臺灣博碩士論文加值系統

摘要:

本研究之目的在於調查全民健康保險實施之後地區醫院之服務量是否有改
變以及地區醫院在全民健康保險實施後經營策略之改變.調查工具為自行
設計之自填結構式問卷,經專家效度審查後定稿,問卷內容,共分四個部分:
醫院基本資料 、醫院在全民健保開辦後所面臨的困難、醫院在全民健保
開辦後之因應之道、作答者基本資料,本問卷所指之因應之道分為組織內
之策略與組織外之策略.調查方式為橫斷面的對地區(含地區教學)醫院進
行普查,於 1997年9月開始調查,對象為1996年9月出版之台灣地區85年度
衛生統計,台灣地區(台,澎,金,馬)所有與中央健康保險局特約之醫療院
所479家,經衛生署醫院評鑑等級為地區醫院及地區教學醫院,利用郵寄問
卷調查,回收有效問卷157家(回收率:32.77%).

研究結果,在醫療業務服務量的變化,包括門診及住診,樣本醫院均有超
過50%認為服務量減少,而在營運總收入以及淨獲利率方面樣本醫院亦是同
樣有超過50%認為較全民健康保險實施前減少.

而在組織內經營策略而言,選擇以全民健康保險給付者為優先考慮為主之
地區醫院佔全部之91.08%,選擇發展全民健保不給付之自費項目之醫院佔
全部之62.24%,選擇發展慢性醫療項目之醫院佔全部之57.32%,而在組織外
之經營策略方面,在水平整合(策略聯盟,連鎖經營,醫院管理顧問公司的介
入)項目中,由全民健保實施前的18家,到目前選擇之36家,到三年後有56
家,顯示願意選擇水平整合為經營策略之地區醫院有增加之趨勢.而在獨資
獨營方面由全民健保實施前的131家,到目前選擇之110家,到三年後只有49
家,顯示因應法規環境之改變經營策略選擇不變之醫院有減少之趨勢.
而影響樣本醫院組織內策略選擇的因素為:選擇以全民健保支付者為發展
之原因與醫院之總員工人數有相關 (p=0.0303),選擇發展為慢性病床之原
因與醫院之總員工人數有(p=0.0303)以及總病床數(p=0.0189)有相關,選
擇發展自費醫療項目之原因與醫院之總員工人數有(p=0.042),以及總病床
數(p=0.05)有相關影響樣本醫院組織外策略之因素:選擇未來三年之

經營策略,與醫院是否有醫院管理人員(p=0.013)及總員工數(p=0,0006)有
相關 . 由於目前全民健康保險已實施三年餘,並且全民健
康保險的經營型態是否會改變也有許多不同的說法,建議後續研究者針對
各個不同經營策略進行績效評估,或進一步討論其他影響因素與經營策略
間之關係.

Abstract

The purpose of this study is to survey whether there are changes
occurring in the service quantity and management strategy of
district hospitals after the enforcement of National Health
Insurance Policy. Method of the survey is a filled-in
questionnaire approved by specialists .There are four major
sessions in the questionnaire including information of
hospitals, difficulties encountering after the enforcement of
National Health Insurance Policy, responses of National Health
Insurance Policy, informatioof examinee. Responses of National
Health Insurance Policy refer to both internal and external
management strategies. Starting from September 1997, the survey
had been horizontally conducted on district hospitals (including
district teaching hospitals.) Examinee are 479 contracted
hospitals of National Health Insurance Bureau in Taiwan area
(including Taiwan, Penghu, Chinmen and Matsu), listed in 1996
Annual Report of Public Health published in September 1997 as
well as evaluated as district hospitals oristrict teaching
hospital by Public Health Bureau. Questionnaires were conducted
through mail. There were 157 valid questionnaires in return and
the retrieving rate is 32.77%. The result
of survey indicates changes of service quantity including
outpatient and inpatient services. Over 50% of sampling
hospitals think that their service quantities have been reduced.
About the same percentage of hospitals believe their net revenue
and profitability has been reduced comparing with those before
the implement of National Health Insurance.

As far as the internal management strategy is concerned, 91.08%
of examinee consider patients with National Health Insurance as
first priority in their management strategy. 62.24% of total
sampling hospitals choose to focus on items, which are not
covered by National Health Insurance. 57.32% have been
emphasized treatments for chronic diseases. In items of
vertical integration (strategy alliance, chain alliance, or the
participation of consulting company of hospital management),
currently there are 3participant hospitals comparing with 18
before the implement of National Health Insurance. It is
expected to have 56 participant hospitals three years later.
This shows that more and more district hospitals choose vertical
integration as their management strategy. There were 131
hospitals operated exclusively with their own investment. The
number reduces to 110 now. After three years, only 49 hospitals
will be operated exclusively with their own investment. It
indicates that fewer hospitals choose to e old management
strategy to cope with the change of national policy.

Factors affecting internal management strategy: hospitals, which
consider patients with National Health Insurance as first
priority, related hospital workers (p=0.0303.),hospital which
choosing to offer service for patients with chronic disease(p=
0.0303); and beds(p= 0.0189,hospitals choosing to focus on
patients who will pay medical bill by themselves: related
hospital worker(p= 0.042); and beds (p=0.05).Factors affecting
external management strategy are linked with the management
strategy in next the years, hospital managers (p=0.013), and
total numbers of hospital workers (p=0.0006).

Owing to the confidentiality of financial resources, data
concerning actual operation of sampling hospitals are not
available in this survey. As a result, in this regard, no
comparison and evaluation of management efficiency before and
after the implement of National Health Insurance Policy can be
done.