新北市居家服務機構之經營效率分析——資料包絡分析法之運用

Technical Efficiency of Home Care Facilities in New Taipei City–Application of Data Envelope Analysis

隨著臺灣人口不斷老化，長照需求日益上升，為滿足未來龐大的長照需求，不但需要更多、更訓練有素的長照人力投入之外，更應提升效率以維持長照服務體系的永續性。因此，本文研究新北市政府衛生局的特約長照機構，以DEA進行機構經營效率的分析。本研究採橫斷性研究，於2022年4月，納入177間新北市居家服務機構作為研究樣本，以機構投入人力資源與服務產出，透過投入導向DEA的BCC模型來分析機構效率。結果顯示整體平均效率值、純粹技術效率值與規模效率值分別為0.386、0.519、0.667，整體效率低於過去研究。其中，有15間為固定規模報酬，規模報酬遞減的有37間，其餘的125間機構為規模報酬遞增，表示大多數居家服務機構資源未得到適當的利用。本研究透過Tobit迴歸進一步分析效率低下原因，發現在控制其他相關因素下，在機構規模越大、未聘居家服務督導員、長照服務人員平均服務年資越長、兼職比率越低、中度失能個案比率越高之機構，其效率值顯著較高。本研究建議政府應藉標竿學習活動，增進機構對長照2.0及新北市管理制度之了解、改善資源配置，並透過留任機制增加居家服務機構人員年資，以及提升全職長照人員數，以提升整體機構服務量能與效率。未來研究建議可進行跨縣市比較及進一步做長期追蹤研究。

As Taiwan's population ages, society's demand for long-term care is increasing. Meeting the huge future demand for long-term care will require not only an increasing number of well-trained workforces, but also increased the efficiency in institutional operations to further maintain the sustainability of long-term care systems. Therefore, this study selected facilities in New Taipei City as the research object to analyze the operating efficiency of the facilities. This cross-sectional study analyzed the efficiency of the 177 home care facilities in New Taipei City in April 2022, through the input-oriented DEA BCC model, which is based on the organization's input of human resources and the output of different services. The results show that the overall efficiency is lower than previous studies. The average efficiency score is 0.386 for overall efficiency, 0.519 for pure technical efficiency, and 0.667 for scale efficiency. Among the 177 facilities, only 15 facilities reached the CRS standard, 37 facilities were at the DRS level, and the remaining 125 institutions were all IRS, indicating that most institutional resources were not used reasonably. This study analyzed explanatory factors by Tobit regression. Results indicated that, the facilities with larger scale, the facilities without home care services supervision, the higher the senior staff in the facility, the lower ratio of part-time staff and the higher ratio of CMS4-6 were significantly associated with a high efficiency score. This study suggests that the government should use benchmarking learning activities to enhance facilities’ understanding of the Long-term Care 2.0 policy and New Taipei City’s management system, improve resource allocation, increase the seniority of home care facility staff through the retention system, and increase the number of full-time long-term care staffs to enhance the overall agency service efficiency and capacity. Future studies can further compare the efficiency of different cities and conduct the long-term follow-up studies.