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研究生:侯穎蕙
研究生(外文):Hou, Ying-Hui
論文名稱:全民健康保險實施前後教學醫院效率變動之探討
論文名稱(外文):A Study of Efficiency Changes in Teaching Hospitals Pre- and Post-implementation of the National Health Insurance
指導教授:張睿詒張睿詒引用關係---
指導教授(外文):Change Ray-E
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:醫療機構管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:1998
畢業學年度:86
語文別:中文
論文頁數:126
中文關鍵詞:醫院效率效率變動資料包絡法競賽理論
外文關鍵詞:hospital efficiencyproductivity changedata envelopment analysisgame theory
相關次數:
  • 被引用被引用:47
  • 點閱點閱:361
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:6
全民健保之實施使台灣之醫療環境產生重大之變革,亦對醫院之營運造成顯著的衝擊
與影響。因此,全民健保實施前後醫院之效率及效率變動趨勢,備受各方關切,值得深入
探討。
本研究為一縱斷性之研究設計,以醫院為分析單位,利用國內地區教學以上醫院82-8
5年之資料進行效率變動之分析,研究樣本共包含(準)醫學中心12家、(準)區域醫院4
2家及地區教學醫院57家,合計111家。主要之目的在於探討國內教學醫院於健保實施前後
之效率變動與效率特質之變化情形,並比較不同評鑑等級醫院間之差異。
本研究初步嚐試將醫院住院產出方面之異質性納入考量,並以各層級醫院每住院人日
之費用進行住院疾病嚴重度之調整。主要以兩種方式進行醫院效率之縱斷分析。一為以比
率效率競賽模式分析醫院各年相對於基年(82年)之相對效率,比較跨年之效率變動情形
﹔另一則利用Fare等所定義之Malmquist生產力指標,分析研究期間內醫院生產力之變動
,並進而將生產力變動區分為技術效率之變動及效率前緣(產業生產技術)之變動。
本研究之主要結論如下:
1. 由各年相對於基年之效率分析結果可知醫學中心之效率顯著高於區域醫院與地區
教學醫院。
2. 經由各年相對於基年之效率分析及Malmquist生產力變動指標之分析結果顯示,健
保實施第一年(84年)國內教學醫院之效率有顯著之下降趨勢。
3. 國內醫院84年生產力之下降主要是因整個產業之效率前緣(產業生產技術)後退
所造成。而85年,醫院之技術效率雖有顯著之成長,然因效率前緣(產業生產技術)之後
退中和了其影響,故在生產力上未見顯著之變動。
4. 研究期間內,醫院之生產力變動、技術效率變動以及效率前緣(產業生產技術)
之變動於不同評鑑等級醫院間均無顯著之差異。
5. 在效率特質之分析方面,醫學中心門急診方面之效率於83及84年有較大之成長,
手術方面之效率則於84年有較顯著之下降﹔區域醫院83、84、85年之非醫師醫事人員使用
效率呈現逐年下降之趨勢,而手術方面之效率則於84年有較大之上升﹔而83、84、85年地
區域學醫院門急診方面之效率逐年下降,且85年其手術方面之效率亦有較明顯之下降趨勢

由本研究之結果可知,全民健保之實施確實對國內教學醫院之效率造成影響,84年及
85年樣本醫院之效率前緣均呈顯著之下降趨勢,此或可能因為此二年位於效率前緣上之醫
院其投入方面之成長大於產出方面之成長之故。而85年或因非效率前緣之醫院其效率有較
大幅之提升,而使其技術效率呈現顯著之成長,因此總合而言85年之生產力並未見顯著之
變動。此外,醫學中心所受之影響較小,82-85年其生產力均未見顯著之變動,而相較於
地區教學醫院,區域醫院則以較少之時間予以因應調適。此外,醫院所著重之效率特質於
不同評鑑等級間亦有不同之變化趨勢,因此建議可針對舊撠|之效率做長期之觀察分析,
以做為未來政策及因應策略擬定之參考。
The implementation of the National Health Insurance (NHI) has tremendously
changed the health care sector in Taiwan. Therefore, many researchers and the
public are interested in the efficiency and efficiency changes of hospitals
before and after the implementation of the NHI. This study is a longitudinal
study. The objectives of the study are to investigate the changed in efficie
ncy and dominant competitive factors of hospitals among different accreditatio
nstatuses from 1993 to 1996. 111 hospitals are included in the sample, consis
ting of 12 medical centers, 42 regional hospitals, and 57 district teaching ho
spitals. Two approaches are employed to analyze efficiency changes. First,
the efficiency scores of hospitals relative to base year (1993) are measured t
hrough "two-person ratio efficiency games." Second, the productivity changes
of hospitals are analyzed through the modified Malmquist Productivity Index (M
PI), further decomposed into changes in technical efficiency and changes in pr
oduction frontier. Besides, costs per inpatient day in different accreditatio
n levels are used to adjust the differences in the severity of inpatient servi
ces provided by different accreditation-leveled hospitals. The major finding
s of this study are as follows:1. Based on the comparisons to the base year,
the efficiency scores of medical centers are significantly higher than those o
f regional and district teaching hospitals in each year.2. Based on the compa
risons to the base year and MPI analyses, the efficiency of teaching hospitals
saeclined significantly in the first year of implementing the NHI.3. The regr
ess of productivity in 1995 wan mainly explained by negative shift of producti
on frontier. In 1996, the deterioration in production frontier was offset by
the improvement in technical efficiency, resulting in no significant change in
productivity.4. No significant difference in productivity changes, technical
efficiency changes, and production frontier shifts is observed among differen
t accreditation-leveled hospitals.5. In medical centers, the efficiency of ou
tpatient services was improved in both years of 1994 and 1995, but the efficie
ncy of surgery was declined in 1995. In regional hospitals, the efficiency of
non-physician labor was continuously declined in the years of 1994, 1995 and
1996, but the efficiency of surgery was advanced in 1995. In district teachin
g hospitals, the efficiency of outpatient services was continuously declined i
n the years of 1994, 1995, and 1996, and the efficiency of surgery was decline
d in 1996 as well. Based on the results, the implementation of the NHI did h
ave some impacts on teaching hospitals. The production frontier of hospitals
declined significantly in 1995 and 1996. It showed that the process of transf
orming resources into services for hospitals on the efficiency frontier contin
uously deteriorated in both years. The reason might be that the resources acq
uired by those hospitals increased more rapidly than services produced. Howev
er, unlike 1995, the overall productivity did not declined in 1996 because of
the improvement in technical efficiency. This might be due to the improvement
of those hospitals not on the efficiency frontier. Moreover, the NHI had dif
ferent impacts on different accreditation levels of hospitals. It seemed that
regional hospitals and district teaching hospitals have incurred greater infl
uence than that of medical centers. The changes in the productivity of medica
l centers was not significant from 1993 to 1996. On the other hand, compared
with district teaching hospitals, regional hospitals spent less time to adapt
this new system. The results should provide insight into future policy making
.
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