市場結構與組織特性對醫院營運效率之影響

洪維河; 江東亮; 張睿詒

doi:10.6504/JOM.2005.22.02.03

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P191 - 203

社会科学 > 管理学

DOI： 10.6504/JOM

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市场结构与组织特性对医院营运效率之影响

The Effect of Market Structure and Organizational Characteristics on Hospital Operating Efficiency

洪维河(Wei-Her Hong) ；江东亮(Tung-Liang Chiang) ；张睿诒(Ray-E Chang)

管理学报； 22 卷 2 期 (2005 / 04 / 01) ， P191 - 203

繁体中文 DOI： 10.6504/JOM.2005.22.02.03

医院效率；市场结构；组织特性；资料包络分析； hospital efficiency ； market structure ； organizational characteristics ； data envelopment analysis

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摘要 │ 参考文献 (31) │ 被引用文献 (9) │ 国际计量

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In most countries hospitals consume the largest portion of a nation's health care resources, and hospital efficiency has therefore been an important issue in the health care system. Hospital executives and policy-makers concerned the determinants of hospital operating efficiency in order to improve hospital performance. Many studies had showed that hospital efficiency was significantly correlated with organizational characteristics. Nevertheless, the relationships between hospital efficiency and market determinants were still unclear. One of the possible reasons was that the determination of local hospital market did not properly reflect the exchange relationships of health services, and then degree of competition could not be properly measured. This study intends to investigate the relationship between the inpatient technical efficiency of general teaching hospitals and market determinants.
Data of 101 hospitals accredited as general teaching hospitals were obtained from the Annual National Hospital Survey of 1995 in Taiwan. The vital factor efficiency scores calculated through the data envelopment analysis (DEA) technique were employed as the measure of the technical efficiency of hospitals. The input variables in DEA consisted of total staffed beds, ICU beds, the number of doctors and number of nurses; the output variables included the total inpatient days and the number of surgical operations. Then multiple regression analyses were conducted to explore the relationships between hospital technical efficiency and organizational and market characteristics. While accredited status, ownership, and surgical operation rate were the organizational variables, the population size, Herfindale index, and the number of large hospitals accredited as regional hospitals or medical centers were the market variables which were measured based on local markets determined by a patient origin method. 
The result showed that on average the vital factor efficiency score of general teaching hospital in Taiwan was 0.702±0.207, with a range from 0.263 to 1.520. Results from multiple regression analyses indicated that 47.2% of the variation in hospital efficiency could be explained by organizational and market variables. After controlling market variables, higher technical efficiency was associated with regional hospitals, private hospitals, and hospitals with higher surgical operation rate.  On the other hand, after controlling organizational variables, hospital technical efficiency was not significantly associated with the population size and Herfindahl index of a local market. However, it is interesting to observe that hospital efficiency increases fist as the number of large hospital increases in a local market. It then decreases as the number of large hospitals in a local market continuously increases. 
The conclusion of this study is that the organizational and market characteristics were all important in determining the technical efficiency of general teaching hospitals in Taiwan. Relationship between hospital technical efficiency and the degree of competition measured in this study may not be simply linear. The information should provide valuable insight for policy makers when policies related to the improvement of hospital efficiency are formulated.  Hospital management can also benefit for their expansion or contraction strategies.

参考文献 ( 31 ) 〈TOP〉

Anderson, P.,Peterson, N. C.(1993).A procedure for ranking efficient unit in data envelopment analysis.Management Science,39,1261-1264.
Baker, L. C.(2001).Measuring competition in health care markets.Health Service Research,36(1),223-250.
Becker, E. R,Sloan, F. A.(1995).Hospital ownership and performance.Economic Inquiry,23,21-36.
Burgress, J. F.,Wilson, P. W.(1998).Variation in inefficiency among US hospital.INFOR,36(3),84-102.
Carter, R. B,Massa, L. J,Power, M. L.(1997).An examination of the efficiency of proprietary hospital versus non-proprietary hospital ownership structure.Journal of Accounting and Public Policy,16,63-87.

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