實施全民健康保險對醫院經營效率影響之研究

A Study of the Impacts of National Health Insurance on Operating Efficiencies of Medical Institutions

10.6226/2012.(22-2).09

歐進士(Chin S. Ou)；趙令海(Ling-Hai Chao)；洪嘉聲(Chia-Sheng Hung)；林惠美(Hui-Mei Lin)

全民健保 ； 公立醫院 ； 經營績效 ； national health insurance ； public medical institutions ； operating performance

臺大管理論叢

22卷2期（2012 / 06 / 01）

253 - 275

繁體中文

台灣自民國八十三年立法實施全民健保，至今已邁入第十六年。但全民健保卻造成鉅額虧損，且虧損金額逐年上升。為此，政府已決定再次調漲健保費率以挹注此一資金缺口。解決全民健保虧損的途徑，除了調漲費率有開源的效果之外，提升醫院經營效率亦是重要途徑之一。各醫院所若能有效提升經營效率，則醫療資源能發揮更大效益，對全民健保則有節流的功效。因此在健保費率調漲之際，實有必要檢視全民健保對醫院經營績效之影響。故本文的主要目的是比較健保開辦前後醫院經營效率之差異，以評估健保開辦後醫院經營效率是否改善。本研究利用民國七十八年至八十七年之財務資料進行研究，比較健保實施前後醫院之經營效率，發現實施全民健保後醫院之經營效率並無顯著提升，本研究結果顯示政府主管機關在調漲健保費率之際，醫院經營之效率亦是一個值得注意的課題。

It has been fifteen years since the National Health Insurance (NHI) was instituted. The financial deficit of NHI has been increasing steadily for the past years. The goal of this study is to examine the impacts of National Health Insurance (NHI) on operating efficiencies of medical institutions. The observations are composed of the public medical institutions during the period from 1989 through 1998. We compare the operating efficiencies between the pre-and post-NHI periods. Empirical results do not support the hypothesis that NHI has positive influences on operating efficiencies of medical institutions. When the government agency tries to raise the premium rate of NHI to cover the financial deficit, how to improve the operating efficiencies of medical institutions remains an issue to be investigated in the future.

