臺灣醫院績效評估及管理

Abstract

世界衛生組織及全民健康保險局呼籲醫療資源有限，各醫院應同時提昇經營效率及醫療品質，因此本論文研究之重點就針對此二部分，第一部分：以資料包絡法分析臺灣大型醫院效率情形，進一步以Tobit廻歸模型分析造成無效率的醫療品質及環境變數；第二部分：剖腹產率高低可以當做醫療品質的指標，因此探討在管理上有那些決定因素會造成臺灣的剖腹產率偏高。

第一部分：台灣規劃了七年的全民健康保險，終於在民國八十四年三月一日起實施，民眾前往大型醫院就醫的經濟負擔減低，更者，全民健康保險降低了民眾直接赴大型醫院就醫的交易成本，結果使得許多患者就直接到大型醫院看病；本篇論文為自民國八十二年至民國九十一年最新最近十年行政院衛生署統計室的官方縱橫面資料，選定醫學中心、區域醫院等大型醫院，再去除資料不完全者及異常者，共計四十九家樣本醫院以資料包絡法分析臺灣大型醫院跨期效率情形，進一步以Tobit廻歸模型分析造成無效率的醫療品質及環境變數。 結果發現這十年來： （一） 、醫療品質及環境變數顯著地影響醫院經營的技術效率值； （二） 、台灣大型醫院的生產力退步，主要是由技術衰退所造成的。

第二部分：剖腹產率的增高是一種全世界的流行趨勢，臺灣亦然，本研究搜集自民國八十一年至民國九十年臺灣最近十年間剖腹產率及其社經因素的官方統計資料做為研究對象，由供給及需求雙方面分析決定剖腹率之因素。 實證結果顯示： （一） 、權屬別中公立醫院的剖腹產率顯著大於私立醫院， （二） 、醫學中心剖腹產率顯著最高，其次為區域醫院，而以地區醫院顯著最低， （三） 、北中南東部各地理位置不同亦造成各地區之剖腹產率顯著不同， （四） 、基督教及天主教信徒人數在該地區總人口比率愈高時，則該地區之剖腹產率愈低。

The World Health Organization and Bureau of National Health Insurance have proposed that every hospital should promote the efficient utilization and high quality under the circumstance of limited medical resources. A procedure is composed of 2 parts. Part 1 is “Technical efficiency of large hospitals in Taiwan: an application of data envelopment analysis (DEA) , and then uses Tobit (censored) regression to find the effects of quality and environmental variables on these efficiency scores.” Part 2 is “The effect of managerial factors on the incidence of medical operations: the case of Cesarean sections in Taiwan.”

Part 1: Taiwan started its National Health Insurance Program (NHIP) on March 1, 1995. Because NHIP subsidizes each hospital visit, reducing the transaction cost for a patient to go to a large hospital directly. We use the latest 1993-2002 official panal data set and select 49 hospitals with medical centers and regional hospitals for analysis. This research applies the DEA to compute hospital efficiency scores, and then uses Tobit (censored) regression to find the effects of quality and environmental variables on these efficiency scores. Our major empirical findings are as follows: (1) Quality and environmental variables significantly affect the technical efficiency scores of large hospitals in Taiwan. (2) The relatively negative productivity trends of large hospitals in Taiwan are mainly caused by technological regress.

Part 2: Increasing Cesarean section rates are a pandemic trend all over the world, and also in Taiwan. This research collects Taiwan’s official data on Cesarean section and the associated socio-economic factors during 1992-2001. We analyze factors determining Cesarean section rates from both supply and demand sides. Our major empirical findings are as follows: (1) Cesarean section rates in public hospitals are significantly higher than those in private hospital. (2) Medical centers have the highest, regional hospitals have the median, and district hospitals have the lowest Cesarean section rates. (3) Different geographic areas in Taiwan also have significantly different Cesarean section rates. (4) An increase in Christian and Catholic population ratio significantly reduces the Cesarean section rate in an area.