| 摘要: | 目的：近年來由於護理之家快速成長，接踵而至面臨市場競爭壓力，為瞭解護理之家之經營效率，本研究以績效觀點探討並比較護理之家之經營績效，期能提供給管理者作為有效率的經營與管理方針之參考。本研究目的有三：(1)探討護理之家整體經營效率；(2)比較不同類型護理之家經營效率是否有差異；(3)探討照護服務品質效率、總體人力效率及收入效率三者之間的關係。 方法：本研究為橫斷性研究(cross sectional study)。為使所選取的樣本資料之真實性，並足以收集代表護理之家效率指標，做為未來發展新的衡量護理之家績效評估工具之測試，採立意取樣(purposive sampling)，研究對象為開辦服務3年以上，選取19個決策單位(decision making unit, DMU)，資料來源使用92年度機構管理者所填問卷及當年全國全面訪查結果。選取6個投入變項及6個產出變項。績效評估採用資料包絡分析法(Data Envelopment Analysis, DEA)二階段模式，以確定區域模式(AR)、交叉效率模式(CEM)、對等比模式(Bilateral)透過差額變數分析進行研究。 結果：研究發現：一、在AR模式下，僅有5個DMU有純技術效率；在規模效率方面，僅有1個80床之DMU達最適規模大小(MPSS)；二、經CEM模式分析後，表現較佳的前4個DMU均為公立醫院型態；三、在使用Bilateral模式分析後的效率值，經無母數檢定結果顯示醫院型態優於獨立型態、80床以下較80床以上有效率，且呈統計上顯著差異。四、不同績效值分析，有9個DMU有品質效率；有4個DMU有收入效率；有9個DMU有總人力效率；同時，有高總人力效率與高收入效率有5個DMU；有高照護服務品質與高收入效率有6 個DMU；高照護品質與高總人力效率有11個DMU。 結論：DEA有別於其它計量分析工具，研究結果針對無效率護理之家需改善空間，可透過差額變數分析提出參考群體與最適改善目標及潛在改善率。本研究確認護理之家應用DEA評估效率之可用性。本研究特色納入照護服務品質，研究分析發現同時具有總體效率、照護服務品質效率、收入效率、總人力效率、護理人力效率、照顧員人力效率的僅有2個DMUs，其中以N1公立醫院型態規模為170床訪查結果較佳；故本研究建議參考群體以N1較值得作為參考。研究結果有助管理者日後提昇經營效率評估之參考，此外，建議日後研究者，除以量化資料比較之外，應進一步分析影響因素並增加決策單位之選取。; Purpose：In recent years, the nursing home has been rapidly developed in a succession, and inevitably obliged to face the pressure of the market competition. In order to comprehend the operating result, this research is to explore and compare the operating efficiency of the nursing home from viewpoint of the achievements, looking froward to offering managers an effective operation and managing guideline as a reference. This study has 3 purposes, which respectively are: 1.To explore the integral operating efficiency of the nursing home; 2. To compare the managing efficiencies in different types of the nursing home if there is any discrepancy 3.To discuss the relationship among the efficiency and service quality of the nursing home, the efficiency of integral manpower, and the efficiency of income. Methods：Our study is a cross sectional study. For the authenticity of the spicment selected, which is capable of collecting efficiency indicator of the nursing home as an achievement assessing instrument to test the new nursing home in the future development, the purposive sampling mode is adopted to select 19 decision-making units, and the studing object has served this initiating service for more than 3 years. The data resource is using the questionnaire filled in by unit’s manager, and the comprehensive investigating result nationwide to select 6-input and 6-output variable each. We adopt the DEA 2-stage evaluation model to evaluate the efficiency to ensure the AR、CEM & Bilateral, through the difference variable to analyze and conduct this study. Results：Study Discovery: 1.Under the AR model, no more than 5 DMU has the pure technique efficiency; in terms of the scale efficiency, only one DMU with 80-bed has achieved the economic effect on MPSS. 2. After the CEM model analysis, the precedeing 4 DMU with better performance are operated in a model of the public hospital. 3. The analyzed efficiency value by the bilateral model through non-denominator examining result shows that the hospital type is better than the individual types, and the 80-bed or less may have better quality efficiency than the 80-bed or more, of which there is a conspicuous discrepancy in statistics. 4. Analysis of different result has 4 DMU with income efficiency, 9 DMU with total manpower efficiency, 5 DMU with high total manpower efficiency and high income efficiencies, 6 DMU with high nnuring service quality and high income efficiency, and simultaneously 11 DMU. Conclusions： The DEA is difference from theother measuring analysis tools. Aiming at the ineffective nursing home with the improved space, the study result may provide with the referencing gatherings and the best potential improving rate to improve the targe through the difference variable analysis. This study has confirmed the feasibility that nurshing home applies DEA to assess the efficiency. Feature of this s |
