運用資料包絡分析法探討署立醫院、縣市立醫院及其委託經營醫院經營效率

Using Data Envelopment Analysis to Examine the Managerial Efficiency of National Public Hospitals, City/County Hospitals and Other Contracted Hospitals

研究目的： 民國84年3月我國實施全民健康保險計畫以來，醫療環境快速變遷，醫院經營面臨各種挑戰。不同權屬別醫院經營效率上有相當差異，而公立醫院受制法令不如私立醫院有較佳的市場反應機制，本研究希望透過資料包絡分析法，以署立、縣市立及其委外經營醫院為例，分析不同權屬別醫院經營效率及可能之影響因素，以提供管理者及主管機關相關政策制定建議。研究方法： 本研究運用資料包絡分析法(Data Envelopment Analysis, DEA)，針對衛生署署立醫院、直轄市以及縣與省轄市立醫院、及其委外經營醫院共42家醫院為研究對象，利用行政院衛生署九十年度醫療機構現況及醫療服務量統計摘要，衡量其經營效率。研究結果： 分析結果顯示，整體相對經營效率依次為：委外經營醫院最佳、其次為縣市立醫院、最差的則是署立醫院，其中委外經營醫院八家中有三家相對效率值為1，且相對效率值大部分在83%以上，其次在縣市立醫院部分，除某台北市立醫院及某高雄市立醫院以外，大部分醫院相對效率值均在80%以上，在署立醫院方面，相較於縣市立醫院及委外經營醫院表現是較差的，其中又以中部某署立醫院相對效率為43.54%是整體表現最差者。結論： 本研究發現缺乏效率之醫院出現行政人員過多現象，醫院管理者可考量將績效制度結合薪資結構，藉由績效制度及薪資結構的改變產生組織變革，進而提升經營效率。此外，醫院主管亦可透過資料包絡分析法，找出相對經營效率較差之個別單位，針對產出效率低落者，透過自費業務開拓或外包經營方式，提升醫院總體經營效率。

Purpose: The medical environment has changed rapidly and hospitals have started to confront various management practices since the National Health Insurance Program was implemented in March 1995. Because hospitals are under different ownership, their managerial efficiency will vary. Also, it is quite obvious that the market response mechanism of public hospitals is no better than that of private hospitals due to the restriction caused by government regulations. The purpose of this research is to identify the possible factors that influence the managerial efficiency in different hospitals (national public hospitals, city/county hospitals and other contracted hospitals) by using Data Envelopment Analysis, and provide suggestions to the responsible government agency and appropriate level of administration for formulating future regulations. Method: By analyzing the Statistical Abstract of Medical Care Institution’s Status and Hospital’ s Utilization in 2001 via Data Envelopment Analysis, the managerial efficiency of 42 hospitals (including National Public Hospitals owned by the Department of Health, City/County hospitals owned by directly-governed cities and provincial cities, and other contracted hospitals) was evaluated. Result: The analysis result indicates that the contracted hospitals have the best managerial efficiency, followed by city/county hospitals, with the national public hospitals having the worst overall managerial efficiency. The relative efficiency index of three contracted hospitals among all eight sampled contracted hospitals is one, while the average relative efficiency is higher than 83%. For most city/county hospitals, except two city hospitals (one in Taipei, the other in Kaohsiung), the average relative efficiency is above 80%. The national public hospitals have the worst performance when compared to city/county hospitals and contracted hospitals. The relative efficiency of a national public hospital in Central Taiwan is 43.54%, the worst among all hospitals. Conclusion: What has been observed in this research is that the hospitals lacking in efficiency always have an excess of administrative staff. For these hospitals, employee salary disbursement could be structured so that it is dependent upon performance assessments, in order to bring about the needed organizational change and expedite managerial efficiency. Furthermore, hospital supervisors may use DAE to analyze which units have the lowest managerial efficiency, and request that the units improve at their own expense, or be outsourced.