臺灣博碩士論文加值系統

由於國內健保制度的影響，醫院面臨外在環境的改變，加以同業間的競爭，導致國內醫療市場走向「高度競爭，低獲利率」的時代，醫療產業跨組織合作的經營模式或策略聯盟已經是一項不可忽視的趨勢，且合作的範圍由以往非核心業務擴大到醫療核心業務的合作，而委外合作策略就是其中的一種方式。有鑑於此，本研究欲探討醫療業務委外因素對醫院委外合作模式之影響。
研究方法分為兩個步驟，首先以個案訪談來分析構面之間的關係，以四家醫院為訪談的對象；接著以定量研究法中之SPSS分析模型的統計結果，導出模式之配適度為何，進一步推導出構念間結果。樣本以中華民國九十二年十月中央健康保險局在約中之地區醫院級以上之醫院名單資料為研究對象，包含了醫學中心23家，區域醫院80家與地區醫院434家，有效問卷為63份。
研究結果顯示，政府政策因素對於醫院委外合作時其股權涉入程度之影響不顯著。規模經濟因素對於醫院委外合作時其股權涉入程度之影響不顯著；範疇經濟因素對於醫院委外合作時其股權涉入程度存在正向影響；醫療儀器設備之更替性因素對於醫院委外合作時其股權涉入程度之影響不顯著。在快速進入新市場因素方面對於醫院委外合作時其股權涉入程度存在顯著影響。而閒置資源、組織學習與過去委外經驗等因素對醫院委外合作時其股權涉入程度之影響均不顯著。

For the public health and insurance policies, most of the hospitals in Taiwan were face the institutional environment and becoming high competition, low profit margin to survive. Under the circumstances, the interorganizational collaboration strategy has become a tendency for decision makers of hospitals to cope with its firms. The range of collaboration extends from non-core services, such as safety-guard, cleanliness, restaurant etc., to core activities and business issues. However, outsourcing is one of the strategies of collaboration. Thus, in this research we examined the relationships between the outsourcing factors of the medical activities and the Clinic Service Cooperative Model.

This study contends two stages of research methods: qualitative method and quantitative method. Firstly, case study aims to revise the conceptual framework and proposed relevant hypotheses observed from this study. We interviewed four directors who are in charge of the hospital. Secondary, the models were proposed to clarify the relationships among the constructs. Mailing questionnaire that is developed and completed will collect pilot study quantitative data. According to the hospital accreditations administered by the central government in Taiwan, conceptual all of the 547 hospitals composed our sample and the effective respondents were 63 sets. Regression analysis and SPSS were conducted for the variable in each model.

The empirical results demonstrate several findings from the hospital-based as follow: the higher the intent of first-mover advantages, the lower equity participated. The higher the extent of economy of scope, the higher the equity participated. But there exists no significant correlation among the government medical policy, economy of scale, organizational slack and the organizational learning.

目 錄

中文摘要……………………………………………………………………..I
英文摘要……………………………………………………………………. II
目錄………………………………………………………………………….IV
表目錄……………………………………………………………………….VI
圖目錄……………………………………………………………………….VII

第一章 緒論………………………………………………………………….1
第一節 研究動機………………………………………………………….2
第二節 研究問題與研究目的.....................................................................3
第三節 研究流程與論文結構…………………………………………….5

第二章 文獻探討…………………………………………………………….6
第一節 委外與醫療委外………………………………………………….6
　第二節 醫療業務委外合作的動機……………………………………...12
第三節 委外合作的模式………………………………………………...27
第四節 研究架構…...……………………………………………………31

第三章 研究方法…………………………………………………………...34
第一節 研究假說………………………………………………………...34
第二節 操作性定義與變數衡量………………………………………...41
第三節 資料收集………………………………………………………...45
第四節 資料分析方法…………………………………………………...48
第五節 信度與效度檢定………………………………………………...49

第四章 研究結果與討論…………………………………………………...53
第一節 敘述性統計分析………………………………………………...53
第二節 醫院醫療業務委外科別與股權涉入模式之敘述性統計分析...55
第三節 醫療業務委外因素與股權涉入模式之實證分析……………...63

第五章 結論與建議………………………………………………………...68
第一節 研究結論………………………………………………………...68
第二節 管理意涵………………………………………………………...77
第三節 後續研究建議…………………………………………………...80
第四節 研究限制………………………………………………………...84

參考書目……………………………………………………………………...86
附錄一：問卷………………………………………………………….……..96
附錄二：醫療事業項目委外調查表………………………………………..100
附錄三：醫療業務委外合作訪談紀錄……………………………………..101
表目錄

表2-1-1 委外與外購之差異............................................................................7
表2-1-2 策略聯盟定義彙總表........................................................................9
表2-1-3　醫院外包前十名項目調查表..........................................................11
表2-2-1 進入市場順序之分類......................................................................20
表2-3-1 聯盟類營定義彙總表......................................................................29
表3-3-1　各變項之操作性定義......................................................................43
表3-4-1　本研究問卷構面與題項彙整表......................................................46
表3-6-1 卷量表內部一致性檢定與信度表..................................................50
表3-6-2 構面驗證性因素分析......................................................................51
表4-1-1 本資料之敘述性統計結果..............................................................54
表4-2-1 各院醫療業務委外科別、股權涉入模式之敘述性統計結果......55
表4-3-1 業務委外因素各變項間相關係數分析表......................................63
表4-3-2 醫療業務委外因素與委外股權涉入模式關係之分析..................65
表5-1-1　本研究假說檢定結果彙整表..........................................................70
圖目錄

圖2-1-1 價值活動自製外包關係圖…………………………………………7
圖2-1-2 競爭優勢－策略易受傷害矩陣圖…………………………..……..8
圖2-1-3 自製與外包關係……………………………………………..……..9
圖2-2-1 企業成長策略動態邏輯….………………..……………………...17
圖2-3-1 資源與交易條件互動的假設示意圖……………………………..30
圖2-4-1 本研究架構......................................................................................33

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