题名

探討醫療組織誘因制度、權益公平認知對醫師工作績效之影響－以預算強調做為權變因素

并列篇名

The Effect of Hospital Incentives and Equity Fairness Perceptions on Physicians' Job Performance: Budget Emphasis as a Contingent Variable

DOI

10.6552/JOAR.2015.60.3

作者

盧正宗(Cheng-Tsung Lu)；張仲岳(Conrad Chung-Yueh Chang)

关键词

預算強調 ； 誘因 ； 權益公平認知 ； 醫師工作績效 ； Budget emphasis ； Incentives ； Equity fairness perceptions ； Physicians' job performance

期刊名称

會計評論

卷期/出版年月

60期（2015 / 01 / 01）

页次

73 - 109

内容语文

繁體中文
中文摘要

由於中央健保署透過總額預算制度來管制與限制醫療機構的財務資源，再加上台灣地區醫院擴張過速且競爭激烈，其結果導致醫師面臨相當大的工作負擔與績效壓力。因此探討醫療組織現行誘因制度對醫師工作績效之影響，是一重要研究議題。然而有關誘因制度對個人層級工作績效之研究上，以往研究呈現不一致的結論。因此本文同時整合權變理論與中介效果之觀點來強化與解釋其間的關連性。在權變因素上，本文加入預算強調之觀點，以配合醫界受制於政府介入醫療規範的研究背景；而在中介變數上，本文則延續權益理論下的權益公平認知觀點。研究樣本包括國內區域級以上醫院的130位醫師，實證結果發現：（1）非財務誘因與醫師工作績效之間並不存在權益公平認知之中介影響效果，反而非財務誘因會正向顯著地提昇醫師工作績效。（2）財務誘因與醫師工作績效間並未存在權益公平認知之中介影響效果，同時財務誘因亦未顯著影響醫師的工作績效。（3）當預算強調程度高時，非財務誘因和權益公平認知的正向連結，會比預算強調低時有更增強的效果。（4）當預算強調程度高時，權益公平認知和醫師工作績效的正向連結，亦會比預算強調低時有更增強的效果。
英文摘要

