林能白Lin, Neng-Pai臺灣大學:醫療機構管理研究所簡聖哲Chien, Sheng-CheSheng-CheChien2010-05-052018-06-292010-05-052018-06-292009U0001-1302200909153800http://ntur.lib.ntu.edu.tw//handle/246246/180799台灣之地區醫院在民國八0年代之前的醫療不足時期，擔負著次級醫療區或是偏遠地區之第一線就醫之功能。由於台灣醫療制度在民國84年開始實施健保制度，以及民國91年總額給付制度開始上路，加上大型醫院紛紛成立，造成點值出現打折的現象；還有私人財團進入醫療市場區塊，診所林立，醫療環境競爭更趨激烈。由於台灣的地區醫院營收面，約有百分之九十五來自於健保醫療給付，故在健保給付醫療費用下，會出現收入越來越減少的現象。因此經過兩次大洗牌，以社區醫療骨幹的地區醫院，由健保實施前民國78年的750多家，到96年底只剩300多家，地區醫院歇業情況非常嚴重，許多地區醫院必須思考這個嚴肅的課題，所以思考醫院轉型已經是刻不容緩。研究以質性研究的文獻探討找出許多醫院轉型的方向，再經轉型成功的地區醫院深度訪談確認轉型的方向，有策略聯盟，外包委外經營，多角化，自費，社區醫院，專科醫院，以及醫療社團法人等等七種類型，最後個案研究分析出醫院轉型的關鍵。研究結果發現，利用SWOT分析的優勢-機會分析出來的10項優勢機會特性，可找出地區醫院許多轉型方向的建議，希望能夠提供一個方法對尋求轉型的地區醫院有幫助。In Taiwan, the medical system was insufficient resources before 1980. The local community hospitals had the most important function that was the front line to help patients in the remote districts. The National Health Insurance (NHI) was established in 1995. In addition, a management-determined system of global budgeting and expenditure limits was beginning in 2002. At the same time more hospitals were established and existing hospitals were expanded their services were. With the advent of NHI, many corporations are interested opportunity in this industry, because the insurance and payment system would be standardization. However, this situation cause a lot of hospitals wants to share this market. The medical industry became very competitive in Taiwan.he hospital income has 95% from the insured of NHI. Because of the density of hospitals vying for the aggregate of payment dollars, the amount a given hospital sees is less each year. In fact, some smaller hospitals are becoming insolvent as a result of this constriction. There were over 750 local hospitals before 1989 in Taiwan, but there were only 300 remaining in 2007. Smaller hospitals are recognizing this serious problem and try to think about the transformation strategy in the hospital. he study uses method of Qualitative Research which examines the successful structures of current local hospitals. The causes of their success include Strategic Alliances, Outsourcing services, Diversification, Deductibles, Community Hospitals, Specialized Hospitals and Medical Corporate Aggregates. These 7 structures were analyzed and infer that strategies for hospital transformation.he study uses the method of SWOT analysis, particularly strengths and opportunities. Also, it has determined 10 strategies for smaller hospitals that want to transform their status or financial solvency. Finally, this study will provide some suggestions to help hospital improvement and transformation of strategy.口試委員審定書………………………………………………………………………0謝………………………………………………………………………..…...………i文摘要………………………………………………………………….……...……ii文摘要………………………………………………………….…..……...….…... iii錄……………………………………………………………………….…………..iv目錄……………………………………………………….…………………..……vi目錄………………………………………………………….……..…..………... viii一章 緒論………………………………………………….………………………1一節 研究動機…………………………………..…………………………1二節 研究背景……………………………………..………………………5三節 研究目的..…………………………………..………………………..7四節 研究貢獻……………………………………..………………………8二章 文獻探討………………………………………….…………………………9一節 地區醫院…………………………………..………………………....9二節 全民健康保險………………………………..………………….….11三節 總額預算支付制................................………..……………………..17四節 浮動點值…………………………………………………………26五節 轉型與變革，策略管理，策略架構…..………..…………………34六節醫院轉型策略………..……………………………………………44三章 研究方法…………………………………………………………………..69一節 研究設計…………………………………..………………………..69二節 研究流程……………………………………..……………………..79三節 研究範圍…………………………………..………………………..80四章 研究結果………………………………………….………………………..81一節 個案研究…………………………………..………………………..81二節 個案轉型策略綜合整理…………………..………………………110五章 討論與建議……………………………………….………………………117一節 優勢與機會特性分析討論………..……..………………………..117二節 內部劣勢與外部威脅導向討論…………..………………………125三節 使用轉型分析表及解決問題分析表尋求醫院轉型方向策略..…128四節 建議…..………………………..…………………….…………..…129五節 研究限制與後續研究建議……..………………….………………131考文獻………………………………………………………….………………..132錄1 : 個案醫院訪談對象表…………………………………………………..140錄2 : 五大議題架構訪談大綱………………………………………………..141錄3 : A醫院2008年五項構面積效.................................................................143錄4 : B醫院2008年五項構面積效………………………………………….145錄5 : C醫院2008年五項構面積效………………………………………….147錄6 : D醫院2008年五項構面積效……………………………………….....149錄7 : E醫院2008年五項構面積效……………..……………..…………….151application/pdf676978 bytesapplication/pdfen-US醫院轉型策略策略聯盟外包委外經營多角化自費社區醫院專科醫院醫療社團法人Hospital transformation StrategyStrategic AlliancesOutsourcing ServicesDiversificationCommunity HospitalSpecialized HospitalMedical Corporation AggregateDeductiblesthesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/180799/1/ntu-98-P94843002-1.pdf