台灣血液透析服務供應商營運成本與財務績效之實證研究

Abstract

本論文主要探討影響台灣血液透析服務供應商營運成本與財務績效的主要因素，全文包含兩個章節。第一章先以台灣某大型連鎖血液透析集團所提供的內部營運資料，來探討影響血液透析成本的因素（成本動因）。研究方法採用複回歸模型，應變數為總醫療變動成本，自變數則強調管理相關的成本動因，同時控制臨床治療項目、病患特性與醫療品質。實證的結果發現，血液透析的醫療成本會受到管理因素的影響，尤其是產能利用率、醫師持股率與透析中心的地理位置等三項。而其它控制變數中的臨床治療項目與病患特性，則跟過去文獻的發現相似，也對成本具有影響。此發現將有助於血液透析集團的經營者釐清什麼是重要的成本動因，得以進行有效的成本管控。同時本研究之結果，也讓透析中心瞭解病患特性的差異，將會影響到經營的利潤。最後，對於醫療與健康保險的決策者（健保局）而言，則該注意在現有的給付制度下，透析中心基於營運成本的考量，難保不會出現挑選病患的可能，因此必須建立適當的監控機制去預防這個問題。 第二章則進一步討論醫療服務品質與血液透析中心財務績效的關連性，藉由此分析掌握在現有健保給付制度下，驅動透析中心獲利的主要品質因素。關於醫療服務品質，本文同時採用主觀（利用問卷取之病患滿意度）與客觀（三項血液檢驗）兩類指標。研究樣本包含492位來自10家透析中心的病患。研究方法採用複回歸分析，除以兩類品質指標為主要之自變數外，同時包含治療項目與病患特性作為控制變數。研究結果發現，只有主觀的病患滿意度與財務績效具有顯著正向關連，而客觀的血液檢驗則與財務績效無關。因此現有給付政策下，透析中心將無誘因去提升客觀品質指標。而對透析集團的經營者來說，持續監控所屬透析心中的病患滿意度，並提供適當的行政支援，為當前管理上的重要課題。此外，在病患滿意度的不同構面中，以對醫師專業能力的滿意最能驅動財務績效，故需視為改善滿意度的最優先項目。

The main purpose of the dissertation is to discuss operation costs and financial performances of dialysis service providers in Taiwan from a management accounting perspective. There are two independent chapters in the study. Chapter 1 (pp. 5-38) analyzes factors influencing dialysis costs (i.e., cost drivers) using administrative data obtained from a large renal clinic chain in Taiwan. We use multiple linear regression analysis to examine factors that influence costs of dialysis. Specifically, the cost under investigation is total variable costs for medical treatments. We examine how cost drivers related to managerial incentives affect medical costs in dialysis by controlling for factors associated with medical treatments, patient characteristics and medical qualities. Our results indicate that treatment costs of dialysis are influenced by managerial factors such as capacity utilization rate, physicians’ shares holding rate, and location of clinics. Consistent with prior literature, cost drivers associated with medical treatments and patient characteristics also affect the medical variable costs. The findings help renal clinics identify areas important to cost control. In addition, our refined cost analysis help clinic better understand profitability resulting from differences in patient profiles. Finally, our findings suggest that health regulators should be cautious about that the dialysis providers may tend to reject costly patients and should establish appropriate monitoring mechanisms accordingly. Chapter 2 (pp. 39-80) investigates the relationship between health service quality and financial performances of dialysis providers (i.e. renal clinics) to help dialysis providers clarify how quality drives profitability under Taiwan’s National Health Insurance. In our analysis, we employ two types of quality measures, i.e., subjective (four factors of patient satisfaction which are collected by questionnaires) and objective (three biochemical examinations) indicators. Data provided by the sample company consist of 492 patients from 10 different clinics. We use the regression analysis to examine how quality factors influence financial performance of the dialysis clinics by also controlling for other relevant variables. Our results indicate that only subjective measures are positively related to profits while objective measures are not. Thus, renal clinics may not have incentives to invest in clinical quality that bears no financial returns. Concerning financial management, the chain company should focus on patient satisfaction supervision and related administrative supports. In particular, satisfaction over the professional ability of physicians is the most critical quality factor relating to profits.