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Incorporating quality into the measurement of productivity change in Taiwan's hospitals: A Malmquist Productivity Index Approach

考慮品質要素再探台灣醫院生產力分析-Malmquist生產力指數法

摘要


Background: Past studies on efficiency evaluations of hospitals only analyzed productivity factors such as a hospital's input resources for service productivity, but ignored the important fact that the quality of medical care also requires resource inputs for maintenance. Purposes: The purpose of this study is to measure productivity and quality changes in Taiwan's hospitals through the Malmquist productivity models incorporating quality elements and then to understand the quality performance and the factors affecting productivity. Methods: This study analyzed data from the National Health Insurance Research Database (NHIRD) by means of the quality-including Malmquist productivity model. We evaluated changes in productivity of Taiwanese hospitals from 2008 to 2014 and furthermore, discuss reasons for these changes in productivity (quality factors, efficiency factors, and technical factors). Results: For results obtained by taking the quality variables into consideration, the average change in the quality-incorporating Malmquist productivity index was >1 (QMPI=1.0012). As for quality changes (QC), the result was 1.0100, indicating that the quality of medical care of the sample hospitals had improved during the period, which contributed to the growth of the hospitals' productivity. The results show that after taking the quality factor into consideration, the productivity index improved, indicating that adding the quality factor into the evaluation had a positive effect on the performance. Conclusions: Inclusion of the quality of medical care can improve traditional efficiency assessments, which only consider inputs and outputs, and also compare and analyze the performance of medical quality and, moreover, facilitate an understanding of reasons behind productivity changes of hospitals.

並列摘要


背景:過去研究在進行醫院績效評估時,僅評估醫療服務產出之表現,鮮少納入醫療品質之衡量,然而醫療服務品質不僅需要投入資源來維持其重要性,亦受到醫院日漸的重視,因而忽略品質要素將會影響醫院績效之評估。目的:本研究目的為透過納入品質要素之麥氏生產力模型,衡量台灣醫院之生產力與品質變動情形,並進而瞭解影響生產力之因子與品質表現。方法:實證資料則以台灣119家醫院作為研究標的,資料來源為台灣健保資料庫,資料期間為2008年至2014年。研究模型為包含品質變項之麥氏生產力模型,該模型不僅能瞭解資料期間醫院生產力之變動情形,還可進一步將生產力變動分解為品質變動、技術效率變動與技術變動,以便瞭解影響醫院生產力之因子。結果:實證結果發現納入品質之麥氏生產力值大於一,其值為1.0012,表示樣本醫院於資料期間其生產力有成長趨勢,至於品質變項其值為1.0100,表示醫療服務品質提升。再者比較有無考量品質變項之麥氏生產力值,結果發現納入品質要素有助於提升醫院之生產力表現。結論:有別於過去進行績效評估只考慮相關之投入產出變項,本研究納入品質要素再探台灣醫院之生產力,不僅可了解醫院生產力與品質變動情形,亦可進一步分析影響醫院生產力變動之因子,本研究成果可作為醫療服務業者在經營策略上與主管機關在政策推動上的參考。

參考文獻


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