全民健保實施前後醫院財務面經營績效之研究

A Study of Operating Performance of Hospitals after the Implementation of National Health Insurance

台灣地區健康照護體系近年來在政府大力推動整合下，八十四年實施全民健康保險，支付制度由回溯性之論量計酬至前瞻性支付制度再至總額預算，嚴重衝擊台灣地區健康照護產業。據衛生署統計資料顯示民國八十三年至九十四年間醫療機構之醫院由823家減少至556家，衰退率為32.4%。健康照護相關產業經營管理者在面臨醫療費用不斷上漲，加上消費者意識抬頭及同業競爭的壓力之下，如何降低成本及促使資源合理分配，提昇經營績效，實是目前極待解決的問題。醫療保健服務對民眾健康的影響甚鉅，而且產業的性質相當特殊，在世界各國均為政府高度介入的產業，雖然在組織理論中，常被定義為服務業中的非營利組織，但在經營上深受政府的醫療政策及相關法令的影響，雖不像一般企業以營利為首要目標，但亦應重視經營績效，以提昇服務品質。本研究向行政院主計處購買民國八十五年及九十年「台閩地區工商及服務業普查」次級資料庫，再篩選醫院之內容，共有1,402筆為研究樣本。本研究採用SPSS10.0進行資料統計分析，以描述性統計分析基本資料的個數、百分比、資產共同比、比率分析的總數、平均值、極大值、極小值；以卡方檢定分析全民健保實施前後與組織特性之相關性；以獨立樣本T檢定分析全民健保實施前後財務績效、財務比率之差異。結果發現，在獲利能力、資產共同比、資產運用效能、成本控制與員工生產力之指標中，發現固定資產面實施前比率較低，流動資產比率較高，然而在資產運用中流動資產之週轉率，在健保實施後呈現較高，固定資產呈現較低；健保實施後獲利能力皆下降近一半，且成本增加之比率高於收入增加之比率；健保實施後呈現每人用人費用增加，然而其生產力亦提高，在全民健保實施前後醫院組織特性之分析中發現，全民健保的實施對小醫院影響較大。

With the Government's full support and consolidation, the health care system in the territory of Taiwan has implemented National Health Insurance since 1995. The payment system transformed from ”fee-for-service” to ”prospective payment system” and finally to ”global budgets”, and thereby made a material impact to the health care industry in the territory of Taiwan. According to the statistics of the Department of Health, the number of hospitals has declined from 823 in 1994 to 556 in 2005, with a declination rate of 32.4%. The medical treatments and health care services have a material influence to the public's health. Meanwhile, due to the particular feature of the industry, it is intervened by governments throughout the world. Though in terms of the organizational theory, it is often defined as a non-profit-making organization in the business of service and its operation is subject to the government's medical treatment policies and relevant laws. Therefore, notwithstanding that such services do not aim at making a profit as its first priority, they still should pay attention to the performance to upgrade the quality of service. This study purchased the database for ”Report on 1996 and 2001 Industry, Commerce and Service Census Taiwan-Fukien Area, the Republic of China from the Directorate-General of Budget, Accounting and Statistics of the Executive Yuan. For the selection of the contents of hospitals, we obtained a total of 1,402 research samples. Using SPSS10.0 data analysis. The study result shows that in terms of such indexes as profitability, consolidated asset data, performance of application of assets, cost control and productivity, the ratio of fixed assets appears to be lower prior to the implementation of the National Health Insurance, while the ratio of current assets appears to be higher. Nevertheless, the turnover ratio of current assets appears to be higher upon the implementation of National Health Insurance, while the turnover ratio of fixed assets appears to be lower. Further, the profitability declined by approximately 50% after the implementation of National Health Insurance, and the ratio of increase in cost was higher than that of increase in income. Due to the implementation of National Health Insurance, it appears that each employee's expenses were increased, and their productivity was increased relatively. According to the study on the characteristics of hospitals before and after the implementation of National Health Insurance, the implementation of National Health Insurance produced a more significant impact on small-sized hospitals.