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醫院因應總額支付制度之策略方案及其相關因素探討

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醫院因應總額支付制度之策略方案及其相關因素探討

莊念慈;黃國哲;許怡欣;郭乃文;魏中仁

Abstract

目標;有鑒於健保支付制度之改變,對醫院經營管理之影響甚鉅,因此各醫院莫不積極採取因應 策略。本研究及探討醫院對於總額支付制度之實施,所採取因應策略之類型,並分析影響其策略 選擇的相關因素。方法;本研究依據Shortell的理論架構,將醫院的策略類型氛圍機構層面、管 理層面、及技術層面等三類。研究設計採橫斷性研究,使用結構式問卷,於總額支付制度實施九 個月後,針對我國地區教學醫院(含)以上的 127 家醫院進行郵寄問券調查,最後回收之有效問 卷共計75 分,回收率為 59.7%。結果:為了因應醫院總額支付制度的實施,樣本醫院在機構 層面上採用最多的策略為教育院內同仁瞭解高制度之情形及其影響;在管理層面上採用最多的策 略為加強內部財務管理,及建立完善成本會計制度;在技術層面上,採用最多的策略則為建立院 際間轉診或轉檢之機制。研究結果亦顯示,醫院權屬別及醫院在總額支付制度實施後住院服務量 的變化情形兩個變項,對於樣本醫院在機構層面所採取的策略有險著性的影響力。而醫院評鑑等 級、醫院所處市場的競爭程度、及醫院在總額支付制度實施後總營運收入的變化情形等三個變 項,則會影響樣本醫院在管理層面所採取的策略。結論;本研究發現醫院特性、醫院所處市場之 競爭程度對於醫院因應總額支付制度所採取之策略有影響力。本研究的研究發現對於醫院經營管 理者採取適當的策略,以因應環境的變動壓力當有所助益。

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