醫院因應總額預算支付制度之適應策略評選——以新竹市醫院為例

Selection of Adaptation Strategy for Hospitals on the Global Budget System - A Case Study of Hospitals in Hsinchu City

總額預算支付制度的實施，對醫院收入衝擊極大。醫院會採取因應措施以減少支出或增加收入。然而，醫院在選擇措施前，須先確定本身的策略目標，正確評選適合醫院之策略，才能避免失敗風險。本文利用平衡計分卡（balanced scorecard; BSC）發展評估模式，並採用網路層級分析法（analytic network process; ANP）來幫助醫院管理者評選適合的因應策略。本文以新竹市醫院為例之研究結果顯示，醫院評估指標之重要性依序為，財務指標（0.27462）、顧客指標（0.26121）、學習與成長指標（0.24940）、內部流程指標（0.21477）。在財務指標下其最重視眾院服務量（0.20565），由於健保局增加住院總額預算，因此，醫院相對會注重醫院之住院服務量，已獲得更高的收入，其次為人事費用佔營收比（0.18447）。在決策方案中，降低人事成本（0.21988）是醫院決策者最佳的選擇，也就是說，醫院傾向降低成本以因應總額預算支付制度的實施。本文建議醫院再採取任何策略時，不應完全以利益為優先，應適度維持醫療品質，才可使醫院永續經營。另外，本文並比較三家不同型態及屬性之個案醫院，其評選策略節果差異。

Because of the global budget system cuts of by the Taiwan National Health Insurance (TNHI) program, hospitals in Taiwan face reduced incomes. Taiwanese hospitals thus have taken various strategy to reduce costs or increase incomes. However, before selecting a strategy, each hospital must clearly understand their goals and select the most suitable strategy. This study describes the ongoing development of an evaluation model with BSC criteria, additionally, this study applies Analytic Network Process (ANP) to offer a feasible assessment method, and help the hospital can choice new strategy correctly. Study results reveal that the criteria considered most important was “Financial performance” (0.27462), “Customer perspectives” (0.26121), “Learning and growth” (0.24940), “Internal business processes” (0.21477); the most important sub-criteria under financial performance was, “Number of inpatient services”(0.20565), because national health insurance increases the budget of inpatient in hospital; thus the related hospitals will be willing to pay attention to the number of inpatient services to obtain the higher income, next is “Ratio of personnel expenses to hospital revenue” (0.18447). And the best alternative was “Decrease costs” (0.21988), hospital tends to adopt cost reduction strategy simply to be in accordance with global budget system. This study suggests the hospitals should make medical quality improvement atop priority for a long-term business operation. “How to increase inpatient numbers should be the second consideration. Additionally, this study compare the optimal strategy of three case hospitals to know how different between three case hospitals. Results of this study, also indicate the policies that administrator drafted for the hospital. Because of the global budget system cuts of by the Taiwan National Health Insurance (TNHI) program, hospitals in Taiwan face reduced incomes. Taiwanese hospitals thus have taken various strategy to reduce costs or increase incomes. However, before selecting a strategy, each hospital must clearly understand their goals and select the most suitable strategy. This study describes the ongoing development of an evaluation model with BSC criteria, additionally, this study applies Analytic Network Process (ANP) to offer a feasible assessment method, and help the hospital can choice new strategy correctly. Study results reveal that the criteria considered most important was “Financial performance” (0.27462), “Customer perspectives” (0.26121), “Learning and growth” (0.24940), “Internal business processes” (0.21477); the most important sub-criteria under financial performance was, “Number of inpatient services”(0.20565), because national health insurance increases the budget of inpatient in hospital; thus the related hospitals will be willing to pay attention to the number of inpatient services to obtain the higher income, next is “Ratio of personnel expenses to hospital revenue” (0.18447). And the best alternative was “Decrease costs” (0.21988), hospital tends to adopt cost reduction strategy simply to be in accordance with global budget system. This study suggests the hospitals should make medical quality improvement atop priority for a long-term business operation. “How to increase inpatient numbers should be the second consideration. Additionally, this study compare the optimal strategy of three case hospitals to know how different between three case hospitals. Results of this study, also indicate the policies that administrator drafted for the hospital.