我國醫療社團法人與財團法人醫院財務績效之研究

Abstract

醫療法於民國93年大幅修正時增訂醫療法人專章，將醫療法人分為醫療社團法人與醫療財團法人。後者係指以從事醫療事業辦理醫療機構為目的，由捐助人捐助一定財產，經中央主管機關許可並向法院登記之財團法人。醫療法所稱醫療社團法人，係指以從事醫療事業辦理醫療機構為目的，經中央主管機關許可登記之社團法人。修正前原存在醫師個人為主體之私立醫療機構因歲月年長衍生之問題，得以藉醫療社團法人解套，醫療法人化的機制使醫療資源於法人名義下有永續經營之可能，不受個人壽命等因素所限，醫療資源管理、配置及運用始能穩定供給，保障民眾就醫權利。 就兩類不同組織型態之醫療法人比較，各由其設立之屬性觀之即迴然不同。醫療財團法人藉捐助章程設有董事會為權利機關，不設置捐助人(或社員或股東)大會，捐助人一經捐助財產後即與醫療財團法人脫離法律關係，醫療財團法人之監督或變更，有賴主管機關或法院基於職權之干涉。反觀醫療社團法人則以社員大會為最高意思機關，權利義務係遵照社員總會決議行使之。社團法人社員總會若決議解散後則剩餘財產得依章程規定比例返還社員。增修醫療機構相關法律之幅度既深且遠，此政策對我國醫療體系影響不可謂不大。本研究欲探討法令政策增修後醫療社團法人之實際營運情形，以瞭解政策實施之成效。 第一家醫療社團法人核准設立始於民國96年，修法施行至今已公布之醫療法人財務資料為民國96年至100年。本研究針對此五年度之財務資料及非財務資料以實證研究方式探討醫療法人財務報表間相同定義之比率分析，擷取相關資料觀察以財務比率變數及非財務資料變數間的統計量，建立相關假說以驗證醫療社團法人與同時期醫療財團法人是否有顯著差異。實證結果為：醫務利益方面，醫療社團法人因應新法規而設立與同時期已成立多年之醫療財團法人比較結果醫務利益較低。以Scheffe多重比較結果，資產報酬率方面大型醫院高於中型醫院，小型醫院最低；在醫務利益方面以中型醫院醫務利益為三者之最，次高者為大型醫院，小型醫院最低；在負債佔資產比率方面，地區醫院高於區域醫院，而醫學中心負債比最低；以區域別觀察資產報酬率時，地理位置於東部之醫院顯著高於排名第二的南部，其次為中部，以北部醫院的資產報酬率最低。以活動力衡量指標之現金流率方面觀察結果，醫療社團法人不如醫療財團法人，本研究於研究結果中分析可能的原因並提出建議。 過去文獻對績效評估建立模式尋出具關連的解釋變數且多數可以得一致之驗證結果，惟對於我國醫療社團法人績效研究極為缺乏。本研究據以建立績效模式，對資產報酬率與醫務利益之被解釋變數提供關連性之迴歸模式並藉由多元迴歸模式找出兩項解釋變數，其一為健保收入，其二為人力資源成本，為醫療體系主要功能中之管理功能提供具實證基礎之研究成果，俾利管理決策及主管機關為參酌依據。

The new chapter of the revision in year 2004 of Medical Care Act has established clearer legal status of Medical Juridical Persons, which consist of Medical Care Corporate and Medical Care Corporation, in order to establish a well-developed, more organized and higher quality system for implementation in medical care and the related practices. The introduction of Medical Care Corporation, a record breaking to the Medical Care Act, has great and far-reaching influence on the system of medical care. After several years since its promulgation, Medical Care Corporation has become the milestone of medical care to the policy makers and to the central competent authority by accommodating a brand new legal institution among the traditional various types of medical service providers. The implementation of Medical Care Corporation since its inception, not only changing the formality but also the substance of the hospital organizations, has been brought into the attention for further study to evaluate the effectiveness of the medical policies and regulations. To distinguish the nature of the legal characteristics from the Medical Care Corporate, the Medical Care Corporation has its applicable articles and detail rulings despite of the same governance from the Medical Care Act. An example of earning distribution after resolutions is allowed in the Medical Care Corporation. Another example is calling for a general meeting of corporation members to vote and elect directors and supervisors. Some rights and obligations are solely for members of Medical Care Corporation. Will the performance be different as a result of different nature of legal characteristics? As of date, five-year historical financial data of Medical Care Corporation and the contemporaneous data for Medical Care Corporate since year 2007 through year 2011 are collected in this study for an empirical design. Among some important practical issues and managerial topics to be discussed, the spotlight on the study of these financial data is to evaluate the performance via the financial reports and ratio analysis. This study first aims to examine the hypotheses of key indicators between Medical Care Corporation and Medical Care Corporate. Then, a multiple linier regression model is also developed to examine the relationship of the financial performance and some key independent variables including financial ratios and non-financial factors. The empirical results show significantly different margin ratio, debt ratio and cash flow ratio, leverage, returns on asset, payroll related costs and some nonfinancial variables between Medical Care Corporation and Medical Care Corporate. The average debt ratio of Medical Care Corporation is higher with more contribution margin generated from health care services than Medical Care Corporate. It shows that the leverage is utilized to maintain its current operation and future possible renewal in medical equipment and/or expansion in premises. It also implies efficiency exists in Medical Care Corporation. The bottom line, however, is lower due to the larger amount of other income to Medical Care Corporate who holds additional assets. As to medical services provided by the Medical Care Corporation, more than 90% of the fee is reimbursed from National Health Insurance(NHI), the insurer, with only 10% from the patients, while respectively 80% and 20% from NHI and patients by Medical Care Corporate. Further findings from the empirical evidence include: the large scale of hospital has higher Return of Assets (ROA) ration and higher margin ratio than those ratios of medium scale and small scale of hospitals while the medium scale hospital has the highest debt ratio. In terms of ranking, our findings are: local hospital has the higher debt ratios than regional hospital and medical center hospital. With respect to area of hospital, in this study it shows that eastern has the highest ROA ratio than southern, central area is in a lower priority while northern suffers the worst ROA ratio. The Empirical results also confirm a positive relationship between two explanatory variables and their performance with respect to margin ratio and ROA ratio while all other independent variables of the multiple linier regression models remained under control: one is Medical Benefits Claim (also known as medical service fee reimbursed from NHI), another is payroll costs. To conclude, the influence of medical juridical persons including Medical Care Corporation and Medical Care Corporate as a whole has increasingly played an important part to the policy makers. In this study, a regression model is built with significant level for explanations of their ROA ratio and margin ratio. The implications on medical care service providers, with which substantial medical resources are invested and operated, remain a lot of issues for decision makers and some for further study.