目的 自實施全民健保至1999年，地區醫院家數約減少15.46%。而醫院歇業會產生許多負面效果，如降低民眾就醫可近性、醫療服務品質等。本研究主要目的為探討市場定位與經營競爭度對地區醫院歇業之影響。方法 研究對象為1996至1998年臺灣地區，通過地區醫院評鑑之急性醫院，以衛生署醫療網計畫之63個次醫療區域作為醫院市場範圍。以邏吉斯迴歸及逐步邏吉斯迴歸分析，進行醫院歇業影響因素的探討。結果 總員工數之差異性、次醫療區域內之醫院數、權屬別、門診人次顯著影響地區醫院歇業與否。歇業醫院傾向於私立醫院、員工數較多、競爭程度較高、門診人次較少的醫院。經由逐步邏吉斯迴歸建立歇業之預測模型，影響醫院歇業的變項為總員工數之差異性、門診人次。研究結果顯示，市場定位及經營競爭度的差異，會影響醫院歇業與否。結論 本研究建議，地區醫院在發展永續經營的策略時，應該審慎的評估市場定位以及經營競爭度。
Objectives. From 1995, the number of district hospitals in Taiwan decreased by about 15%. This study aimed to investigate the effects of operational strategies and market competition on the closure of district hospitals in Taiwan. Methods. From 1996 to 1998, all hospitals accredited as district hospitals were selected as study samples. The market was difined as the 63 sub-medical regions according to the Department of Health. The dependent variable was dichotomized as “closed” or “open”. The independent variables were categorized into three groups: market position, competition, and control variables. Data were obtained from three sources, the “Hospital Medical Care Organization Survey in Taiwan”, the “Taiwan-fukien Demographic Fact Book”, and a “Report on the Survey of Family Income and Expenditure in the Republic of China”. The relationship between dependent variables and independent variables was analyzed by logistic regression. Results. The density of the market, the number of full-time employees, the number of outpatient visits and ownership (private vs public hospitals) were significant variables. Conclusions. Both operational strategies and market competition had impacts on the closure of district hospitals.