The global budget system adopted by National Health Insurance Administration to control the financial resources for hospitals in combination with intensifying competition has led to considerable performance pressures on physicians. The influence of incentive systems on physicians' job performance has become a crucial research issue. This study aims to explain the connection between incentives and physicians' job performance from the integrative perspective of mediating effect and contingency theory. Budget emphasis is incorporated as a contingent variable in align with the restriction on medical practices imposed by government intervention as the research background. Equity fairness perception is taken as a mediate variable. The samples for analysis consist of 130 physicians from hospitals above the regional level. The results show that: (1) Nonfinancial incentives positively affect physicians' job performance at a significance level, which cannot be accounted for by the mediating effect of equity fairness perceptions. (2) The mediating effect of equity fairness perceptions does not exist between financial incentives and physicians' job performance. (3) The positive effect of nonfinancial incentives on equity fairness perceptions is evident with high budget emphasis. (4) The positive effect of equity fairness perceptions on physicians' job performance is also more evident with high budget emphasis.
主题分类 社會科學 > 財金及會計學
参考文献
  1. 祝道松、倪豐裕、盧正宗(2010)。預算控制制度對醫院組織效能影響之探討─以角色壓力作為中介變數。會計評論，50，57-87。
    連結：
  2. 張睿詒、李明純、張怡秋、陳楚杰(2003)。台灣地區醫院預算制度之質性研究：以六家區域級以上醫院為例。醫護科技學刊，5(2)，85-95。
    連結：
  3. 許碩芬、楊雅玲、陳和全(2007)。社會困境？全民健保總額預算制下醫療提供者策略的均衡分析。管理學報，24(2)，155-166。
    連結：
  4. 潘奇、魏誠佑、祝道松、侯勝茂(2006)。總額預算實施前後署立醫院營運績效之評估。醫務管理期刊，7(4)，403-417。
    連結：
  5. 財團法人醫院評鑑暨醫療品質策進會，2010，醫院評鑑及教學醫院評鑑簡介。網址：http://www.tjcha.org.tw/FrontStage/page.aspx?ID=088AB6C2-1B58-42F4-9E27-6597273D5ECF。(Taiwan Joint Commission on Hospi tal Accreditation Website. 2010. The introduction of hospital accreditation and teaching hospital accreditation. Available at: http://www.tjcha.org.tw/FrontStage/page.aspx?ID=08 8AB6C2-1B58-42F4-9E27-6597273D5ECF.)
  6. 行政院衛生福利部，2010，90至95年度醫院評鑑及教學醫院評鑑合格名單。網址：http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=1& now_fod_list_no=4396&level_no=4&doc_no=46337 。(Ministry of Health and Welfare Website. 2010. The hospital accreditation and teaching hospital accreditation qualification during 2001 to 2006. Available at: http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=1&now_fod_list_no=4396&level_no=4&doc_no=46337.)
  7. 中央健康保險署，2012，健保業務執行報告。網址：http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=661&webdata_id=815&WD_ID=661。(National Health Insurance Administration Website. 2012. Statistical annual reports. Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=661&webdata_id=815&WD_ID=661.)
  8. Abernethy, M. A.,Stoelwinder, J. U.(1995).The role of professional control in the management of complex organizations.Accounting, Organizations and Society,20,1-17.
  9. Abernethy, M. A.,Stoelwinder, J. U.(1991).Budget use, task uncertainty, system goal orientation and subunit performance: A test of the fit hypothesis in not-for-profit hospitals.Accounting, Organizations and Society,16,105-120.
  10. Adams, J. S.(1965).Inequity in social exchange.Advances in Experimental Social Psychology,2,267-299.
  11. Aidemark, L. G.(2001).Managed health care perspectives: A study of management accounting reforms on managing financial difficulties in a health care organization.European Accounting Review,10,545-560.
  12. Aidemark, L. G.,Funck, E. K.(2009).Measurement and health care management.Financial Accountability & Management,25,253-327.
  13. Aranya, N.(1990).Budget instrumentality, participation and organizational effectiveness.Journal of Management Accounting Research,2,67-77.
  14. Aurier, P.,Siadou-Martin, B.(2007).Perceived justice and consumption experience evaluations: A qualitative and experimental investigation.The Service Industries Journal,18(5),450-471.
  15. Awashti, V.,Pratt, J.(1990).The effects of monetary incentives on effort and decision performance: The role of cognitive characteristics.The Accounting Review,65,797-811.
  16. Baiman, S.(1990).Agency research in managerial accounting: A second look.Accounting, Organizations and Society,15,341-371.
  17. Baron, R. M.,Kenny, D. A.(1986).The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations.Journal of Personality and Social Psychology,51,1173-1182.
  18. Becker, D. A.(1997).The effects of choice on auditors' intrinsic motivation and performance.Behavioral Research in Accounting,9,1-19.
  19. Bonner, S. E.,Hastie, R.,Sprinkle, G. B.,Young, S. M.(2000).A review of the effects of financial incentives on performance in laboratory tasks: Implications for management accounting.Journal of Management Accounting Research,13,19-64.
