| 摘要: | 全民健康保險自民國84年實施至今已滿6年，雖然民眾滿意度居高不下，但健保財務危機屢傳不鮮，為應付財務困境，健保局施行不少抑制支出的方案，如藥品部分負擔、門診合理量及藥價給付的調降，和即將實施的西醫總額預算，都對醫院的收入造成衝擊，加上勞基法的實施，人力成本的上升，醫院平均佔床率的下降，使許多醫院生存發展面臨環境巨變之重大挑戰。策略聯盟（Strategic Alliance）可以讓企業做橫向或縱向的整合，充分發揮快速性、互補性及綜效性等效果，在資源不足、競爭激烈的環境下，策略聯盟不失為救亡圖存的一項利器。 本研究特別針對區域醫院及地區教學醫院等中型醫院，以問卷方式調查中型醫院過去聯盟對象對該醫院之助益程度；未來各種不同層級醫療機構聯盟對象之重要程度；希望與聯盟對象的所有權和管理權之關係；及中型醫院參與各種價值活動之策略聯盟之意願和最希望的聯盟對象，並以醫院特性和內外環境來測試是否對上述問題造成影響。本研究共寄發問卷至111家中型醫院，回收問卷家數為51家，計有效樣本達46%，其中區域醫院32家，地區教學醫院19家。 本研究結果顯示：地區教學醫院比區域醫院經營情況更艱困，醫學中心是中型醫院最希望的聯盟對象，其次是區域醫院。中型醫院雖然參加策略聯盟的意願很高，但是仍很堅持自主權，在所有權及管理權方面仍相當保守，妥協空間不大，但有少數價值活動是例外，例如「後勤作業外包或合作」。在各項價值活動聯盟之意願程度方面，在臨床醫療合作上，急診、腫瘤科及呼吸治療的對外合作意願，明顯高於有多年合作的洗腎及牙科項目，有關各項價值活動方面，醫學中心囊括大部分項目之最佳聯盟，僅有後勤作業外包或合作由非醫療院所領先；採購及保險申報由區域醫院領先。 雖然有些研究發現規模愈小的醫院參與策略聯盟的意願越高，但本研究發現這些小型醫院並非中型醫院策略聯盟的優先對象，這是一項警訊，值得小型醫院負責人深思，慎選合適的價值活動項目，保持所有權與管理權有彈性的談判空間或許有助於策略聯盟之達成。本研究也建議政府在法令上儘速鬆綁，讓醫院也能以公司法人或社團法人方式來管理以達永續經營之目標及有助於策略聯盟之進行。; It has been over six years since the national health insurance（NHI）was implemented in 1995. Though most people are satisfied with NHI, however, bureau of National Health Insurance has to face the financial crisis. In order to solve the financial problems, many payment reforms had been adopted, like the co-payment for prescription, the reasonable outpatient volume control, reduction of reimbursement in drug and global budget for outpatient services. Under the turbulent environment, strategic alliance is a good way to integrate the services either horizontally or vertically. This study survey all regional hospitals and local teaching hospitals. It try to answer how beneficial from the past strategic alliance for medium-sized hospitals, to understand the importance of partner among different levels of hospitals, to verify the relationship of management and ownership between the alliance hospitals and to evaluate what type of hospitals to be allied. This sample included all 111 medium-sized hospitals, totally 51 valid questionnaires were obtained. The response rate is 46 %, including 32 regional hospitals and 19 local teaching hospitals. The study found local teaching hospitals operated not as well as regional hospitals. Medical centers were the first choice to be allied for the medium-sized hospitals, and next were the regional hospitals. Although the medium-sized hospitals were glad to join the strategic alliance, they also insisted to hold on their ownership. Medium-sized hospitals were still conservative when dealing with ownership issues, but open to outsourcing supporting systems and cooperation, for example, in the department of emergency、oncology、respiratory therapy, they are very cooperative. Generally speaking, medical centers were the first choice as alliance partner for medium-sized hospitals. Expect in the area of purchasing and health insurance payment claims, regional hospitals were the first choice. Though smaller hospitals were more willing to join the strategic alliance, however, they were less often selected by medium-sized hospitals as partner for strategic alliance. The study also suggested the government should deregulate as soon as possible, so the private hospitals can be managed by the corporation or the non-profit organization to foster strategic alliance among hospitals. |
