台灣醫療機構企業社會責任表現探討

Abstract

台灣政府為保障醫療事業，對所有醫療機構均有免繳營業稅、減免地價稅及醫療設備關稅的優惠。以台灣政府給予醫療事業的稅賦優惠支持來看，所有醫療機構均應承擔企業社會責任，然而國內法規、學者及社會組織，通常只針對公立及醫療財團法人醫療機構，倡議企業社會責任貢獻；且在衡量醫療機構企業社會責任貢獻時，通常只用「社會服務和教學研究的支出」多少來評價。然而醫療機構的企業社會責任面向有許多，從單一指標，評價醫療機構的企業社會責任，不夠全貌。 本研究嘗試以醫療機構的五個面向：「法定公益支出面」、「自費項目定價面」、「自費收入佔率」、「基本醫療責任面」、「企業社會責任重視度」，共8個量化指標，並採德菲法，由專家遴選合適評量醫療機構企業社會責任之指標及權重，量測台灣總床數超過1,000床之26個醫療系統、轄下150間醫療機構，了解不同醫療體系的企業社會責任，摘要重點如下： 一、 公立醫院整體表現優於法人醫院，尤其在「公益支出」及「自費訂價」面向；法人醫院則在「基本醫療責任」面向，優於公立機構。 二、 私校附設醫院整體表現相對較差，這應與台灣醫療法規範了公立醫院、財團法人及社團法人公益支出標準，卻未對私校附設醫院有所規範有關。 三、 財團法人醫院與私校附設醫院的自費訂價普遍較公立醫院為高。 四、 體系設有醫學中心的機構編寫「企業社會責任白皮書」的比例較高。 五、 26體系在「門診掛號費」、「單人病床差額費用」、「自費醫材低於同儕均價比率」、「健保床設置超出法定比率」均有顯著差異，且受到「機構是否位於六都」、 「機構屬性(公立、法人)」 、「機構類型(公立、財團法人、社團法人、私校附設醫院)」、 「評鑑層級(醫學中心、區域醫院、地區醫院)」影響。 六、 六都醫療機構的自費訂價高於非六都醫療機構；六都醫療機構的健保床設置超過法定比率低於非六都機構。 七、 法人醫療機構的自費訂價高於公立醫療機構；法人醫療機構的健保床設置超過法定比率高於公立醫療機構。 八、 門診掛號費：公立醫院<社團法人醫院<私校附設醫院<財團法人醫院；單人房差額費用：公立醫院<財團法人醫院<私校附設醫院；自費醫材低於同儕均價比率：社團法人醫院<財團法人醫院<公立醫院；健保床設置超過法定比率：財團法人醫院<公立醫院<私校附設醫院。 九、 門診掛號費及單人房差額費用，醫學中心高於區域醫院、高於地區醫院。健保床設置超過法定比率，地區醫院高於區域醫院、高於醫學中心。

In order to help boost the healthcare industry, all medical institutions in Taiwan are exempt from business tax, land tax and medical equipment tariffs. In light of such incentives for medical services, all medical institutions and facilities should take the social responsibility for CSR. However, the status quo is that domestic laws, scholars and social organizations usually ask only public and medical corporations to follow suit. When evaluating a medical organization’s contribution, only expenditures on social services and academic research are taken into consideration. In order to have a wholesome assessment, there should be more aspects and factors to be considered when it comes to such evaluation. This study attempts to address 8 quantitative indicators adopted by the Delphi method under five aspects of a medical institution/facility: 'Statutory Pub;ic Welfare Expenditures,' 'Pricing for Optional Nonfunded Items,' 'Revenue Structure,' 'Responsibility for Basic Medical Treatment,' and 'Social Responsibility.' Experts have decided the weight of each indicator, evaluating the country’s 26 medical systems (150 medical institutions) with more than 1,000 beds. The assessment finds that: 1. Public hospitals generally do better than corporate hospitals in CSR, especially in the aspects of “Statutory Public Welfare Expenditures' and 'Pricing for Optional Nonfunded Items;' while corporate hospitals outshine in the aspect of “Responsibility for Basic Medical Treatment.” 2. In general, hospitals under private schools do poorly in CSR, an apparent result of the current laws which do not ask them to abide such rules on statutory public welfare expenditures. 3. Hospitals owned by corporations and those under private schools usually set optional nonfunded items at higher prices. 4. Institutions which have jurisdiction over a medical center have more tendency to compile the White Paper on Corporate Social Responsibility. 5. Influenced by the factors of location, attribute, type and level, the 26 medical systems give varying performances on indicators of “Outpatient Registration Fee,” “Private Room Cost,” “Pricing on Self-paid Medical Treatment Below Average,” and “Ratio of Hospital Beds Covered by Health Insurance.” 6. Medical institutions in the six special municipalities see higher pricing for optional nonfunded items and lower rate of hospital beds covered by National Health Insurance than those in other parts of Taiwan. 7. Corporate medical institutions set higher prices for optional nonfunded items, and have higher rates of hospital beds covered by National Health Insurance than public medical institutions. 8. All from low to high: (1) Outpatient registration fee: public hospitals, hospitals owned by associations, hospitals under private schools and then hospitals owned by corporations. (2) Fees for private rooms: public hospitals, hospitals owned by corporations and then hospitals under private schools (3) Rate of self-paid medical treatment below average: hospitals owned by associations, hospitals owned by corporations and then public hospitals. (4) Rate of hospital beds covered by National Health Insurance: hospitals owned by corporations, public hospitals and then hospitals owned by private schools. 9. From high to low: (1) Outpatient registration fee and difference in private rooms: medical centers, regional hospitals and then local hospitals. (2) Rate of hospital beds covered by National Health Insurance: local hospitals, regional hospitals and then medical centers.