  20. Bonner, S. E.,Sprinkle, G. B.(2002).The effects of monetary incentives on effort and task performance: Theories, evidence, and a framework for research.Accounting, Organizations and Society,27,303-345.
  21. Bouwens, J.,Lent, L. V.(2006).Performance measure properties and the effect of incentive contracts.Journal of Management Research,18,55-75.
  22. Brownell, P.,Dunk, A. S.(1991).Task uncertainty and its interaction with budgetary participation and budget emphasis: Some methodological issues and empirical investigation.Accounting, Organizations and Society,16,693-703.
  23. Brownell, P.,McInnes, M.(1986).Budgetary participation, motivation and managerial performance.The Accounting Review,61,587-600.
  24. Burney, L. L.,Henle, C. A.,Widener, S. K.(2009).A path model examining the relations among strategic performance measurement system characteristics, organizational justice, and extra-and in-role performance.Accounting, Organizations and Society,34,305-321.
  25. Camerer, C. F.,Hogarth, R. M.(1999).The effects of financial incentives in experiments: A review and capital-labor-production framework.Journal of Risk and Uncertainty,19,7-42.
  26. Chong, V. K.,Eggleton, I. R. C.(2007).The impact of reliance on incentive-based compensation schemes, information asymmetry and organizational commitment on managerial performance.Management Accounting Research,18,312-342.
  27. Chow, G. C.(1960).Tests of equality between sets of coefficients in two linear regressions.Econometrica,28,591-605.
  28. Cuieford, J. P.(1965).Fundamental Statistic in Psychology and Education.New York, NY:McGraw-Hill.
  29. Davila, T.,Wouters, M.(2005).Managing budget emphasis through the explicit design of conditional budgetary slack.Accounting, Organizations and Society,30,587-608.
  30. Doran, H. E.(1989).Applied Regression Analysis in Econometrics.London, LON:CRC Press.
  31. Dougherty, C.(2007).Introduction to Econometrics.New York, NY:Oxford University Press.
  32. Dunk, A. S.(1993).The effect of budget emphasis and information asymmetry on the relation between budgetary participation and slack.The Accounting Review,68,400-410.
  33. Ederhof, M.(2011).Incentive compensation and promotion-based incentives of mid-level managers: Evidence from a multinational corporation.The Accounting Review,86,131-153.
  34. Editors(2005).Principles for the construct of pay-for-performance programs.Medical Benefits,22,6-8.
  35. Efebera, H.,Hayes, D. C.,Hunton, J. E.,O'Neil, C.(2004).Tax compliance intentions of low-income individual taxpayers.Advance in Accounting Behavioral Research,7,1-25.
  36. Eisenhardt, K. M.(1989).Agency theory: An assessment and review.Academy of Management Review,14,57-74.
  37. Govindarajan, V.,Gupta, A. K.(1985).Linking control systems to business unit strategy: Impact on performance.Accounting, Organizations and Society,10,51-66.
  38. Gruen, R.,Anwar, R.,Begum, T.,Killingsworth, J. R.,Normand, C.(2002).Dual job holding practitioners in Bangladesh: An exploration.Social Science & Medicine,54,267-279.
  39. Gujarati, D. N.(2003).Original: Basic Econometrics.New York, NY:McGraw-Hill, Inc..
  40. Halbesleben, J. R. B.,Wakefield, D. S.,Wakefield, B. J.(2008).Work-arounds in health care settings: Literature review and research agenda.Health Care Management Review,33,2-12.
  41. Hanson, E. I.(1966).The budgetary control function.The Accounting Review,41,239-243.
  42. Hartmann, F.,Moers, F.(1999).Testing contingency hypotheses in budgetary research: An evaluation of the use of moderated regression analysis.Accounting, Organizations and Society,24,291-315.
  43. Heneman, H. G. III,Schwab, D. P.(1985).Pay satisfaction: Its multidimensional nature and measurement.International Journal of Psychology,20(1),129-141.
  44. Hronsky, J. J. F.,Houghton, K. A.(2001).The meaning of a defined accounting concept: Regulatory changes and the effect on auditor decision making.Accounting, Organizations and Society,26,123-139.
  45. Ittner, C. D.,Larcker, D. F.(1998).Innovations in performance measurement: Trends and research implications.Journal of Management Accounting Research,10,205-238.
  46. Jackson, B. R.,Milliron, V. C.(1986).Tax compliance research: Findings, problems, and prospects.Journal of Accounting Literature,5,125-161.
  47. Jacobs, K.(1998).Costing health care: A study of the introduction of cost and budget reports into a GP association.Management Accounting Research,9,55-70.
  48. Kaiser, H. F.,Rice, J.(1974).Little Jiffy, Mark IV.Educational and Psychological Measurement,34(1),111-117.
  49. Kaplan, R. S.,Atkinson, A. A.(1998).Advanced Management Accounting.New Jersey, NJ:Prentice Hall.
