員山榮民醫院多面向改善之研究

Abstract

台灣的醫療市場，自從全民健保實施後，已形成單一買方市場，每個醫院的營運也深受支付制度的影響。隨著健保財務赤字的擴大，醫院的營運也愈顯困難。 本院為公立的榮民醫院，過去一直肩負政府照顧榮民及平衡城鄉差距的政策任務；全民健保實施後，榮民醫院不再是榮民的唯一選擇，許多醫療機構也用各種優惠來爭取此一客群，造成不少榮患的流失。然而員山榮民醫院就如同其他多數榮民醫院一樣，地處偏遠，地區人口又少，欠缺醫療可近性之誘因。近年來政府財政惡化，公立醫院民營化、去任務化之音喧囂塵上；因此，如何做好管理、爭取客源、提昇營運績效就成為本院能否生存的重要議題了。 任職員山榮民醫院近五年期間，除了面對我國醫療環境生態的劇變，也必須面臨高同質性的署立宜蘭醫院絕地逢生後的競爭。此間筆者運用在陽明大學醫務管理研究所以及台灣大學管理學院商學所所習之學理，經營管理員山榮民醫院，成效頗佳，除了深獲地方鄉親的肯定，也是退輔會所屬醫療機構中轉型較為成功的醫院之一。因此，筆者希望藉這個回顧性的個案研究來探討其關鍵成功因素（key success factors）。

本研究結果，發現員山榮民醫院轉型成功的關鍵因素和結論是： 1. 組織改造，「由下而上」並於最短時間內完成全院問卷，取得全體共識， 設定醫院願景；目標達成，「由上而下」，執行力力求貫徹落實。 2. 環境分析時，除了以五力分析瞭解競爭優勢，醫院的競合賽局中也可以成為互補者（第六力）在市場上共存共榮。 3. 單一買方的醫療市場中，配合支付制度調整經營型態和策略，是醫院存續的唯一選擇。 4. 配合既有競爭優勢、積極開發潛在市場，能有效發揮營運績效的槓桿作用。 5. 當醫療市場屬買方市場，非價格競爭環境時，以改善及提昇品質是創造競爭優勢的最佳策略。 除了以上所述，本研究也發現公立醫療機構，未來要賡續為百姓服務，除了要有明確定位外，應該再加強管理會計的技巧概念及人才培育；而組織的設計也應隨著環境快速變遷而有「動態」的設計觀念。

The health market has become a single buyer market after the implementation of the National Health Insurance(N.H.I). The operation performance has also been impacted by the expenditure system. The more the financial red of N.H.I., the more the difficult of the revenue of hospital. Our hospital is a public veterans hospital(V.H.). Previously, it still performed the political mission which included to take the responsibility of veterans medical care and to make the balance between urban and rural medical resources. After the implementation of N.H.I., the V.H. became not to be absolutely selected by the veterans. Many medical organization releases some incentives to get this consumer group, it make the V.H lost lots old consumer. As the major of other V.H., Yuan-Shan veterans hospital (Y.S.V.H.) located at a rural, lower population area, it is short of accessibility. In the recent years, the govern financial becomes worse. And the deprivation & deobligation is more concerned. So, It becomes an important issue in our hospital that how to make a good management, how to attract and capture the consumer & how to increase the revenue of operation. During five years working in Y.S.V.H., the writer faced both the mass change of our national environment and the competition of I-Lan Hospital’s revival(highly homogeneous hospital). What I learned from the Institute of Hospital & Health Care Administration of NYMU and the Department and Graduate Institute of Business Administration of NTU have been performed to run Y.S.V.H.. The outcome is quiet good that we received the affirmation of local people and also the better successful transformation among hospitals of V.A.C.. Therefore, the writer would like to discuss the key success factors of our hospital through this review of case study. The main key points and conclusion of successful transform of Y.S.V.H. has been found as following: 1. Organization reform-- bottom up, to finish hospital poll as soon as possible to gain group commitment, to set hospital vision; target achievement—top down, to execute thoroughly. 2. During the environment analysis, except using the Five Forces to analyze the competitive advantage, also the Sixth Force as complements to co-survival in the market. 3. Among the single buyer’s medical market, the only choice for hospital survival is to adjust the strategy and the business model to match the expenditure system. 4. With competitive advantage we already had, to create potential market aggressively, this can also sufficiently develop the operating leverage of performance. 5. When medical market belongs to buyer, no price competition, the best strategy to create competitive advantage is verify and upgrade quality. Except above description, the writer has also found some other important factors for reforming public medical institutes. Besides clear position, they must enforces the managerial accounting and culture the accounting talents. And during the organization design, they need have dynamic opinion to match the rapidly changing environment.