請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48198
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 劉順仁(Shuen-Zen Liu) | |
dc.contributor.author | Chia-Ching Cho | en |
dc.contributor.author | 卓佳慶 | zh_TW |
dc.date.accessioned | 2021-06-15T06:48:41Z | - |
dc.date.available | 2021-01-19 | |
dc.date.copyright | 2011-07-06 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-04-14 | |
dc.identifier.citation | 1. Levy JM, Robst J, Ingber MJ. Risk-adjustment system for the Medicare Capitated ESRD Program. Health Care Financ Rev 2006;27: 53-69
2. Fowles JB, Weiner JP, Knutson D. Taking health status into account, when setting capitation rates. J Am Med Assoc 1996;276: 1316-21 3. Van Vliet RC, Van de Ven WP. Capitation payments based on prior hospitalizations. Health Econ 1993;2: 177-88 4. Kurtin P, Nissenson AR. Variations in End-Stage Renal Disease patient outcomes: What we know, what should we know, and how do we find it out? J Am Soc Nephrol 1993;3: 1738-47 5. U.S. Renal Data System. USRDS 2007 Annual data report: atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2007. 6. Ullmann SG. Cost analysis and facility reimbursement in the long-term health care industry. Health Serv Res 1984;19: 83-102 7. Menke T. The effect of chain membership on hospital costs. Health Serv Res 1997;32: 177-96 8. Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34: 346-53 9. Hertenstein JH, Polutnik L, McNair CJ. Capacity cost measures and decisions: Two field studies. J Corp Account Finance 2006;17: 63-78 10. Dranove D, Satterthwaite MA. The industrial organization of health care markets. In Culyer AJ and Newhouse JP (Eds), Handbook of Health Economics (pp. 1093-1139), North Holland: Elsevier Science, 2000. 11. Jensen MC, Meckling WH. Theory of the firm: Managerial behavior, agency costs, and ownership structure. J Finan Econ 1976;3: 305-60 12. Ang JS, Cole RA, Lin, JW. Agency Costs and Ownership Structure. J Finance 2000;55: 81-106 13. Strope SA, Daignault S, Hollingsworth JM, Ye Z, Wei JT, Hollenbeck BK. Physician ownership of Ambulatory Surgery Centers and practice patterns for Urological Surgery: Evidence from the state of Florida. Med Care 2009;47: 403-10 14. Mitchell W, Baum J, BertaW, Banaszak-Holl J, Bowman D. Opportunity and constraint: chain-to-component transfer learning in multiunit chains of U.S. nursing homes, 1991-1997. In Bontis N and Choo CW (Eds.), The Strategic Management of Intellectual Capital and Organizational Knowledge (pp. 555-573), New York: Oxford University Press, 2000. 15. Rogers E. The diffusion of innovation, fourth ed. Free Press, New York, 1995. 16. White H. A Heteroskedasticity-Consistent covariance matrix estimator and a direct test for Heteroscedasticity. Econometrica. 1980;48: 817-38 17. Cheng CT, Hou HP, Chien CW. Factors associated with resource utilization of End Stage Renal Dialysis patients. J Healthc Manag 2005;6: 291-308 18. Knauf F, Aronson PS. ESRD as a window into America's cost crisis in health care. J Am Soc Nephrol 2009;20: 2093-7 19. Barber JA, Thompson SG. Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy 2004;9: 197-204 20. Howland J, Stokes J 3rd, Crane SC. Adjusting capitation using Chronic Disease Risk Factors: A preliminary report. Health Care Financ Rev 1987;9: 15-23 21. Schauffler HH, Howland J. Using chronic disease risk factors to adjust Medicare capitation payments. Health Care Financ Rev 1992; 14: 79-91, 1992 22. Agus, A., S. K. Krishnan, S. L. S. A. Kadir, 2000. The structural impact of total quality management on financial performance relative to competitors through customer satisfaction: A study of Malaysian manufacturing companies, Total Quality Management, 11(4-6), 808-819. 23. Al-Hawari, M. and T.Ward, 2006. The effect of automated service quality on Australian banks' financial performance and the mediating role of customer satisfaction, Marketing Intelligence & Planning 24(2), 127-147. 