[[alternative]]A study on congestion efficiency and quality efficiency of hospital

[[abstract]]背景與目的全民健康保險自1995年3月開辦以來，台灣醫療產業產生了巨大的變化，全民健保制度不但降低民眾就醫成本與提升就醫可近性。隨著醫療技術進步，民眾對醫療服務的要求已經不再是量的滿足，因此民眾積極尋求高品質及多樣化之醫療照護服務。近年來，由於民眾就醫可得性增加，醫療服務量也隨之大幅提升，使得各醫療院所常常充斥著求診的病人，在如此不均之醫病比例之下，日益增加之醫療服務量，是否會影響醫療品質?為此本研究利用資料包絡分析法，探討醫療服務之提供與日益增加之醫療服務量，醫院投入之資源投入是否有擁擠效率，及探討其對醫療服務品質的影響。研究方法本研究資料來源為衛生福利部統計處之「全國醫療現況檔以及醫院醫療服務量檔」，民國101年之醫院營運資料。經檢查、整理，並排除遺漏值後，最後總計89家醫院為本研究之樣本，其中包括民國101年通過醫院評鑑之醫學中心5家、區域醫院23家、地區醫院61家。研究採用DEA-SOLVER-LV(V3)統計分析軟體，計算變項之描述性統計分析、Pearson相關係數檢視投入變項與產出變項之關係程度、以資料包絡分析法探討醫院之擁擠效率及品質效率。 研究結果研究結果顯示，產出變項為門診人次、急診人次、住院人日、手術人次時，不分醫院層級89家醫院中，有36家醫院有擁擠效率，其中1家為醫學中心，11家為區域醫院，24家為地區醫院；投入變項不變情況下，產出變項為門診人次時，2家醫學中心有擁擠效率；19家區域醫院出現擁擠效率；39家地區醫院有擁擠效率。研究結果顯示，醫療機構模型3之品質效率中，醫學中心顯示沒有品質無效率之現象發生；23家區域醫院中有10家為品質無效率；61地區醫院中有29家醫院為品質無效率。模型1中，擁擠效率伴隨品質無效率的醫療機構，11家具擁擠效率之區域醫院中，有6家為品質無效率(佔54.54%)；24家具擁擠效率之地區醫院中，有21家為品質無效率(佔87.50%)；模型2中，擁擠效率伴隨品質無效率的醫療機構，19家具擁擠效率之區域醫院中，有8家為品質無效率(佔42.10%)；39家具擁擠效率之地區醫院中，有22家為品質無效率(佔56.41%)。討論研究結果我們發現，門診人次之醫療服務量多寡，確實是影響醫院擁擠效率之主要原因；本研究樣本中存在擁擠效率的醫療機構，其品質效率也有較差的表現，且主要發生在地區醫院，本研究推測醫療機構有擁擠效率發生時之品質效率也較差，主要原因為低層級醫院以高層級醫院為標竿，因此資源過度投入，又無相對的醫療服務量，而導致醫療資源無法做最適分配，導致資源浪費，長期下來可能造成醫療財務困境。[[abstract]]Background and PurposeSince March 1995, medical industries have had huge impacts because of the implementation of the National Health Insurance in Taiwan (NHI). NHI system eliminates the economic barrier of people to receive healthcare service but also enhances the utilization of healthcare service. Recently, people have received the sufficient healthcare service in Taiwan and thus would seek for high quality healthcare service. Because of the information asymmetric, people may believe the high level hospitals may provide better healthcare survive quality. Therefore, people may centralize to the medical center for better quality service and thus cause medical centers full of patients. In this study, we employ Data Envelopment Analysis (DEA) to investigate the efficiency of healthcare services and calculate the congestion efficiency of each hospital in TaiwanMethodsIn this study, the data resource is obtained from both Ministry of Health and Welfare and Department of Statistics in Ministry of the Interior, including hospital operational data in 2012. We analyze 89 hospitals in Taiwan, including 5 medical centers, 23 regional hospitals and 61 district hospitals. The data is analyzing by using DEA-SOLVER-LV(V3) statistical analysis software and descriptive statistics, and Pearson correlation coefficient is also adopted to describe the characteristics of data. ResultsIn Model 1, the results show that the congestion is existed in 36 hospitals, including 1 medical centers, 11 regional hospitals, and 24 district hospitals. In Model 2, the congestion is existed in 39 hospitals, including 2 medical centers, 19 regional hospitals and 39 district hospitals. In model 3, 10 regional hospitals and 29 district hospitals exist quality inefficiency. DiscussionAccording to the results, the amount of outpatient is an important factor to affect the efficiency and may cause low quality efficiency. We suggest that people may centralize to medical centers for better healthcare service, so the utilization of healthcare service is high. On the contrary, the amount of patients is low in the district hospitals that may cause the low utilization of healthcare service. Therefore, the congestion may exist in the district hospital because of excessive healthcare service