全民健康保險總額預算支付制度對醫院經營績效之影響－－以南部之地區級以上醫院為例

Impact of Global Budget System of National Health Insurance on Hospital Performance－An Analysis of the Hospital of District, Regional, and Medical— Center Level in Southern Taiwan

為有效抑制醫療費用上升，健保局於2002年7月開始實施總額支付制度，此制度實施後對醫療院所帶來的影響眾說紛紜，因此，此制度實施前後各醫院經營績效之比較分析，將有助於瞭解制度實施後對臺灣的醫療環境所帶來的影響。本研究針對南部9縣巿166家地區層級以上的醫院，同時採用量性及質性研究方法來進行分析。量化研究部分是蒐集各醫院於制度實施前後各三年之健保申報資料加以比較，質性研究部分係採用深度訪談法，分別從醫院經營者及健保政策執行者的觀點來分析此制度對醫院績效的影響。量化研究的結果顯示制度實施後：(1)醫院住院收入及總收入有顯著性增加；(2)醫學中心較其他層級醫院在門診收入有明顯減少；(3)醫學中心與區域醫院較地區醫院的住院收入方面明顯增加；(4)總收入方面則是以區域醫院增加最多、地區醫院最少；(5)考量醫師數與病床數的投入，醫院的每位醫師與每病床的住院收入皆有顯著性的增加。而質性研究結果顯示受訪者對此制度實施的觀點會因為其所扮演的角色而會有認知的差異，且量性與質性的研究結果比較也有差異。

In order to constrain expenditures for health care from rising, Bureau of National Health Insurance (BNHI) put GBS into practice in July 2002. However, it is worth studying its impact on hospital performance after actualization. This research is to compare hospital performance and its influence in Taiwan before and after implementation of GBS so as to provide reference to the governmental agencies when making policy concerning GBS. This research has analyzed performance of 166 district hospitals in 9 counties in Southern Taiwan with quantitative and qualitative research. Quantitative research is to collect health insurance data of hospitals in three years before and after implementation of GBS for analysis, while qualitative research is to apply depth interview to analyzing impact of GBS on hospital performance on basis of viewpoints of hospital administrator and health insurance policy executor. Results of Quantitative research are as follows: 1. incomes have increased remarkably; 2. out-patient incomes of the medical center have decreased sharply than other hospitals; 3. in-patient incomes of the medical center and the regional hospital have increased sharply than district hospitals; 4. as for total income, the regional hospital ranked the top, while district hospital had the least increase; 5. the in-patient incomes of per physician and each sickbed have increased remarkably after the system than before. The result of qualitative research can be concluded as follows: The viewpoint on the implementation of GBS is inconsistent between hospital managers and BNHI staffs. There is also difference between the research result of quantitative research and qualitative research.