臺灣地區放射治療單位營運效率與影響因素分析

The Impact of Organization Attribution, Location and Technology on Operating Efficiency of Radiotheraph Departments in Taiwan's Major Hospital

本文針對1999~2003 年間台灣各公私立醫院之放射治療單位，利用資料 包絡分析法，進行技術、純技術及規模效率之推估，並進一步以Tobit 迴歸模 型，評估醫院組織屬性（公立、私立、宗教、非宗教）、區位因素（台北市、 北區、中區、東南區）及科技（二D 與三D） 等因素對效率三指標之影響。實 證結果發現： （1 ）在35 個放射治療單位中，僅振興醫學中心、台中榮民總醫 院及澄清中港分院，達到最佳效率（效率三指標皆為1 ） ，而為標竿單位 （Benchmark） ；換言之，其他32 個營運單位，在產出組合、資源配置與生產 規模上，尚有改善之空間。（2 ）在組織屬性方面，我們發現營運效率之排 序，依序為公立醫院、非宗教型私立醫院、宗教型私立醫院；此可能肇因於 放射治療單位之病人，大多屬於癌症就醫者，在考量醫療風險與品質下，大 多會選擇醫療資源較多之公立醫院；反觀宗教型醫院，接納相對多之癌末病 患而需要投入更多醫療資源，這種非營利機構之經營管理，必須在效率上有 所犧牲。（3 ）在區位因素方面，本文發現中區及北區醫療院所之營運效率， 相對高於北市及東南區；顯示醫療資源最豐沛之台北市，其資源使用效率相 較於其他地區，存在較大之改善空間。（4 ）在科技因素方面，顯示採行三D 之新技術，在純技術效率方面反而顯著低於二D 之舊式療程；說明放射治療 單位所引進之新技術'在現階段尚未成熟而需要其他硬體設備之搭配。

Since most of the radiotherapy equipments in Taiwan are imported, whether these highly sophisticated and expensive equipments are employed efficiently or not has become an important issue to the hospital authorities. The aim of this study is to evaluate the operating efficiencies of the radiotherapy department in Taiwan s major hospitals, and figure out the factors (organization, location and technology) which reduce operating efficiencies.Using the data from 1999 to 2003 provided by the Department of Health, this study employs Data Envelopment Analysis (DEA) approach to evaluate technical efficiencies of thirty-five radiotherapy department in Taiwan, and utilizes Tobit regression model to analyze the factors that have negative impacts on operating efficiencies. The results indicate the following: (1) The average technical efficiency of the sample department is 0.562, implying there is 44% of capacity remains unused. (2) The benchmark units are Cheng Hsin Rehabilitation Medical Center, Taichung Veterans General Hospital, and Chung Kang Branch of Chen Ching Hospital. (3) In organization attribution, we find the sequencing of operating efficiency is the public, private non-religionary, and private religionary hospital. (4) The Radiotherapy departments in Taipei city, on average, have lower technical efficiencies than geographic location. (5) Technological factor shows the pure technical efficiency of applicate new 3D is significant lower than the traditional 2D technique institutes.