醫療服務品質與財務績效：台灣血液透析診所的實證分析

Health Service Quality and Financial Performance: Findings from Renal Clinics in Taiwan

本研究以台灣某大型連鎖血液透析集團所提供的內部資料進行實證分析，探討醫療服務品質與財務績效之間的關係。關於醫療服務品質，我們同時採用主觀（病患滿意度）與客觀（血液檢查數據）兩種指標。本研究之樣本來自透析集團所屬的10家診所，共計492位病患。本研究採用回歸分析檢驗影響透析診所財務績效的品質因子，實證結果發現只有主觀品質指標與獲利具有顯著正向關係，而客觀指標則不顯著。對整個連鎖集團的財務績效而言，加強對病患滿意度的要求與提供增加滿意度的支援，將是經營管理的重點。而在各項主觀的病患滿意度中，尤以對醫師專業能力的滿意最為重要。最後對醫療主管機關來說，由於透析診所可能沒有財務誘因去改善客觀醫療品質，健保局必須考慮提高官方透析品質標準或提供適當財務誘因，才能真正保障病患權益。

The purpose of this study is to investigate the relationship between health service quality and financial performance using administrative data from a large renal clinic chain in Taiwan. The analysis helps dialysis providers clarify how quality drives profitability. With respect to quality measures, both subjective (patient satisfaction surveys) and objective measures (biochemical examinations) are employed. Data provided by the sample company consist of 492 patients from 10 different clinics. We use the regression analysis to examine how quality factors influence financial performance of the dialysis clinics by also controlling for other relevant variables. Our results indicate that only subjective measures are positively related to profits while objective measures are not. Thus, renal clinics may not have incentives to invest in clinical quality that bears no financial returns. Concerning financial management, the chain company should focus on patient satisfaction supervision and related administrative supports. In particular, satisfaction over the professional ability of physicians is the most critical quality factor relating to profits. Concerning health policy, health regulators may have to directly adjust the baseline of objective quality or provide better financial incentives to achieve better health outcomes.