衛生署所屬醫院醫療品質與經營績效相關性之研究

Abstract

台灣全民健保自民國84年開始實施起，醫療費用日益高漲，各型醫院在經營上倍感艱辛，降低成本乃成為追求績效的常用手段。然而，隨著成本緊縮，醫院是否犧牲醫療品質，進而影響經營績效，是現階段台灣醫療服務需要面臨的重要課題。國內外研究多指向醫療品質與經營績效存在某種關係，但此種關係的相關性卻待進一步研究。 衛生署所屬醫院為台灣公立醫院之最大體系，因此對於品質與績效的相關性，有必要以自身所收集的資料進行分析。本研究收集民國93年20家較具規模之署立醫院的品質指標與績效指標，進行研究與探討。一方面做為衛生署醫院管理委員會制定相關政策的參考基礎，另一方面則做為各署立醫院經營策略的調整依據。 本研究主要發現如下： 1.署立醫院軟硬體設施重北輕南。以台北醫療區域醫院為參考，就平均醫師住院及門急診生產力而言，署立醫院之醫師生產力應屬相對有效率；但若論及平均員工住院及門急診生產力，整體員工則屬相對無效率。 2.署立醫院之醫療品質與經營績效的服務量及財務呈顯著正相關。醫院規模愈大及平均住院日愈短，醫院的服務量與財務指標就愈高。 3.署立醫院之結構面醫療品質與經營績效的效率呈顯著正相關，但與生產力呈顯著負相關。亦即署立醫院規模越大，醫院效率越高，但其醫師生產力則下降。 4.經複迴歸分析得知，署立醫院的經營績效主要受結構面的品質指標影響，而非過程與結果面。 根據以上結果，本研究建議衛生主管機關應平均分配資源，致力縮短南北城鄉醫療水準的差異。並且設立公正的第三者，提供民眾各醫院全面而客觀的品質指標，減少醫療體系中資訊不對稱的情形，以使病患就醫權益得到保障。而署立醫院管理者如欲提昇競爭力及效率，可考慮從精簡醫師以外的人力著手。整體而言，本研究認為醫療品質會影響醫院的經營績效。因此，建議各醫院經營者，應更加重視醫療品質的提昇，選定專人負責品質監控，建立一套標準系統，以取得有利於本身的競爭優勢。

Since National Health Insurance in Taiwan began in 1995, to reduce cost has become the common means of pursuing performance owing to the rising fee of health care and difficulty in hospital management. However, the medical service system faces an important issue in fear of sacrificing quality of health care and influencing operating performance with cost constraint. Many studies point out there are some relationships between quality of health care and operating performance, but they deserve further studies. The Hospitals of the Department of Health (DOH) is the largest public hospital system in Taiwan, so it is necessary to analyze its own data to realize the relationship between quality and performance. This study made a research and discussion by collecting the quality and performance indicators of 20 larger hospitals of DOH in 2004. One is for the basis of making relevant policies by DOH; the other is for the strategic adjustment of the hospital management. Findings of this study are presented as follows: 1.The Hospitals of DOH pays much attention to its northern subsidiaries than the southern in hardwares as well as softwares. By comparing with the hospitals in Taipei Medical Region, the doctor productivity of the Hospitals of DOH is relatively efficient and the employee productivity is relatively inefficient. 2.The quality of health care and the service volume and finance of the operating performance show a positive relationship in the hospitals of DOH. The larger a hospital scale and the shorter average hospitalization duration, the higher the service volume and financial indicators of a hospital. 3.The structural quality of health care and the efficiency of the operating performance show a positive relationship in the hospitals of DOH, but a negative one with the productivity. 4.By the results of multiple regression analysis, the operating performance of the Hospitals of DOH is chiefly influenced by structural quality indicators, not process-outcome indicators. Based on the above findings, this study suggests DOH to allocate resources evenly, devote itself to shorten the discrepancy of medical care between different areas, provide people general and objective quality indicators about hospitals by setting up a fair third party, reduce information imbalance in health care system, and protect patients’ medical privilege. The Hospitals of DOH can raise competitiveness and efficiency by simplifying manpower other than doctors. In conclusion, this study proposes that quality of health care can influence operating performance of hospitals. Therefore, it is recommended that the hospital managers should put more emphasis on the promotion of medical care, arrange a specific unit in charge of quality monitor, built up a standard system to earn a competitive advantage.