健保資訊對醫院營運策略影響之研究

Abstract

醫院産業自民國八十四年健保開辦，歷經十年至今産生了重大改變。中央健保局爲改善健保財務，先後推出總額制度，自主管理等措施，對醫院產業産生重大衝擊。醫院爲降低營運成本、提高營運績效，管理與策略必須有所突破。而醫院在擬定營運策略時，「産業競爭分析」所需之產業營運資訊（包括競爭者資訊）卻相當缺乏。反而中央健保局掌握醫院百分之八十以上營運資料，而目前該等資訊並未有系統普遍詳盡彙整提供產業界，殊屬可惜。 本研究藉由文獻探討及資料搜集，建立醫院産業營運管理資訊（指標）構面及醫院策略構面。並由醫院營運管理資訊構面，建構出醫院營運管理多維度分析系統，輔以健保實際資料，而產出實際之醫院營運管理資訊，將此系統與資訊進行個案醫院之決策階層的深入訪談與調查，以實證瞭解健保資訊對醫院營運策略之影響。 研究結果發現，本研究建構之「健保資訊對醫院營運策略影響模式」，經實務研究驗證獲得相當之可用性與可靠性。開發設計之「醫院營運管理多維度分析系統」，經醫院決策人員使用，驗證其對營運策略之影響幫助很大。 健保資訊之「醫院結構面」資訊對醫院醫師人力調整之營運策略有重要影響。資訊內容部分則以，病床、醫師配置相關資料最為需要。健保資訊之「醫療利用面」資訊對醫院營運量調整之營運策略有重要影響。其中以經濟規模策略項目影響最為顯著。健保資訊之「醫療品質面」資訊對醫院醫師人力調整、營運量調整之營運策略有影響。對醫院策略影響，除健保資訊（即產業資訊）外，「健保支付制度」之改變，對醫院營運策略有顯著重要影響。

Since the implementation of National Health Insurance from 1995, the hospital industry has been through significant changes for the past ten years till now. To improve NHI financial situation, the Bureau of National Health Insurance introduced a few policies such as Global Budget, Self Management that significantly impacted the hospital industry. The hospitals management and strategy must have some breakthrough to reduce operating costs and enhance operating efficiencies. But when hospitals drafted their operating strategy, the business information from 'Industry competitiveness analysis' (including competitor information) is very weak. Beside, the Bureau of National Health Insurance collected 80% of hospitals operating information and, it’s a pity that such information at present has not been shared with the hospital industry. Based on literature review and data collection, this research created a model (Index) for information and operation management. Combined with an input of healthcare data multi-dimensional analysis system can construct to understand the operation better. Through individual face-to-face investigation at hospital management level, data can be inputted into the analysis system to study the impact of strategy employed in the National Health Insurance. The research of 'The impact of National Health Insurance information to the hospital management strategy' has been proven to be useful and reliable. The 'Hospital management multi-dimensional analysis system' has also been proven helpful for hospital decision-makers in crafting management strategy. The data about how the “Hospital Infrastructure' is shaped plays an important part in helping hospital decision-makers learn to adjust the resource allocation. For example, how the hospital beds and doctor shift time should be arranged. The information of “Medical Uses” in National Health Insurance practically has a significant influence on hospital operating efficiency. It is more obvious in the strategy of making use of scale of economy. The information of “Medical Quality” could hospital help adjust doctor manpower, operating amount and business strategy. In developing the strategy for hospital management (namely industrial information), the 'National Health Insurance Payment System' in addition to the industrial data has also made a significant impact to hospital strategy.