探討機率性環境下國內教學醫院技術無效率之誤差

Abstract

過去有關醫院服務效率實證研究認為 資料包絡法（DEA）與機率性前緣法（SFA） 為相互替代分析方法，本研究採取結合 DEA與SFA成為兩段式分析模式來探討醫 療機構特質、環境制度因素以及醫院服務 效率之關係。本研究以地區教學以上綜合 醫院為樣本，選取醫療服務之投入與產出 項目，並且調整各醫院病床資本投入與住 院服務產出差異性後，採用改良DEA 區辨 能力問題之比例效率競賽模式來衡量各年 度相對於基期效率值，再透過SFA 來探討 各項影響因素與我國綜合醫院服務效率之 間關聯性。本研究結果發現：私立醫院服 務效率較公立醫院高；醫學中心效率表現 較其他等級醫院來得佳；專科服務類別愈 廣之醫院服務效率也愈佳；所在市場競爭 預激烈則服務效率也愈差；最後，實施全 民健保對於醫院服務效率短期會產生負面 影響。

Previous studies of hospital efficiency apply either DEA or SFA in a relative efficiency measurement. The theme of this study focuses on combining deterministic DEA with SFA to open additional avenues for evaluating hospital efficiency, and consider the effects of institutional and environmental characteristics on it. This study employs panel data with 104 teaching hospitals in Taiwan for six years. Moreover, after selecting input and output items about medical services and adjusting the severity of inpatient illness, the hospital efficiency scores are measured through two-person ratio efficiency games in stage one. In stage two, the results of stage one are incorporated in the model of SFA to be estimated, and exploring the relationship between hospital efficiency and its determinants. The major findings of this study are as follow: (1) Because of financial or operational burdens, private hospitals were much more efficient than government-owned hospitals, and medical centers were more efficient than others. (2) The scope of services were positively and significantly associated with efficiency, which means that economy of scope may exist in hospital services market. (3) The more competitive the environment hospitals face, the more inefficient these hospitals behaved. (4) Hospital efficiencies decreased after the implementation of the National Healthcare Insurance, but apparently it probably was a transient effect only.