24. Anderson, E. W., and V. Mittal, 2000. Strengthening the satisfaction-profit chain, Journal of Service Research 3(2), 107–120. 25. Banker, R. D., G. Potter and D. Srinivasan, 2000. An Empirical Investigation of an Incentive Plan That Includes Nonfinancial Performance Measures, The Accounting Review 75(1), 65-92. 26. Bodenheimer, T., 1999. The Movement for Improved Quality in Health Care, The New England Journal of Medicine 340(6), 488-492. 27. Cleverley, W. O. and R. K. Harvey, 1992. Is There a link between hospital profit and quality?, Healthcare Financial Management 46(9), 40-45. 28. Dey, A., 2008. Corporate Governance and Agency Conflicts, Journal of Accounting Research 46(5), 1143-1179. 29. Dixon, J., 2004. Payment by results—new financial flows in the NHS, British Medical Journal 328, 969-970. 30. Donabedian, A., 1966. Evaluating the quality of medical care, Milbank Memorial Fund Quarterly 44(3), 166–203. 31. Donabedian, A., 1988. The Quality of Care: How Can It Be Assessed?, Journal of the American Medical Association 260 (12), 1743-1748. 32. Edvardsson, B., M. Johnson, A. Gustafsson and T. Strandvik, 2000. The effects ofsatisfaction and loyalty on profits and growth: Products versus Services, Total Quality Management 11(7), 917-927. 33. Fernandez, J. M., M. E. Carbonell and N. Mazzuchi, 1992. Simultaneous Analysis of Morbidity and Mortality Factors in Chronic Hemodialysis Patients, Kidney International 41, 1029-1034. 34. Flood, A. B., S. M. Shortell and W. R. Scott, 1994. Health Care Management: Organization, Design and Behavior, 3rd Ed. New York: Delmar Publishers. 35. Gomez, M. I., E. W. McLaughlin and D. R. Wittink, 2004, Customer satisfaction and retail sales performance: an empirical investigation, Journal of Retailing 80(4), 265-278. 36. Grol, R., 2001. Improving the Quality of Medical Care: Building Bridges Among Professional Pride, Payer Profit, and Patient Satisfaction, Journal of the American Medical Association 286(20), 2578-2585. 37. Gustafsson, A. and M. D. Johnson, 2002. Measuring and managing the satisfaction-loyalty-performance links at Volvo, Journal of Targeting, Measurement and Analysis for Marketing 10(3), 249-258. 38. Hegji, C. E., D. R. Self and C. S. Findley, 2007. The link between hospital quality and services profitability, International Journal of Pharmaceutical and Healthcare Marketing 1(4), 290 – 303. 39. Hynes, D. M., K. T. Stroupe, J. W. Greer, D. J. Reda, D. L. Frankenfield, J. S. Kaufman, W. G. Henderson, W. F. Owen, M. V. Rocco, J. B. Wish, J. Kang and J. R. Feussner, 2002. Potential cost savings of erythropoietin administration in end-stage renal disease, The American Journal of Medicine 112(3), 169–75. 40. Ittner, C., and D. F. Larcker, 1998. Are nonfinancial measures leading indicators of financial performance? An analysis of customer satisfaction. Journal of Accounting Research 36 (Supplement): 1-35. 41. Larcker, D. F., S. A. Richardson and I. Tuna, 2007. Corporate governance, Accounting Outcomes and Organizational Performance, The Accounting Review 82(4): 963–1008. 42. Li, Z., N. L. Lew, J. M. Lazarus and E. G. Lowrie, 2000. Comparing the urea reduction ratio and the urea product as outcome-based measures of hemodialysis dose, American Journal of Kidney Diseases 35(4), 598-605. 43. Levy, J. M., J. Robst, and M. J. Ingber, 2006. Risk-adjustment system for the Medicare Capitated ESRD Program, Health Care Financing Review 27(4), 53-69. 44. Nelson, E. C., R. T. Rust, A. Zahorik, , R. L. Rose, P. Batalden and B. A. Siemanski, 1992. Do patient perceptions of quality relate to hospital financial performance?, Journal of health care marketing 12(4), 6-13. 