臺灣博碩士論文加值系統

本文以民國98年、99年與100年度的醫療服務量檔與醫療機構現況檔，依其型態(一般醫院與綜合醫院)以及權屬(公立醫院與非公立醫院)群組績效評估。評估方式則依資料包絡分析法，將決策單位依效率做階層分類，計算其相對吸引力以及相對進步力，提供決策單位規劃自身的學習標竿路徑。本研究採用投入項為總科別數、醫師人數、護理人數以及開放病床數；產出項為住院人日、出院人次、門診人次與急診人次。
本文結論：最佳效率前緣內的決策單位，相對其他階層效率前緣，其平均投入量並非為最大，表示醫院並非增加人力與資本投入就能提高效率。多數效率較高的醫院，提供的總科別數相對較少，因為醫院提供服務量越多，則資源分配易產生不均而降低效率。新制醫院評鑑結果與效率分層結果並未一致，主要為新制醫院評鑑項目主要以醫院經營管理、運作與服務品質為導向，而本研究主要以技術效率為導向，因而有不同結果，若醫院在短期針對提高技術效率，則可依據自身在不同階層所建立的學習標竿路徑為方向依循。

The source of study database is from ministry of health and welfare. The decision making unit are classified by different type and ownership and used the data envelopment analysis to evaluate the performance of efficiency focus on 2009, 2010 and 2011. The groups are identified to different efficient frontiers and discuss their relative attractiveness and progress. According the benchmarking path, the each hospital do the effort to improve the efficiency guided by the suitable model. The research use the input variables: beds, physicians, nurses and the service complexity, the output variables: outpatient visits, patient days, inpatient discharges and emergency room visits.
Results of this study：Decision making units within the leading efficient frontier relative to other levels of the efficient frontier, which invested in inputs is not the largest average amount. It indicates that the hospital increasing the human resources and capital can be sure to improve the efficiency. Most of the lower efficiency hospital with higher service complexity may cause from the uneven distribution of resources and reduce efficiency of performance.
The results of hospital accreditation are not consistent with the results of the efficiency of stratification. The main reason is that the hospital accreditation is mainly in hospital management, operations and service quality. The research focuses on technical efficiency, and thus has different result. If hospital aim for improving technical efficiency in the short term can according to their own benchmarking path which is established at different levels for the direction to follow.

1、 緒論
1.1 研究起源
1.2 研究目的
2、 文獻探討
2.1 醫療績效分析法
2.2 DEA在醫療上的應用
3、 研究方法
3.1 資料包絡分析方法
3.1.1 CCR模型
3.1.2 BBC模型
3.2 情境相依資料包絡分析法(Context-dependent Data Analysis)
3.2.1 階層資料包絡分析方法(Stratification DEA Method)
3.2.2 吸引力(Attractiveness)
3.2.3 進步力(Progress)
4、 研究結果
4.1 研究流程
4.1.1 研究對象與資料選取
4.1.2 分析模型選取
4.1.3 變項選定
4.2 實證結果
4.2.1 描述性統計
4.2.2 投入項與產出項Pearson相關性分析
4.2.3 醫院評鑑結果與各階層分布情形
4.2.4 型態別與權屬別之階層描述性統計
4.3 相對吸引力
4.4 相對進步力
4.5 標竿路徑(The Benchmarking Path)
5、 結論與建議
5.1 研究限制
5.2 研究結果與討論
參考文獻