1. 王媛慧、李文福(2004)。我國地區醫院技術效率之研究─DEA方法的應用。經濟研究，40(1)，61-95。
   連結：
2. 王瑜琳、洪嘉聲(2001)。檢驗『自願投保』存款保險制度下的『逆向選擇』與『道德危機』問題：以台灣區農會信用部為例。財務金融學刊，9(3)，71-88。
   連結：
3. 聯合報，2008，「克魯曼讚台灣健保、要美國效法」，10月14日，A3版。(United Daily News. 2008. Paul Krugman applauded Taiwan's NHI: A good paragon for U.S. Health Insurance. Oct. 14, Page. A3.)
4. 魏怡嘉，2004，「醫院自主管理，陳楷模憂心」，http://www.libertytimes.com.tw/2004/new/jun/26/today-life2.html，搜尋日期：2010 年12 月05 日。(Wei, Yi-Chia. 2004. Self-management of hospital makes Chen Kai-Mo worried. http://touchedbyarticle.blogspot.com/2010/03/1165-2010-03-22.html. Accessed Dec. 05, 2010.)
5. 胡釗維，2010，「健保費憑什麼漲？健保黑洞形成的四大主因」，http://touchedbyarticle.blogspot.com/2010/03/1165-2010-03-22.html，搜尋日期：2010年12月03日。(Hu, Jhao-Wei. 2010. Why should premiums of National Health Insurance be raised? Four factors of National Health Insurance deficits. http://touchedbyarticle.blogspot.com/2010/03/1165-2010-03-22.html. Accessed Dec. 03,2010.)
6. Banker, R. D.,Charnes, A.,Cooper, W. W.(1984).Some models of estimating technical and scale inefficiencies in data envelopment analysis.Management Science,30(9),1078-1092.
7. Biorn, E.,Hagen, T. P.,Iversen, T.,Magnussen, J.(2003).The effect of activity-based financing on hospital efficiency: A panel data analysis of DEA efficiency scores 1992-2000.Health Care Management Science,6(4),271-283.
8. Cellini, R.,Pignataro, G.,Rizzo, I.(2000).Competition and efficiency in health cases: An analysis of the Italian case.International Tax and Public Finance,7(4/5),503-519.
9. Chang, H.,Chang, W. J.,Das, S.,Li, S. H.(2004).Health care regulation and the operating efficiency of hospital: Evidence from Taiwan.Journal of Accounting and Public Policy,23(6),483-510.
10. Charnes, A.,Cooper, W. W.,Rhodes, E.(1978).Measuring the efficiency of decision making units.European Journal of Operational Research,2(6),429-444.
11. Chu, H. L.,Liu, S. Z.,Romeis, J. C.,Yaung, C. L.(2003).The initial effects of physician compensation programs in Taiwan hospitals: Implications for staff model HMOs.Health Care Management Science,6(1),17-26.
12. Dervaux, B.,Leleu, H.,Nogues, H.,Valdmanis, V.(2006).Assessing French nursing home efficiency: An indirect approach via budget-constrained DEA models.Socio-Economic Planning Sciences,40(1),70-91.
13. Farrell, M. J.(1957).The measurement of productive efficiency.Journal of the Royal Statistical Society,150(3),253-290.
14. Giokas, D.(2002).The use of goal programming, regression analysis and data envelopment analysis for estimating efficient marginal costs of hospital services.Journal of Multicriteria Decision Analysis,11(4/5),261-268.
15. Harris, J.,Ozgen, H.,Ozcan, Y.(2000).Do mergers enhance the performance of hospital efficiency?.The Journal of the Operational Research Society,51(7),801-811.
16. Hu, J. L.,Huang, Y. F.(2004).Technical efficiencies in large hospitals: A managerial perspective.International Journal of Management,21(4),506-513.
17. Hyer, N. L.,Wemmerlöv, U.,Morris, J. A.(2009).Performance analysis of a focused hospital unit: The case of an integrated trauma center.Journal of Operation Management,27(3),203-219.
18. Linna, M.,Nordblad, A.,Koivu, M.(2003).Technical and cost efficiency of oral health care provision in Finnish health centres.Social Science & Medicine,56(2),343-353.
19. O''neill, L.,Rauner, M.,Heidenberger, K.,Kraus, M.(2008).A cross-national comparison and taxonomy of DEA-based hospital efficiency studies.Socio-Economic Planning Sciences,42(3),158-189.
20. Pasiouras, F.(2008).Estimating the technical and scale efficiency of Greek commercial banks: The impact of credit risk, off-balance sheet activities, and international operations.Research in International Business and Finance,22(3),301-318.
21. Shimshak, D. G.,Lenard, M. L.,Klimberg, R. K.(2009).Incorporating quality into data envelopment analysis of nursing home performance: A case study.Omega,37(3),671-685.
22. Sommersguter-Reichmann, M.(2000).The impact of the Austrian hospital financing reform on hospital productivity: Empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach.Health Care Management Science,3(4),309-321.
23. Su, J.(2000).University of Kansas.
24. Sufian, F.(2009).Determinants of bank efficiency during unstable macroeconomic environment: Empirical evidence from Malaysia.Research in International Business and Finance,23(1),54-77.
25. Wang, E. C.,Huang, W.(2007).Relative efficiency of R&D activities: A cross-country study accounting for environmental factors in the DEA approach.Research Policy,36(2),260-273.
26. Watcharasriroj, B.,Tang, C. S.(2004).The effect of size and information technology on hospital efficiency.Journal of High Technology Management Research,15(1),1-16.
27. 王慕凡(2000)。國立中正大學會計研究所=Department of Accounting and Information Technology, National Chung Cheng University.。
28. 吳家思(2000)。國立交通大學經營管理研究所= Institute of Business and Management, National Chiao Tung University.。
29. 張石柱、廖哲聖(2000)。國軍醫院經營效率之實證研究。國防管理學院學報，21(1)，1-17。
30. 張睿詒、陳隆鴻、侯穎蕙(2002)。醫師團隊相對效率評估與效率提升典範分析。管理學報，19(1)，41-58。
31. 許美媛(2002)。私立靜宜大學會計研究所=Department of Accounting, Providence University.。
32. 陳純慈(2004)。私立高雄醫學大學公共衛生研究所=Department of Public Health, Kaohsiung Medical University.。
33. 楊順成(1997)。私立淡江大學會計研究所=Department of Accounting, Tamkang University.。
34. 楊銘欽、江東亮、盧美鈴(1995)。全民健康保險實施初期台灣地區一般與加護病床供需之推估。醫院，28(5)，1-8。
35. 韓揆(1980)。全民健康保險對醫院經營管理之影響評估台灣地區綜合醫院之分布、利用、管理及與全民健保之關係。台北=Taipei:台北行政院經濟建設委員會=Economic Planning and Development。
36. 藍美玲(1995)。國立台灣大學公共衛生研究所=Institution of Public Health, National Taiwan University.。

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