45. Parasuraman, A., V. A. Zeithaml and L. L. Berry, 1988. SERVQUAL: a multiple item scale for measuring consumers' perceptions of service quality, Journal of Retailing 64(1), 12-40. 46. Porter, M. E., and E. O. Teisberg, 2006. Redefining Health Care: Creating Value-Based Competition on Results, Boston: Harvard Business School Press. 47. Sitzia, J., and N. Wood, 1997. Patient satisfaction: a review of issues and concepts, Social Science and Medicine 45(12), 1829-1843. 48. Szczech, L. A., E. G. Lowrie, Z. Li, N. L. Lew, J. M. Lazarus, and W. F. Owen JR, 2001. Changing hemodialysis thresholds for optimal survival, Kidney International 59, 38–745. 49. Van Vliet, R. C., and W. P. Van de Ven, 1993. Capitation Payments Based on Prior Hospitalizations, Health Economics 2(2), 177-188. 50. Walshe, K., 2009. Pseudoinnovation: the development and spread of healthcare quality improvement methodologies, International Journal for Quality in Health Care 21(3), 153-159. 51. Wood, G. G., R. Spahr, J. Gerdes, Z. S. Daar, R. Hutchison and W. F. Stewart, 2009. Patient Satisfaction and Physician Productivity: Complementary or Mutually Exclusive?, American Journal of Medical Quality 24(6), 498-504. 52. Zeithaml, V. A., 2000. Service Quality, Profitability, and the Economic Worth of Customers: What We Know and What We Need to Learn, Journal of the Academy of Marketing Science 28(1), 67-85. 53. Zeller, T. L., B. B. Stanko and W. O. Cleverley, 1997, A New Perspective on Hospital Financial Ratio Analysis, Healthcare Financial Management 51(11), 62-66. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48198 | - |
dc.description.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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T06:48:41Z (GMT). No. of bitstreams: 1 ntu-100-D91722005-1.pdf: 594907 bytes, checksum: ad63a07087f8681593a11e38553a4143 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | CHAPTER 1: Cost Driver Analysis for Dialysis: Lessons from Renal Clinics in Taiwan
1. Introduction 1 2. Background 3 3. Data and Research Methods 5 3.1 Data Source 5 3.2 Research Method 6 4. Empirical Results 12 4.1 Descriptive statistics 12 4.2 Multiple linear regression model 13 4.3 Sensitivity Tests 16 5. Conclusions, Limitations and Future Directions 17 References 20 CHAPTER 2: Health Service Quality and Financial Performance: Findings from Renal Clinics in Taiwan 1. Introduction 28 2. Institutional Background and Related Literature 30 2.1 Institutional background 30 2.2 Related literature 31 3. Research methods 34 3.1 Data Source 34 3.2 Measures of main variables 35 3.3 Subjective quality: patient satisfaction 35 3.4 Objective quality: biochemical examination 36 3.5 Financial performance 37 3.6 Research model 38 4. Empirical results 39 4.1 Descriptive statistics and patient satisfaction questionnaires 39 4.2 Regression results 41 4.3 Sensitive tests 42 5. Conclusions, Limitations and Future Directions 43 References 46 Appendix 1. Satisfaction questionnaire 60 Appendix 2. Variable Definitions 62 | |
dc.language.iso | en | |
dc.title | 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 | zh_TW |
dc.title | Empirical studies on operation costs and financial performances of dialysis service providers in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 朱炫璉(Hsuan-Lien Chu),陳明賢(Ming-Shen Chen),王泰昌(Tay-Chang Wang),劉啟群(Chi-Chun Liu) | |
dc.subject.keyword | 血液透析,成本動因,台灣全民健保,透析中心,醫療服務品質,財務績效, | zh_TW |
dc.subject.keyword | dialysis,cost drivers,Taiwan National Health Insurance,dialysis clinic,health service quality,financial performance, | en |
dc.relation.page | 62 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-04-15 | |
dc.contributor.author-college | 管理學院 | zh_TW |
dc.contributor.author-dept | 會計學研究所 | zh_TW |
顯示於系所單位: | 會計學系 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-100-1.pdf 目前未授權公開取用 | 580.96 kB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。