  50. Kaplan, R. S.,Norton, D. P.(1996).The Balanced Scorecard: Translating Strategy into Action.Boston, MA:Harvard Business School Press.
  51. Kelly, K. O.(2007).Feedback and incentives on nonfinancial value drivers: Effects on managerial decision making.Contemporary Accounting Research,24,523-556.
  52. Klein, S. M.(1973).Pay factors as predictors to satisfaction: A comparison of reinforcement, equity, and expectancy.Academy of Management Journal,16,598-610.
  53. Lam, S. S. K.,Schaubroeck, J.,Aryee, S.(2002).Relationship between organizational justice and employee work outcomes: A cross-national study.Journal of Organizational Behavior,23,1-18.
  54. Land, K. C.(1969).Principles of Path Analysis.San Francisco, SF:Jossey-Bass.
  55. Leventhal, G. S.(1980).Equity Theory: Toward a General Theory of Social Interaction.New York, NY:Academic Press.
  56. Moser, D. V.,Evans, J. H. III,Kim, C. K.(1995).The effects of horizontal and exchange inequity on tax reporting decisions.The Accounting Review,70,619-634.
  57. Nakamura, K.,Okamura, T.,Kanda, H.,Hayakawa, T.,Okayama, A.,Ueshima, H.(2007).Medical costs of individuals with proteinuria: A 10-year follow-up study of national health insurance in Shiga, Japan.Public Health,121,174-176.
  58. Nalli, G. A.,Scanlon, D. P.,Libby, D.(2007).Developing a performance-based incentive program for hospitals: A case study from Maine.Health Affairs,26,817-824.
  59. Neter, J.,Wasserman, W.,Kutner, M. H.(1990).Applied Linear Statistical Models.Homewood, IL:Richard D. Irwin, Inc..
  60. Otani, K.,Herrmann, P. A.,Kurz, R. S.(2010).Patient satisfaction integration process: Are there any racial differences?.Health Care Management Review,35,116-123.
  61. Podsakoff, P. M.,MacKenzie, S. B.,Podsakoff, N. P.(2003).Common method biases in behavioral research: A critical review of the literature and recommended remedies.Journal of Applied Psychology,88,879-903.
  62. Roland, M.,Campbell, S.,Bailey, N.,Whalley, D.,Sibbald, B.(2006).Financial incentives to improve the quality of primary care in the U. K.: Predicting the consequences of change.Primary Health Care Research and Development,7(1),18-26.
  63. Samad, S.(2006).Procedural and distributive justice: Differential effects on employees' work outcomes.The Business Review,5(2),212-218.
  64. Scott, I. A.(2007).Pay for performance in health care: Strategic issues for Australian experiments.The Medical Journal of Australia,187,31-35.
  65. Shields, M. D.,Deng, F. J.,Kato, Y.(2000).The design and effects of control systems: Tests of direct-and indirect-effects models.Accounting, Organizations and Society,25,185-202.
  66. Sholihin, M.,Pike, R.(2009).Fairness in performance evaluation and its behavioural consequences.Accounting & Business Research,39,397-413.
  67. Swieringa, R. J.,Moncur, R. H.(1975).Some Effects of Participative Budgeting on Managerial Behavior.New York, NY:National Association of Accountants.
  68. Tang, T. L. P.,Sarsfield-Baldwin, L. J.(1996).Distributive and procedural justice as related to satisfaction and commitment.Sam Advanced Management Journal,61,25-31.
  69. Trivedi, V. H.,Chung, J. O. Y.(2006).The impact of compensation level and context on income reporting behavior in the laboratory.Behavioral Research in Accounting,18,167-183.
  70. Wentzel, K.(2002).The influence of fairness perceptions and goal commitment on managers' performance in a budget setting.Behavioral Research in Accounting,14,247-271.
  71. Wynder, M.(2010).The effect of performance-contingent incentives when task complexity is manipulated through instruction.Australasian Accounting Business and Finance Journal,4(4),51-72.
  72. Young, S. M.(1985).Participative budgeting: The effects of risk aversion and asymmetric information on budgetary slack.Journal of Accounting Research,23,829-842.
  73. 吳文祥、林進財、彭廣興(2009)。醫院因應總額預算支付制度之適應策略評選－以新竹市醫院為例。健康管理學刊，7(1)，79-92。
  74. 李玉春(2001)。醫院合理門診量能拯救基層嗎？全民健保醫院合理門診量政策之形成背景與可能影響。醫望雜誌，33，94-98。
  75. 林淑姬、樊景立、吳靜吉、司徒達賢(1994)。薪酬公平、程序公正與組織承諾、組織公民行為關係之研究。管理評論，13(2)，87-108。
  76. 邱芝駖(2008)。國立中正大學社會福利研究所=Graduate Institute of Social Welfare, National Chung Cheng University。
  77. 倪豐裕、邱炳乾(2000)。參與式預算制度對預算寬列傾向影響之實證研究─以任務不確定性及偵測預算寬列能力為調節變數。當代會計，1(1)，41-54。
  78. 倪豐裕、蔡惠丞(1997)。預算參與、預算強調、任務不確定性對管理績效影響之研究三維交互作用效果之檢定。管理學報，14(1)，1-14。
  79. 倪豐裕、蘇志泰(2003)。策略型態和角色模糊對預算制度效能的影響。中山管理評論，11(4)，739-757。
  80. 祝道松、彭雅惠、董鈺琪、龔建吉、陳秀珠、陶阿倫(2009)。醫療機構成本與管理會計。台北=Taipei, TP:華杏出版社=Farseeing Publishing Group。
  81. 涂醒哲(2005)。防漏洞建新制，落實全民健保美意。新台灣新聞周刊，463-464
  82. 張庭(2005)。談我國健康保險政策重點及改革方向。行政試訊，14，3-96。
  83. 謝序偉、簡立建、譚大純(2005)。以策略觀點探討醫療機構績效管理：以高雄榮民總醫院為例。經營管理論叢，1(2)，41-58。
被引用次数
  1. 盧正宗,祝道松(2019)。預算支出目標調整之困難度對後續預算執行及預算績效之影響：以策略性溝通作為權變因素。會計評論，69，131-172。
  2. 張振傑,林沂臻(2020)。以對偶關係探討認知差異對員工態度及行為的影響。弘光學報，86，37-52。
print cancel