署立醫院外包業務管理策略對外包績效之影響

蘇淑芬

doi:10.6833/CJCU.2011.00075

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署立醫院外包業務管理策略對外包績效之影響

A Study on Outsourcing Performance and Outsourcing Management Strategy among DOH Hospitals

蘇淑芬 , Masters　　Advisor：陳金淵　　

繁體中文 DOI： 10.6833/CJCU.2011.00075

外包管理策略；外包績效；交易成本； Outsourcing ； Outsourcing strategy ； Outsourcing performance ； Transaction cost

Abstract │ Reference (44) │ Times Cited (3) │ Altmetrics

Abstract 〈TOP〉

目的：	自1995年全民健保實施以來，隨著醫療可近性的增加，促使醫療院所產生白熱化的競爭。醫院管理者面對更大的經營挑戰，同時承受提高醫療品質與降低醫療成本的雙重壓力，因此，許多與醫療相關的業務開始考慮內製或外購的策略，「合約管理」即為其中之一，也就是我們時常提及之「外包（outsourcing）」。本研究以署立醫院為對象，探索其外包業務績效及管理策略，並進一步檢測外包管理策略與外包績效表現之相關性，希冀所得結果能提供醫院經營策略上之參考。

方法：	本研究參考醫院相關業務外包之文獻，發展出結構式調查問卷，包括外包管理策略八個構面（監督過程、監督結果、控制誘因、控制處罰、信任合作、信任競爭、資訊理性、資訊隨機）及外包績效三構面（成本控制、交易成本、服務品質），針對行政院衛生署所屬28家醫院外包使用單位及管理單位進行調查。共發出840份問卷，回收醫院樣本24家，個人問卷樣本506份，醫院樣本及個人問卷樣本回收率分別為85.71%、60.45%，有效問卷461份。問卷回收後，以SPSS for Windows12.0版統計套裝軟體進行各項統計分析。

結果：	回收之24家署立醫院計有23項外包業務，其中52.2%（12項）屬非醫療事務、47.8%（11項）為醫療相關業務，每家醫院分別有4~16項業務採行外包。在24家醫院中非醫療業務外包項目中，以感染性廢棄物清運（95.8%）、一般事業廢棄物清運（91.7%）較高；與醫療業務相關者，則以體外震波碎石（29.2%）、護理之家（20.8%）、健檢中心（20.8%）、呼吸照護病房（20.8%）等4項較多。依據醫院屬性來看，區域醫院業務外包項目較地區醫院及精神專科醫院為多；在外包績效中，成本控制方面以精神專科醫院表現最佳(F=9.27，P=0.000)。
在外包業務管理策略方面，不同醫院層級之外包管理策略在「控制誘因」（F =3.62，p=0.028）及「控制處罰」（F=4.23，p=0.015）之得分有顯著性差異；不同外包業務管理者間對於「成本控制」（t=2.20，p=0.029）、「交易成本」（t=2.89，p=0.004）及「服務品質」（t=3.96，p=0.000），在得分上亦有顯著性差異。
外包業務管理策略構面中之「監督過程」、「控制處罰」及「信任合作」與「成本控制」分別呈現正相關（ r=0.324、r=0.206、r=0.174）；「監督過程」、「控制處罰」、「信任合作」及「資訊理性」與「交易成本」則呈現正相關（r=0.336、r=0.229、r=0.235、r=0.312）；而「監督過程」、「控制誘因」、「控制處罰」與「信任合作」及「資訊理性」與「服務品質」呈現正相關（r=0.431、r=0.129、r=0.329、r=0.261）；而「監督結果」與「服務品質」則呈現負相關（r=-0.101）。
複迴歸分析發現，外包管理策略及外包業務管理人員類別對「成本
控制」、「交易成本」及「服務品質」皆有正向的影響，調整後模式的解釋變異量分別為0.102、0.169、0.207，且具有統計上的顯著性。

結論：  署立醫院在外包策略的使用率已達100%，醫院之所以將非核心業務甚至是核心業務釋出，主要的原因在於自製相對不合乎經濟效益。而本研究發現，業務外包最大因素為「降低成本」（73.3%），與文獻中各學者之觀點一致。再者，就外包業務項目來看，可發現一向注重醫療專門技術優勢的醫療產業，因受到醫療生態環境的改變，已開始將醫療核心業務進行外包。在醫療業務外包中又以地區醫院佔多數（33.3%），可見中小型醫院在資源不足的情況下，會偏好採用外包方式來拓展服務項目。外包管理策略採用「監督過程」、「資訊理性」、「信任合作」、「監督結果」可預期在外包績效的成本控制、交易成本及服務品質有正向影響。

Parallel Abstract 〈TOP〉

Objectives	Since the implementation of National Health Insurance in 1995, the health care environment in Taiwan has changed dramatically with increased competition among hospitals. Hospital managers suffer more severe pressure and a higher demand for their operational management. Therefore, more and more healthcare-related services are considered to be outsourced, especially in the domain of DoH hospitals. This study was aimed to examine the effectiveness of outsourcing management and the relationship between outsourcing strategy and outsourcing performance.

Methods		The 28 DoH-affiliated hospitals are the targeted research population. A structured questionnaire was developed and distributed to the operation and management departments within each hospital to collect outsourcing-related information, such as outsourcing strategies and operational effectiveness (cost control, transaction cost and service quality). SPSS 12.0 for Windows was used to provide statistical analyses. Of the 840 questionnaires distributed to 506 persons within 24 hospitals, 461valid questionnaires were collected with a response rate of 60.45%.

Results		The results indicate that there were 23 outsourcing services in 28 hospitals with 52.17% related to general affairs and 47.8% related to medical services. Infectious wastes removal (95.83%) and general wastes removal (91.67%) ranked the top two services in general affairs while extracorporeal shock wave lithotripsy (29.17%), nursing home (20.86%), health exam center (20.83%) and respiratory care ward (20.83%) were the top three in medical services. Regional hospitals were more likely to outsource than district and psychiatric hospitals. Psychiatric hospitals (F=9.27, p< 0.001) responded with a better cost control in outsourcing effectiveness. The scores of management strategy were significantly different in “incentive” (F = 3.62, p= 0.028) and “punishment” (F= 4.23, p= 0.015). There also existed significant difference in “cost control” (t= 2.20, p= 0.029), “transaction cost” (t= 2.89, p= 0.004) and “service quality” (t= 3.96, p< 0.001) among outsourcing administrators. Besides, “process surveillance,” “control and punishment,” and “trust and corporation” had a positive correlation with cost control (r=0.336, r=0.229, r=0.235); “process surveillance,” “control and incentive,” “control and punishment,” “trust and corporation,” and “information rational” had a positive correlation with service quality (r=0.431, r=0.129, r=0.329, r=0.261, r=0.256); and, “result surveillance” was negatively related to service quality (r=-0.101). The regression analysis modeling implied that strategic management and outsourcing administrators had positively influence on cost control, transaction cost and service quality with an adjusted R square (Adj. R2 ) equal to 0.120, 0.169 and 0.207, respectively.

Conclusions		Outsourcing strategies were thoroughly adopted among DOH hospitals. In addition to the traditional non-core healthcare services, some core health services were being turned into outsourcing targets as well. The major concern for outsourcing is cost down (73.3%). District hospitals (33.3%) preferred to outsource medical services to expand their scope in lack of resource. Their primary management strategies included “process surveillance,” “information rational,” “trust and cooperation,” and “outcome surveillance,” with an expectation of positive influence on cost control, transaction cost, and service quality.

Reference ( 44 ) 〈TOP〉

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