私立醫院醫療社團法人化之探討

Abstract

民國九十三年醫療法新增醫療社團法人制度，提供私立醫療機構轉型為醫療社團法人契機，能解決原先私人組織不具法人格、無法永續經營等問題，從法規面觀之，此制度似提供私立醫院一條解決其現行問題的道路，然為何至今提出申請改制之醫院不如預期?是否醫療社團法人相關規範存有問題、降低私立醫院轉型之意願？又或私立醫院考量耗費巨大轉型成本，縱轉型成法人後，又會面臨何種問題或經營上困境，而多選擇採取觀望態度？ 本研究以國內轉型成功並以新制運行近一年之某醫療社團法人為研究對象，採用個案研究法，以其改制經驗為核心，就其醫院原有背景、組成分子等因素，探討其改制之決策原因、過程、所遇問題及解決方式，並揭露其運作一年之實務經驗。試圖透過描繪組織的發展以及決策時間點的時空背景，探究其過往的組織型態為何、考量轉型成醫療社團法人之原因與過程、困難為何，提供其他欲轉型之私立醫院改制時之參考。 透過個案研究訪談後發現，個案醫院轉型時因尚無前例，確實面臨諸多程序、及立法不周延引生之問題，導致其轉型時程延長；而轉型一年中，也影響其組織型態變革、經營者醫療糾紛風險降低、募集資金來源擴大，加上現行法對外投資有明確規範，醫院可透過多角化經營及適度的架構規劃，有效降低租稅負擔，並考量將原先合作診所納入法人體系，同收永續經營之利，其更能募集資金擴大經營規模，有利其醫療資源整合。此外，本研究針對現行法疑義處進行討論，分析醫療社團法人是否具營利性、可否發行股票上市、排除法人成為社員是否妥適等問題。最後並佐以美國營利性醫院長年積累之實務經驗與問題，提出營利性醫院適度發展、維持高效率與優質服務、及醫療機構資本市場籌資多元化之建議。針對其他欲轉型之私立醫院，建議其妥善規劃改制時董事會之組成、多元化其甄選及留任員工方式；而政府亦應儘速制訂相關配套規則、加強部會間協調。願能透過本研究，對我國初期實行醫療社團法人制度提供啟示與建議，期盼國內具營利色彩之醫療社團法人能謹記醫療為公益事業之精神，繼續努力於提昇醫療品質與病人權益，營造醫病雙贏之新局。

In 2004, the Medical Care Act added medical corporation aggregate system that offered opportunities for private medical institutes to transform into medical corporation aggregates. The system seemed to be the solution for private hospitals to solve their current problems. However, why the hospitals that applied for transformation have not reached the expectation yet? Is it because there are problems existing in the related regulations that lower the willingness for private hospitals to be transformed? Or is it because private hospitals are considering what issues or managerial difficulties they will face, so they are still estimating the risks? The research is based on some Medical Corporation Aggregate which has been operated for almost one year and is the successful example of the transformation. The case study focused on its transformation experiences while examining its reasons to decide the transformation and the process, problems, and solutions during the transformation in regard to the hospital’s background, partnerships, and other factors. The research will also reveal its practical experiences during the one-year operation. The study tries to visualize the development of the organization and the process of decision making. Then it will research into the hospital’s structure in the past and consider the reasons, process, and difficulties during its transformation to a medical corporation aggregate. The results of the research can serve as the reference for other private hospitals that plan to do so. After interviewing with the research target, it was found that due to a lack of previous examples of hospital transformation, there are various problems concerning the procedure and the completeness of legislation, which resulted in the elongation of transformation. In the coming year after the transformation, the hospital has been influenced to reform its organization structure, but the risks in medical argument have been reduced, the capital resources have been expanded, and the number of investors who planned to buy its shares has thus increased. The current laws have definite regulations to foreign investment that a hospital can effectively lower the rents through its multi-faceted management and appropriate structural planning. It can also consider integrating former partner private clinics into the aggregate for sustainable profits. Lastly, the research also conducts discussion and amendment suggestions to dubious explanations existing in current regulations. It exemplifies the current development status of for-profit hospitals in the U.S. and suggests comments to the execution of medical corporation aggregate system based on the country’s practical experiences and problems. This should prevent for-profit hospitals from sacrificing the rights of consumers and any behaviors that induce them to consume for the purpose of making profits from them. The research hopes that for-profit medical corporation aggregates in Taiwan can bear in mind that medical care is a public welfare establishment and should keep contributing their efforts in improving the medical care quality and the rights of patients for a win-win situation between the two sides.