| 摘要: | 近年來由於健保費用持續上漲，政府機構透過總額支付制度及DRGs住院診斷關聯群支付制度等方法，透過費用控制來處理健保失衡。但隨著時間的經過，根據黃煌雄等人(2012)的研究提到費用控制手段可能使得醫生提高服務量或降低服務品質。因此，本研究主要探討醫院經營績效高低是否影響醫療品質。此次研究對象為2007年全台灣 329 家醫療院所。醫療品質指標分別為住院超過 30 天率、平均住院日數、7 日內再住院率、14 日內再住院率、30 日內再住院率六項指標作為分析,經營績效則透過資料包絡分析法(data envelopment analysis, DEA)作為績效評估,以 CCR 模式以及 BCC 模式之效率值作為衡量,並為避免內生性問題,以 2006年經營績效值進行分析。由於部分醫療品質指標為截斷型資料,因此使用 Tobit 截斷模式迴歸作為分析。
研究結果顯示,前一年之BCC效率值及CCR效率值與當年度的醫療品質均呈現顯著正相關,表示醫療院所效率愈高,醫療品質則愈高。此外，針對權屬別所做的探討，結果顯示所有權屬別均部分呈顯著正相關，相較於公立醫院及財團法人醫院，私立醫院呈現顯著的指標數最高；在評鑑等級的部分，僅地區醫院呈現顯著正相關；最後，對於規模的分析，發現中規模醫院均呈顯著正相關。
Recently, the premium of national health insurance continuously raise, so government of Taiwan try to solve this problem by conducting global budget system and diagnosis related groups (DRGs) to control premium. According to Huang et al.(2012), however, the way controlling premium may make doctors raise medical service volume or lower quality of hospital..
The purpose of this study is to understand the effect of performance on quality of hospital. The object of this study is 329 hospitals in Taiwan in 2007. The measurements of quality of hospital of this study are over 30 days admission rate, the average length of stay, 7 days readmission rates, 14 days readmission rates, 30 days readmission rates. We use technical efficiency and pure technical efficiency of data envelopment analysis to measure the performance and choose indicator of performance in 2006 for avoiding endogeneity problem. Owing to the truncated data in parts of measurement of quality of hospital, we use tobit regression to analyze the data.
The result indicates that performance last year has positive correlation with quality of hospital of this year. In addition, the result of own of hospital shows that performance of all kind of own of hospital last year has positive correlation with part of quality of hospital. Especilly, private hospitals have more positive and significant results.And the result of level of hospital illustrate that only regional hospitals have positive correlation with quality of hospital. Finally, the consequence of size of hospital express that medium hospitals have positive correlation with quality of hospital. |
