醫院經營效率衡量模式建立-DEA、DEA-ANN、CART與Malmquist 方法應用

Constructing a Hospital Efficiency Measurement Model Using DEA, DEA-ANN, CART and Malmquist Approaches

陳建文(Chien-Wen Chen)

指導教授 ： 林榮禾

國立臺北科技大學/管理學院/商業自動化與管理研究所/碩士(2008年)

摘要

隨著健保支付方式不斷變革和新制醫院評鑑制度實施，嚴重影響了醫院的經營行為，造成醫院莫大的衝擊與挑戰。因此，醫院必須降低醫療成本與提升醫療品質來提高競爭力，方能達永續經營之目的。而衡量醫療效率，不但可以瞭解醫院的管理成效，也可做為決策者對醫療資源有效運用的參考依據。本研究主要分為四部分，首先，藉由資料包絡法分析台灣地區93年至95年評鑑合格以上的醫院之相對效率，且針對無效率的醫院，以差額變異分析和規模報酬分析，了解其應改善的幅度和方向；第二部份，我們使用DEA-ANN模式進行評估，此模式運用類神經網路非線性的特性，結合效率衡量法的優點，求取更客觀、合理的效率值；第三部份利用分類與迴歸樹 (Classification and Regression Tree, CART) 建立醫院經營效率判別的規則，以建構醫院經營效率衡量模型；第四部份，以Malmquist生產力指數分析93年至95年間醫療服務業環境的變化，了解醫院在技術效率變動、技術變動、生產力變動等情況。
結果顯示:1. 三層級醫院的效率值，除93年達顯著差異外，94和95年均未達顯著差異；2.DEA-ANN模式平均的效率值要高於DEA，且標準差較低，可見此法的確可以降低傳統DEA低估決策單元的情形，也能夠解決DEA對於有效率的決策單元無法進一步排序的缺憾；3.判定醫院經營績效指標上，CART生成的分類樹，以95年度的準確率最高，93、94年套用亦然；其判定規則醫生人數、醫事人員數、護理人員數、門(急)診人次最易判斷醫院經營的狀況；4.從Malmquist生產力變動來看，醫院平均生產力下降3.7%，就生產力變動來源而言，技術成長率 (-4.1%) 與技術效率成長率 (0.04%)，技術變動是阻礙生產力成長的主要原因。

關鍵字

資料包絡法 ； Malmquist生產力指數 ； DEA-ANN模式 ； 新制醫院評鑑

並列摘要

The constant changes in health insurance payment method and the implementation of the new hospital accreditation system have triggered drastic impacts and challenges on hospital management in Taiwan. Hospitals are required to reduce medical costs and upgrade healthcare quality so as to enhance competitiveness and ensure sustainable development. Hospital efficiency measurement not only offers an understanding of the management effectiveness of a hospital but alos provide decision-makers with valuable references for optimal utilization of medical rsources. The study is divided into four parts. The first part adopts Data Envelopment Anaysis (DEA) to measure the relative efficiency of the hospitals that passed accreditation in Taiwan during the three years from 2004 to 2006. For hospitals whose efficiency needs to be strengthened, Slack Variable Analysis and Returns to Scale analysis are performed to understand the scale of and directions for improvement. In the second part, the DEA-ANN model is used to obtain a more objective nd reasonable efficiency score as the model integrates the non-linearity feature of neural network with the advantages of efficiency measurement method. The third part applies CART (Classification and Regression Tree) to establish relevant rules for measuring hospital efficiency and to build up the hospital efficiency measurement model. In the fourth part, the Malmquist productivity index are consulted to analyze the changes in the healthcare industry and to understand the changes in technical efficiency, technology, and productivity of the sample hospitals.
The results show that: (1). The efficiency scores of primary, secondary and tertiary hospitals report a significant different only in 2004; there was no significant difference in 2005 and 2006. (2). The DEA-ANN model reaches an average efficiency score higher than the one obtained by the DEA model and a lower standard deviation, suggesting that the DEA-ANN model is able to reduce the underestimation of decision-making units frequently associated with the DEA approach. It can further rectify the inability of DEA to rank the efficienct decision-making units. (3). In terms of the indicators of hospital efficiency, the CART-generated classification tree reports the highest accuracy rate in 2006; this is also applicable to 2004 and 2005. The numbers of physicians, medical specialists, nurses and outpatients (and ER patients) appear to be the indicators most compatible with measuring hospital efficiency. (4). By the Malmquist productivity index, the average hospital productivity drops 3.7%. For the sources of changes in productivity, technical growth (-4.1%) and growth in technological efficiency indicate that technical/technological changes are major hindrance to the increase in productivity.

並列關鍵字

Data Envelopment Analysis ； Malmquist productivity Index ； DEA-ANN Model ； New Hospital Accreditation

參考文獻

[4] 石淦生、羅紀瓊、陳國樑，公私立綜合醫院服務層面效率差異之探討，中華衛誌，第十五卷，第五期，1996，第469-482頁。

[5] 行政院衛生署，95年報分析，行政院衛生署，2007。

[18] 陳世能，醫學中心與區域醫院生產力變動之研究-含服務品質之Malmquist指數bootstrap方法，醫務管理期刊，第七卷，第一期，2006，第57-80頁。

[13] 高強、黃旭男，管理績效評估－資料包絡分析法，台北：華泰文化事業股份有限公司，2003。

[26] 董鈺琪、鍾國彪、張睿詒，綜合教學醫院推行品質管理與營運績效之關係研究，中華衛誌，第十九卷，第三期，2000，第221-230頁。