臺灣博碩士論文加值系統

　　我國的醫療產業在近年來所面臨的營運環境日漸惡化，從健保實施以來，醫療費用的年平均成長幅度均高於保費收入，促使保險人不得不推行總額支付制度、醫院合理門診量、醫院自主管理、加強違章查處等動作。
本論文利用2001年至2003年間，以117家醫院的資料為基礎，利用調整DEA之方法就三階段方式加以處理。第一階段係透過DEA模型衡量在此三年間各家醫院生產效率；第二階段為計算各家醫院鬆弛變數（slack）；第三階段則就投入項鬆弛變數為被解釋變數，以外在環境變數（包括：淨轉診人次（轉入-轉出）、自殺或自傷死亡率、經濟成長率）為解釋變數，求得投入項調整值後，將其代入第一階段的DEA模型重新計算生產效率值，並計算調整後的Malmquist生產力指數，藉以證明透過環境因素所得無效率值經調整後，可以提高各醫院的生產效率。
經研究結果如次：
一、從第一段階實證分析發現，行政院國軍退除役官兵輔導委員會所屬的榮民醫院、財團法人醫院或宗教財團法人附設醫院之營運績效較其他類型醫院為高，故建議我國的醫療產業可以其營運流程為範本。
二、從第一階段實證研究亦發現，大型醫院之營運績效大致上比中小型醫院為佳。建議我國的醫院可以加速整合或合併，讓其發揮規模經濟與綜合績效。
三、就平均值觀之，調整後的Malmquist生產力指數比調整前為高。
四、依第三階段實證分析，證明經過環境因素調整後，醫院的效率平均值會提高。故考慮外在環境變數（包括：淨轉診人次（轉入-轉出）、自殺或自傷死亡率、經濟成長率），求取其間無效率值，藉以作適當調整，確實可以使效率值提高。

The medical service in our country was facing an worsening environment in recent years. From the administration of the National Health Insurance system, the yearly growth of expense in medical service was higher than the revenue from the insurance fee. It pushes the insurance provider to adopt the Global Budget Payment System, reasonable hospital out-patient clinic amount, self-management of hospital, and augmenting search of illegal practice.
This paper based on the data from 117 hospitals between 2001 and 2003. It uses the method of adjusting DEA in three steps. The first step was evaluating the specific hospital’s working efficiency in these three years by using the DEA model. The second step was calculating the slack in the hospitals. The third step was using the investing item’s slack as the translated variable and the external environmental variable (including: net transferred people (transferred in – transferred out), suicide or self- hurting rate, financial growth rate) as the translation variable to acquire the investing item adjusted value. Bring the adjusted value into the DEA model in step one to recalculate the working efficiency and calculate the adjusted Malmquist production index to prove that we can elevate the individual hospital working efficiency by adjusting the inefficiency value of environmental factor.
1.Based on the first stage of evidence-based analysis, the business efficiency of the juridical person hospital, the religion juridical person subsidiary hospital are better than other types of hospital. Therefore, we suggest that the medical service of our country can take their business processing as the model.
2.Based on the first stage of evidence-based study, the business efficiency of large-scale hospital is better than that of the intermediate and miniature hospital. Therefore, we suggest to speed up the integration or combination of the hospital of our country to develop return to scale and synthetic efficiency.
3.Based on the average value, the Malmquist production index after adjustment is higher than that before adjustment.
4.Based on the third stage of evidence-based analysis, we prove that the average value of the efficiency of the hospital will raise after the adjustment of environmental factors (including: net transferred people (transferred in – transferred out), suicide or self- hurting rate, financial growth rate) into consideration and calculating the inefficiency vale to adjust properly.

目錄
致謝 Ⅰ
摘要 Ⅱ
目錄 Ⅳ
圖目錄 Ⅴ
表目錄 Ⅵ
第一章 緒論 1
第一節 研究動機與目的 1
第二節 研究對象 2
第三節 研究架構 3
第二章 我國醫療產業體系營運概述與相關文獻回顧 5
第一節 國內醫療產業發展之歷程與現況概述 5
第二節 國內外研究效率與風險文獻 10
第三章 方法論—資料包絡分析法 16
第一節 效率的基本理論 17
第二節 資料包絡分析法 18
第三節 Malmquist生產力分析法 25
第四章 模型建構與實證結果分析 29
第一節 實證模型建構與資料分析 29
第二節 實證結果分析 30
第三節 Malmquist生產力分析 72
第五章 結論與未來研究方向 83
第一節 結論 83
第二節 未來研究方向 85
參考文獻 86
附錄 89

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