以社會認知理論探討影響醫院預算參與之前置因素

Abstract

臺灣健保系統採行總額預算制度，導致多數醫院無法分配合理的醫療資源。相關研究發現若具備有效的預算系統，醫院除了具備明確的量化數據以及預算指標達成率之健保協商基礎外，更能妥善規劃醫院現有的資源。而建構有效的預算系統，學者認為高度的預算參與是影響其最終績效的主因。然而，以往文獻大多聚焦於探討預算參與對績效與預算態度之影響，甚少檢視影響預算參與之前置相關因素。本研究引用社會認知理論並整合外部環境面因素（醫療環境不可預測性與醫療環境競爭性）、內部組織面因素（「成本抑制」與「收入創造」之策略強調）、與預算主管的認知面因素（認知預算有用性與認知工作負荷程度），進一步檢視對其預算參與行為之影響。研究樣本係國內評鑑後為優等之地區教學醫院156位醫療預算主管，透過問卷調查方式取得實證資料。實證結果發現：（1）外部環境面因素（醫療環境不可預測性與醫療環境競爭性）會對「成本抑制」與「收入創造」之策略強調呈現正向顯著的影響關係。（2）醫療環境競爭性越高亦會正向顯著影響醫療預算主管之認知預算有用性程度。（3）「收入創造」之策略強調會正向影響醫療預算主管之認知因素。（4）「成本抑制」之策略強調僅會正向影響認知預算有用性之程度。（5）透過醫療環境面因素與策略強調因素之影響，當認知預算有用性與認知工作負荷程度越高，會正向影響醫療預算主管最終之預算參與行為。最後，本研究建立起影響醫院預算參與行為之模型，實證結果可提供預算管理之參考。

Taiwan's health insurance system adopts global budget system, which makes most hospitals unable to allocate resources reasonably. Related studies show that an effective budget system in place enables hospitals not only to present specific quantitative data and indicator-based success rates that can serve as a basis of their negotiations for medical funding, but also to better plan their existing resources. For the creation of an effective budget system, this paper suggests that high budgetary participation is a key factor that affects hospitals' performance. However, past researches mostly focus on examining the impact of budgetary participation on performance and budgetary attitudes and rarely explore the antecedents affecting budgetary participation. This study therefore cites the social cognitive theory and integrates external environmental factors (medical environmental unpredictability and medical environmental competition), internal organizational factors (strategic emphasis of cost containment and revenue generation) and factors related to budget supervisors' perceptions (perceived usefulness of budget and perceived work-related tension) to take a closer look at the effect of these factors on budgetary participation behaviors. The research samples are 156 medical budget supervisors from regional teaching hospitals rated as ＂excellent＂ in a national accreditation and the data for empirical research are collected through a questionnaire survey. The empirical results show that (1) the external environmental factors (medical environmental unpredictability and medical environmental competition) have significant positive effect on strategic emphasis of cost containment and revenue generation; (2) greater medical environmental competition is more likely to have a significant positive effect on medical supervisors' perceived usefulness of budget; (3) Strategic emphasis of revenue generation has a positive effect on medical budget supervisors' personal cognitive factors; (4) Strategic emphasis of cost containment has a positive effect only on perceived usefulness of budget; and (5) the medical environmental factors and strategic emphasis factors are more likely to have positive effects on medical budget supervisors' final budgetary participation behaviors when their perceived budget usefulness and perceived work-related tension are greater. Finally, this study created a model for factors that affect hospitals' budgetary participation behaviors and the presented empirical results may provide some insight into budget management.