英文文獻
Chang, H., Chang, W. J., Das, S., &; Li, S. H. (2004). Health care regulation and the operating efficiency of hospitals: Evidence from Taiwan. Journal of Accounting and Public Policy, 23(6), 483-510.
Chern, J.-Y., &; Wan, T. T. (2000). The impact of the prospective payment system on the technical efficiency of hospitals. Journal of Medical Systems, 24(3), 159-172.
Grosskopf, S., Margaritis, D., &; Valdmanis, V. (2004). Competitive effects on teaching hospitals. European Journal of Operational Research, 154(2), 515-525.
Harris, J., Ozgen, H., &; Ozcan, Y. (2000). Do mergers enhance the performance of hospital efficiency? Journal of the Operational Research Society, 51(7), 801-811.
Harrison, J. P., Coppola, M. N., &; Wakefield, M. (2004). Efficiency of federal hospitals in the United States. Journal of Medical Systems, 28(5), 411-422.
Helmig, B., &; Lapsley, I. (2001). On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study. Health Services Management Research, 14(4), 263-274.
Huang, Y.-G., &; McLaughlin, C. P. (1989). Relative efficiency in rural primary health care: an application of data envelopment analysis. Health Services Research, 24(2), 143.
Lee, K.-H., Yang, S.-B., &; Choi, M. (2009). The association between hospital ownership and technical efficiency in a managed care environment. Journal of Medical Systems, 33(4), 307-315.
Nunamaker, T. R. (1983). Measuring routine nursing service efficiency: a comparison of cost per patient day and data envelopment analysis models. [Research Support, Non-U.S. Gov't]. Health Services Research, 18(2 Pt 1), 183.
Park, J. S., Fowler, K. L., &; Giebel, S. A. (2011). Measuring hospital operating efficiencies for strtegic decisions. international Journal of business and social science, Vol.2No.13.
Puig-Junoy, J. (2000). Partitioning input cost efficiency into its allocative and technical components: an empirical DEA application to hospitals. Socio-Economic Planning Sciences, 34(3), 199-218.
Seiford, L. M., &; Zhu, J. (2003). Context-dependent data envelopment analysis—measuring attractiveness and progress. Omega, 31(5), 397-408.
Simonson, I., &; Tversky, A. (1992). Choice in context: Tradeoff contrast and extremeness aversion. Journal of Marketing Research (JMR), 29(3).
Wang, S.-C. (2007). A model for Evaluating the Efficiency of Teaching Hospitals. Mid-Taiwan Journal of Medicine, 12(2), 83-91.
Watcharasriroj, B., &; Tang, J. (2004). The effects of size and information technology on hospital efficiency. The Journal of High Technology Management Research, 15(1), 1-16.
Zere, E., Mbeeli, T., Shangula, K., Mandlhate, C., Mutirua, K., Tjivambi, B., &; Kapenambili, W. (2006). Cost Effectiveness and Resource Allocation. Cost Effectiveness and resource allocation, 4, 5.
 
中文文獻
江靜穎 (2007)，以資料包絡分析法 (DEA) 評估國內醫院相關管理研究所之效率， 中國醫藥大學醫務管理學系碩士班學位論文， 1-106。
杜功仁、林義芳、林坤緯、 潘信如 (2007)，醫療機構設施管理部門之績效評估: 資料包絡分析法之應用，物業管理學會論文集, 30-43。
李文福、 王媛慧 (2006)，台灣醫療產業生產力與效率實證研究之回顧與展望， 輔仁醫學期刊，4(4), 215-230。
李佳容、林進財、譚醒朝、 張曉芬 (2010) ，台灣地區財團法人醫院財務績效之評估 台灣地區財團法人醫院財務績效之評估， Journal of Health Management, 8(2), 199-208。
洪嘉聲、陳重光、林惠美. (2013) ，實施總額支付制度對醫院營運效率之影響-資料包絡分析法之應用 經營管理論叢 (pp. 1-21) 。
張石柱、蕭幸金、陳美惠、王詩鳳 (2008) ，醫療品質與生產力變動之評估─以台灣醫療品質指標計畫 (TQIP) 為例，當代會計, 9(1), 1-32。
郭蘊慧 (2009)，醫院醫療服務面經營績效及品質績效相關性研究-以新制醫院評鑑受評醫院為例，臺灣大學醫療機構管理研究所學位論文，1-96。
陳宗義 (2004)，全民健保之總額支付制度下醫院經營效率之研究─DEA之應用。
陳明進, &; 黃崇謙 (2001)，全民健保支付制度改變前後公立醫院與財團法人醫院服務量及醫療利益之比較，當代會計, 2(2)，169-194。
陳仁惠、黃月桂(2005)，不同權屬與評鑑等級醫院之效率評估－DEA法之應用， 醫護科技學刊，Vol.7 No.4 346-362。
陳巧珊、程于珊、許怡欣(2008)，運用資料包絡分析法探討署立醫院，縣市立醫院及其委託經營醫院經營效率，澄清醫護管理雜誌， 4(3)，7-13。
游濬遠、邱健泰、耿慶瑞、黃馨瑩、邱志洲 (2007)，從效率性分析觀點探討醫療服務品質之提升—以台灣地區大型醫院為例，品質學報14(2) 197-206。