院因支付制度之策略方案及 其相因素探
念慈1 哲1,* 怡欣1 郭乃文1 魏中仁2
Nien-Tzu Chuang1, Kuo-Cherh Huang1,*, Yi-Hsin Elsa Hsu1 Nai-Wen Kuo1, Zhong-Ren Wei2
1 北大管理研究所，北市街250
School of Health Care Administration, Taipei Medical University. No.250, Wu-Hsing St., Taipei, Taiwan, R.O.C.
2 仁大院公共生系
Department of Public Health, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, R.O.C.
＊通作者Correspondence author. E-mail: kchuang@tmu.edu.tw
目：有於健保支付制度之改，院管理之影甚，因此各院莫不取因策略。本研究即探院於支付制度之施，所取因策略之型，分析影其策略的相因素。方法：本研究依Shortell的理架，院的策略型分面、管理面、及技面等三。研究性研究，使用式卷，於支付制度施九月後，我地教院(含)以上的127家院行寄卷查，最後回收之有效卷共75份，回收率59.1%。果：了因院支付制度的施，本院在面上用最多的策略教育院同仁解制度之情形及其影；在管理面上，用最多的策略加部管理，及建立完善成本制度；在技面上，用最多的策略建立院或之制。研究果亦示，院及院在支付制度施後住院服量的化情形，於本院在面所取的策略有著性的影力。而院等、院所市的程度、及院在支付制度施後收入的化情形等三，影本院在管理面所取的策略。：本研究院特性、院所市之程度於院因支付制度所取之策略有著影力。本研究的研究於院管理者取的策略，以因境的力有所助益。(台2004；23(2)：150-158)
：支付制度、策略方案
Factors associated with strategic choices of hospitals
in response to the global budget payment system Objectives: Due to the continuous revolutions in the national health insurance payment system, the management of hospitals have been seeking a better strategy to cope with these changes. The purpose of this study was to explore the factors associated with strategic choices of hospitals in response to the global budget payment system. Methods: This study employed Shortell掇 model by dividing strategies into three types: institutional-level response, managerial-level response, and technical-level response. This cross-sectional study investigated 127 hospitals in Taiwan (including district teaching hospitals and higher levels) by sending them structured questionnaires. The response rate was 59.1% with 75 hospitals returning the questionnaires. Results: The results of the study indicated that in respect to institutional-level response to the global budget payment system, most hospitals adopted the strategy of further educating their staff about the major changes in the global budget payment system. In regard to managerial-level response, the majority of hospitals adopted the strategy of enhancing their financial management and constructing a better cost accounting system. Finally, for the technical-level response, most hospitals employed the strategy of establishing a referral system. The results of the study also showed that strategies at the institutional-level were influenced by hospital ownership and service volume following the implementation of the global budget payment system. Hospital level, degree of market competition, and change in operating income after the implementation of the global budget payment system were significant indicators of the strategies at the managerial-level that the hospitals would adopt. Conclusions: The results demonstrated that the characteristics of the hospital and degree of market competition were significant indicators of strategies that hospitals would adopt in response to the global budget payment system. (Taiwan J Public Health. 2004;23(2):150-158)
Key Words: global budget payment system, strategic choices
[ 回到目 ]
文章定位：
