市場定位與經營競爭度對地區醫院歇業影響之探討; Effects of Market Position and Competition on District Hospital Closures

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題名:	市場定位與經營競爭度對地區醫院歇業影響之探討;Effects of Market Position and Competition on District Hospital Closures
作者:	洪思雯;Hung, Ssu-Wen
貢獻者:	中國醫藥學院醫務管理研究所
關鍵詞:	醫院歇業;市場定位;經營競爭度;Hospital Closure;Marker Position;Competition
日期:	1990
上傳時間:	2009-12-03 09:19:39 (UTC+8)
摘要:	本研究目的為瞭解歷年醫院組織特性、分析歷年地區醫院歇業的趨勢與分佈情形，以及探討市場定位與經營競爭度對地區醫院歇業之影響。研究對象為1996年至1998年臺灣地區（金馬地區除外）通過地區醫院評鑑之急性醫院（排除中醫、慢性、精神科醫院），並以衛生署醫療網計畫規劃之63個次醫療區域作為醫院市場範圍。由於各自變項對醫院歇業之影響並非歇業當年才產生，因此所有醫院之自變項將以前一年之資料進行分析。資料來源分別為1995-1999年行政院衛生署「臺灣地區公私立醫療院所現況與服務量調查」電腦資料檔、1995-1999年內政部「臺閩地區人口統計」、1995-1999年行政院主計處「中華民國臺灣地區家庭收支調查報告」。研究結果如下：一、1995-1999年醫院家數逐年遞減，組織特性中均以私立醫院、型態別為醫院、通過地區醫院評鑑的醫院為主；整體來說，醫院規模與產出（門診人次、住院人次、住院人日等）均逐年遞增，但醫院間的差異亦逐年增大。二、1996-1998年歇業醫院家數逐年遞減，但就歇業的規模來說，則呈現逐年擴大的趨勢。各年歇業醫院組織特性均以私立醫院、型態別一般科醫院為主，且總病床數、總員工數、總科別數均少於存活醫院，位於競爭程度較高的次醫療區。三、總員工數之歐基里德距離、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。四、經由逐步羅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歐基里德距離、門診人次。根據本研究結果，建議地區醫院管理者其應考重新思考醫院本身之定位，評估內部員工生產效率以發揮最大生產力，且擴充門診人次以增加醫院財務收入。就衛生政策主管機關方面，建議規劃門診與住院比例的合理分配，重新評估公立醫院之功能以提供民眾合理的醫療照護。; The study was designed to investigate the effects of operational strategies and market competition on the closures of district hospitals in Taiwan. From 1996 to 1998, all hospitals accredited as district hospitals in Taiwan were selected to be research samples. Market was partitioned according to the sixty-three sub-medical regions from the Department of Health, Executive Yuan. The dependent variable was dichotomized as "closure" or "not closure". The independent variables were categorized into three groups：market position, competition, and control variables. Data were obtained from three sources, including the “Hospital Medical Care Organization Survey in Taiwan Area” which were collected annually by the Department of Health, Executive Yuan, “Taiwan-Fukien Demographic Fact Book” published yearly by the Ministry of the Interior, and “Report on the Survey of Family Income and Expenditure in Taiwan Area of Republic of China” published annually by the Directorate-general of Budget, Accounting and Statistics, Executive Yuan. To analysis the relationship of dependent variable and independent variables, Logistic regression was adopted as statistical method. The major finding of this study was that both operational strategies and market competition had impacts on the closure of district hospitals. District hospitals operating in market with high density measured by the hospitals had high risk of closure. In terms of operational strategies, district hospitals that differentiated from others in the size on the basis of the number of full-time employments were significant on the closure of hospitals. District hospitals with more employees were tend to close. Finally, the ownership and the number of outpatient visit were also significant factors of the closure of hospitals. Private hospitals and hospitals with less number of outpatient visit had high risk of closure. Based on the results of this study, the implications of hospitals’ managements, the health policy, and the future study research were discussed.
顯示於類別:	[醫務管理學系暨碩士班] 博碩士論文

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