Hospitals

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