地區醫院轉型策略之研究

The Study of Transformation Strategy in the District Hospital

簡聖哲(Sheng-Che Chien)

指導教授 ： 林能白

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.00995

摘要

台灣之地區醫院在民國八0年代之前的醫療不足時期，擔負著次級醫療區或是偏遠地區之第一線就醫之功能。由於台灣醫療制度在民國84年開始實施健保制度，以及民國91年總額給付制度開始上路，加上大型醫院紛紛成立，造成點值出現打折的現象；還有私人財團進入醫療市場區塊，診所林立，醫療環境競爭更趨激烈。由於台灣的地區醫院營收面，約有百分之九十五來自於健保醫療給付，故在健保給付醫療費用下，會出現收入越來越減少的現象。因此經過兩次大洗牌，以社區醫療骨幹的地區醫院，由健保實施前民國78年的750多家，到96年底只剩300多家，地區醫院歇業情況非常嚴重，許多地區醫院必須思考這個嚴肅的課題，所以思考醫院轉型已經是刻不容緩。
本研究以質性研究的文獻探討找出許多醫院轉型的方向，再經轉型成功的地區醫院深度訪談確認轉型的方向，有策略聯盟，外包委外經營，多角化，自費，社區醫院，專科醫院，以及醫療社團法人等等七種類型，最後個案研究分析出醫院轉型的關鍵。
本研究結果發現，利用SWOT分析的優勢-機會分析出來的10項優勢機會特性，可找出地區醫院許多轉型方向的建議，希望能夠提供一個方法對尋求轉型的地區醫院有幫助。

關鍵字

醫院轉型策略 ； 策略聯盟 ； 外包委外經營 ； 多角化 ； 自費 ； 社區醫院 ； 專科醫院 ； 醫療社團法人

並列摘要

In Taiwan, the medical system was insufficient resources before 1980. The local community hospitals had the most important function that was the front line to help patients in the remote districts. The National Health Insurance (NHI) was established in 1995. In addition, a management-determined system of global budgeting and expenditure limits was beginning in 2002. At the same time more hospitals were established and existing hospitals were expanded their services were. With the advent of NHI, many corporations are interested opportunity in this industry, because the insurance and payment system would be standardization. However, this situation cause a lot of hospitals wants to share this market. The medical industry became very competitive in Taiwan.

The hospital income has 95% from the insured of NHI. Because of the density of hospitals vying for the aggregate of payment dollars, the amount a given hospital sees is less each year. In fact, some smaller hospitals are becoming insolvent as a result of this constriction. There were over 750 local hospitals before 1989 in Taiwan, but there were only 300 remaining in 2007. Smaller hospitals are recognizing this serious problem and try to think about the transformation strategy in the hospital.

The study uses method of Qualitative Research which examines the successful structures of current local hospitals. The causes of their success include Strategic Alliances, Outsourcing services, Diversification, Deductibles, Community Hospitals, Specialized Hospitals and Medical Corporate Aggregates. These 7 structures were analyzed and infer that strategies for hospital transformation.

The study uses the method of SWOT analysis, particularly strengths and opportunities. Also, it has determined 10 strategies for smaller hospitals that want to transform their status or financial solvency. Finally, this study will provide some suggestions to help hospital improvement and transformation of strategy.

並列關鍵字

Hospital transformation Strategy ； Strategic Alliances ； Outsourcing Services ； Diversification ； Community Hospital ； Specialized Hospital ； Medical Corporation Aggregate ； Deductibles

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