市場結構與組織特性對醫院營運效率之影響

The Effect of Market Structure and Organizational Characteristics on Hospital Operating Efficiency

本研究旨在探討臺灣綜合教學醫院住診技術效率，與其組織特性及市場特性的關係。採用1995 年衛生署「公私立醫院服務量統計暨現況調查」的101 家綜合教學醫院資料，選取總床數、加護病床數、醫師數、及護理人員數等為投入項目，以及總住院人日、住院手術人次等為產出項目。經資料包絡分析關鍵因素效率模型測量其技術效率，並採複迴歸分析，探討醫院技術效率與組織特性、市場特性的關係。臺灣綜合教學醫院的關鍵因素效率值，平均為0.702±0.207，全距為0.263 到1.520。複迴歸分析顯示：區域級醫院、私立醫院，及住院手術率高等的醫院，其效率值較高，而市場規模及賀芬達指標，與醫院技術效率無統計相關，但大型醫院家數則顯示：中度競爭對醫院效率有顯著正向影響，高度競爭則反而降低醫院效率。因此，對教學醫院的住診技術效率而言，市場結構與組織特性均是重要的決定因素。

In most countries hospitals consume the largest portion of a nation’s health care resources, and hospital efficiency has therefore been an important issue in the health care system. Hospital executives and policy-makers concerned the determinants of hospital operating efficiency in order to improve hospital performance. Many studies had showed that hospital efficiency was significantly correlated with organizational characteristics. Nevertheless, the relationships between hospital efficiency and market determinants were still unclear. One of the possible reasons was that the determination of local hospital market did not properly reflect the exchange relationships of health services, and then degree of competition could not be properly measured. This study intends to investigate the relationship between the inpatient technical efficiency of general teaching hospitals and market determinants. Data of 101 hospitals accredited as general teaching hospitals were obtained from the Annual National Hospital Survey of 1995 in Taiwan. The vital factor efficiency scores calculated through the data envelopment analysis (DEA) technique were employed as the measure of the technical efficiency of hospitals. The input variables in DEA consisted of total staffed beds, ICU beds, the number of doctors and number of nurses; the output variables included the total inpatient days and the number of surgical operations. Then multiple regression analyses were conducted to explore the relationships between hospital technical efficiency and organizational and market characteristics. While accredited status, ownership, and surgical operation rate were the organizational variables, the population size, Herfindale index, and the number of large hospitals accredited as regional hospitals or medical centers were the market variables which were measured based on local markets determined by a patient origin method. The result showed that on average the vital factor efficiency score of general teaching hospital in Taiwan was 0.702 ± 0.207, with a range from 0.263 to 1.520. Results from multiple regression analyses indicated that 47.2% of the variation in hospital efficiency could be explained by organizational and market variables. After controlling market variables, higher technical efficiency was associated with regional hospitals, private hospitals, and hospitals with higher surgical operation rate. On the other hand, after controlling organizational variables, hospital technical efficiency was not significantly associated with the population size and Herfindahl index of a local market. However, it is interesting to observe that hospital efficiency increases fist as the number of large hospital increases in a local market. It then decreases as the number of large hospitals in a local market continuously increases. The conclusion of this study is that the organizational and market characteristics were all important in determining the technical efficiency of general teaching hospitals in Taiwan. Relationship between hospital technical efficiency and the degree of competition measured in this study may not be simply linear. The information should provide valuable insight for policy makers when policies related to the improvement of hospital efficiency are formulated. Hospital management can also benefit for their expansion or contraction strategies.