醫院財務績效趨勢影響與影響因素研究

A Study on the Trend and Influence Factors of Hospital Financial Performance

林郁淳(Yu-Chun Lin)

指導教授 ： 陳芬如

義守大學/醫學院/醫務管理學系/碩士(2014年)

https://doi.org/10.6343/ISU.2014.00098

摘要

近年來醫院的經營狀況被廣為探討，造成其經營不佳的影響，除了健保總額的實施，亦包含近年消費者意識抬頭、人口高齡化、追求高醫療照護服務及醫療資源有限、成本耗用等情形。根據衛生福利部統計資料發現，醫院家數從民國86至100年銳減至243間，顯示醫院在面臨經營困境上，具有極大與迫切改善的壓力。本研究目的在藉由衛生福利部公布之財報資料，加上自行彙整其他家醫院財報內容，探討96年至100年間，60間醫院及涵括分院後之106間醫院，在各類財務指標表現與績效的趨勢變化，並透過各項財務指標的交叉分析探討影響醫院財務績效因素之關聯性，另外藉由財務表現分級探討表現優劣醫院在趨勢變化上的差異性。
本研究以次級資料分析方式針對96至100年內(1) 衛生福利部醫事司公布之國內財團法人醫院會計查核簽證財務報表；(2) 衛生福利部隸屬之署立醫院財務決算表；(3)其他醫院公布之財務決算表，進行資料蒐集與統計分析。研究結果發現，5年來，60與106間研究樣本群在安定、短期償債、效率性、成長及其他成本管控能力等5類財務指標績效表現皆有明顯成長與上升趨勢。而獲利能力表現雖無大幅下滑，但在整體趨勢上仍屬表現較差之情形。其代表醫院應定期評估資產運用的有效性、最終獲利情形，及醫務收入成長與成本費用管控是否確實，以避免獲利能力的表現影響醫院整體經營與利潤的成長。
影響因素方面，內部特質(如醫院規模、病床類別、權屬別、成立年數、健保特約類別、評鑑等級及醫療機構現況)對整體財務績效之表現與發展性呈統計上顯著差異。外部環境因素方面(老年人口比率、每百萬人口醫師數以及平均家庭所得於醫療保健支出費用)對醫院獲利、效率及成長能力皆有顯著相關影響，且市場競爭程度的高低會造成醫院財務績效表現上的落差。另外，財務績效分組趨勢中，平均表現較差之組別在五年間各別財務績效表現上有愈趨佳境之跡象，且獲利能力的成長表現亦較其他三組來得高；而其他三組財務績效表現雖呈穩定發展趨勢，但在獲利能力表現上仍顯小幅下滑，表示各醫院於5年度間整體獲利能力之表現上仍有待改善之處。
透過兩群樣本5年度的財務績效表現與趨勢分析，對醫院而言，獲利能力之表現攸關整體利潤與最終獲利情形，醫院須確實注意整體在醫務利益、稅後純益以及總資產報酬率等相關獲利能力指標表現的成長；對政府而言，財務報表內容可供其瞭解醫院相關資金、資源的運用情形，每年度準確的申報財務報表，不僅可提供民眾了解醫院財務狀況，也能使學者們藉由財報內容進行各項相關研究，因此政府可對現有的申報內容進行檢視與修改，以利醫院每年度能提供更準確之資料，以達財務公開資訊化。另外，從醫院內部特質對財務績效的表現情形可發現，台灣醫院規模愈大、特約層級愈高、評鑑等級愈高、科別與醫事人員數愈多、競爭程度愈高等特質的影響下，在安定、獲利以及成長能力的財務績效表現會較佳於其他醫院。

關鍵字

醫院財務指標 ； 財務分析 ； 財務績效趨勢 ； 經營效率 ； 醫院特質

並列摘要

The state of operation of hospitals has been widely discussed in recent years. Besides the implementation of the Global Budget System of the National Health Insurance, the factors that result in their poor operation also include rising consumer awareness, an aging society, the pursuit of high level medical care services, limited medical resources, and cost expiration. According to the statistical data of the Ministry of Health and Welfare, the number of hospitals had dropped to 243 from 1997 to 2011, showing that hospitals, faced with the difficulty, have come under pressure for great and urgent improvement. This research aims at discussing the changes in 60 hospitals and 106 hospitals (60 hospitals plus branches) in the trends of various financial index performances from 2007 to 2011, based on the financial statements released by the Ministry of Health and Welfare and financial statements of other hospitals collected by the author. Through the cross analysis of those financial indexes, the correlation among factors that affect financial performance of those hospitals are discussed And the difference between good and poor operating hospitals in the trend changes are analyzed in groups based on their financial performance.
By means of secondary data analysis, this research collects data and conducts statistical analysis on (1) corporate hospitals’ financial statements with audited certification published by the Department of Medical Affairs, Ministry of Health and Welfare, (2) final statements of hospitals under the Ministry of Health and Welfare, (3) final statements published by other hospitals. It’s found that the research sample clusters of both 60 hospitals and 106 hospitals (60 hospitals plus branches) show significant growth and rising trend in 5 financial index performances (stability, short-term liquidity, efficiency, growth and other costs control ability) over the 5-year period. However, though they didn’t drop significantly in profitability, the overall trend was relatively bad. The findings indicate that hospitals should evaluate the effectiveness of the utilization of assets and final profits, and verify the hospital revenue growth and cost control, to prevent their performance in profitability from affecting their overall operations and profit growth.
As for influence factors, the internal characteristics (such as hospital scale, sickbed type, type of ownership, history, type of hospital contracted with the National Health Insurance Administration, type of accreditation and status of institution) are significantly different statistically in terms of the overall financial performance and development. The external environment factors (aging population ratio, the number of physicians per million people, and the ratio of health care expenditure to average household income) are correlated significantly with hospitals’ profitability, efficiency and growth ability. And the market competition levels cause a difference in financial performance of hospitals. Besides, in trends of groups based on financial performance, the group with poorer performance on average did increasingly better in financial performance in most of the 5 years and their growth in profitability are higher than the other 3 groups. Though the financial performance of the other 3 groups is in a stable trend of development, they drop slightly in profitability, showing that hospitals’ performance in profitability has to be improved.
Through the analysis on the financial performance and trend of the 2 sample clusters, it can be known that for hospitals, the performance in profitability is vital to the overall profits and final profits. Hospitals must pay attention to the growth in profitability indexes, such as medical profits, profit after tax and rate of return on total assets. For the government, the content of financial statements can help it determine the utilization of capitals and resources. The accurate annual financial statements can not only show people the financial conditions of hospitals, but also enable scholars to conduct related researches based on the content of financial statements. Therefore, the government can review and revise the current statement items so that hospitals can provide more accurate data annually to disclose their financial positions. Besides, it can be found from the correlation between internal characteristics and financial performance that hospitals on a larger scale, with higher admission level, higher grade of evaluation, more departments and medical staff, and higher level of competition, do better in financial performance in terms of stability, profitability and growth ability than other hospitals.

並列關鍵字

Hospital Financial Index ； Financial Analysis ； Trend of Financial Performance ； Operating Efficiency ； Characteristics of Hospitals

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