整併策略對於醫療產業經營績效的影響：以臺北市立聯合醫院為例

The Impact of Merge Strategy on Medical Industry Performance: A Case Study on Taipei City Hospital

近年來，醫療服務產業貼近資本化主義市場，醫院彼此間競爭日趨激烈，為了強化其市場競爭力，逐漸朝往規模化經營為目標。由於公立院所在經營上有法規限制，組織無法輕易依照市場機制調整，導致部分公立醫院的競爭力逐年衰退，因此面臨著「維持現狀」或「轉型重生」之經營轉折點；有鑑於此，陸續有許多公立醫院提出整併策略以提升競爭力，臺北市立聯合醫院便是一個顯明的例子，但整併至今能否達到預定成效仍是未定之數。本研究藉由資料包絡分析法與Malmquist生產力指數進行績效評估，比較整併後之經營績效是否有所改善，且相較於同級區域醫院是否具備競爭優勢。研究結果指出整併策略未能立即提升經營績效，主要原因係各分院原本是獨立組織，各分院間的管理風格差異甚大，而合併初期以「部科經營」方式進行管理，部科主任與院區院長之權責區分不易；但管理政策調整「院區經營」後，經營績效逐漸提升。另一方面，藉由事前的溝通協調來降低不確定性，能有效提升員工對組織的認同，同時提升經營規模，皆能有效改善經營績效。因此，整併非是提升經營績效的唯一方法，如何讓不同的組織型態有效磨合，才是提升績效的關鍵因素。本研究結果可作為醫療院所採行整併策略以提升經營績效的重要參考。 Due to the capitalistic market, the competition for medical industry becomes sharp and the large–scaled private-owned hospital is seen as a solution to enhance competition. The legal regulation limits public hospitals to expand arbitrarily to meet market demand, and thus they gradually lose relative competitiveness and face financial loss. In order to reinforce competition power in the market, many public hospitals are forced to select the optimal strategy between reorganization and maintenance of current status. Merger is believed an effective tool to improve the performance of hospitals among reorganization strategies. Taipei City Government follows the merge strategy and merges 10 small hospitals into Taipei City Hospital (TCH) that is taken as an example to analyze the performance improvement of mergers in this paper. Data Envelopment Analysis (DEA) is adopted to evaluate the efficiency of each branch hospital of TCH and the overall performance of TCH by using Malmquist production index. The results indicate that the merger strategy cannot improve the performance immediately because the organization structures and management style vary in a large scale among branch hospitals. The financial performance is evaluated based on the department of each branch at the early stage after the merger and now is changed to be based on the branch. The analysis reveals that the financial performance is not found to have significant improvement at the early stage but is improved currently. The performance improvement may attribute to the consistency of management responsibility and the elimination of uncertainty by enhancing coordination and organizational commitment. This paper suggests that merger is not a panacea, but requires the appropriate integration of management style.

Due to the capitalistic market, the competition for medical industry becomes sharp and the large–scaled private-owned hospital is seen as a solution to enhance competition. The legal regulation limits public hospitals to expand arbitrarily to meet market demand, and thus they gradually lose relative competitiveness and face financial loss. In order to reinforce competition power in the market, many public hospitals are forced to select the optimal strategy between reorganization and maintenance of current status. Merger is believed an effective tool to improve the performance of hospitals among reorganization strategies. Taipei City Government follows the merge strategy and merges 10 small hospitals into Taipei City Hospital (TCH) that is taken as an example to analyze the performance improvement of mergers in this paper. Data Envelopment Analysis (DEA) is adopted to evaluate the efficiency of each branch hospital of TCH and the overall performance of TCH by using Malmquist production index. The results indicate that the merger strategy cannot improve the performance immediately because the organization structures and management style vary in a large scale among branch hospitals. The financial performance is evaluated based on the department of each branch at the early stage after the merger and now is changed to be based on the branch. The analysis reveals that the financial performance is not found to have significant improvement at the early stage but is improved currently. The performance improvement may attribute to the consistency of management responsibility and the elimination of uncertainty by enhancing coordination and organizational commitment. This paper suggests that merger is not a panacea, but requires the appropriate integration of management style.