全民健保影響醫院組織文化與經營績效之研究

The Study of the National Health Insurance Toward the Hospital Organizational Culture and Operating Performance

李勝祥(Sheng-Hsiang Li)

《高雄海院學報》 18期 (2003/12) Pp. 289-303

摘要

我國實施全民健保制度後，醫療保險體系邁入新階段，使得過去沒有公、勞、農保的國人直接受益，得到保障，全民健保制度對一般民眾而言，實在是一大福音，但對醫療機構而言，卻可能是嚴厲的挑戰。目前已對醫院經營造成三方面之影響，首先是醫院數目減少，診所數目增加。其次是規模小之醫院減少，規模大之醫院增加。第三則是大型醫院門診服務量增加，小型醫院門診服務量減少。本研究採取個案研究方法，個案描述應受訪醫院之要求，採匿名方式，分別挑選了醫學中心層級之集團醫院、退輔醫院、大學附設醫院等三家醫院，區域醫院層級之教會醫院、市立醫院、私立市區醫院等三家醫院，以及地區醫院層級之私立郊區醫院，合計七家醫院。本研究主要參考Deshpande,Farley,& webster (1993)對於組織文化之區分，結果發現，集團醫院傾向於創新型之組織文化，退輔醫院及教會醫院傾向於市場型之組織文化，大學附設醫院、私立市區醫院、私立郊區醫院等傾向於宗族型之組織文化，市立醫院則傾向於階層型之組織文化。若以經營績效為目標，各醫院宜以集團醫院為標竿，進行標竿學習，將本身之組織文化朝創新型調整，以有效提升經營績效。

關鍵字

全民健保 ； 醫院 ； 組織文化 ； 經營績效

並列摘要

The health insurance system has entered a new progress when the National Health Insurance begun in Taiwan. The National Health Insurance has improved the protection degree of all the people. It has brought much benefit to everyone, but it is also a great challenge to the hospitals. There are three impacts on the hospital operation. First, the number of the hospitals is decreasing, but the quantity of the clinics is increasing. Second, the number of the small- scale hospitals is decreasing, but the quantity of the large-scale hospitals is increasing. Third, the service amount of the large- scale hospitals is increasing, but the service amount of the small- scale hospitals is decreasing. This study adopts the case study method. The visited hospitals asked the study not to reveal their real name. There are three medical centers hospitals, including corporate hospital, retired serviceman hospital, and the university hospital. There are three regional hospitals, including church hospital, city public hospital, and the private downtown area hospital. There is one district hospital, which is the private suburban hospital. The total amount is seven hospitals. This study is referred to the Deshpande, Farley, & Webster’s (1993) distinction of the organizational culture. The result is the corporate hospital is belonged to the adhocracy culture. The retired serviceman hospital and the church hospital are belonged to the market culture. The university hospital, private downtown area hospital, and the private suburban hospital are belonged to the clan culture. The city public hospital is belonged to the hierarchy culture. If the hospital objective is the operating performance, the corporate hospital can be the benchmark hospital. The other hospitals should learn the corporate hospital. Their organizational culture should be changed to the adhocracy culture. Then the operating performance will be improved.

並列關鍵字

the National Health Insurance ； Hospital ； Organizational Culture ； Operating Performance