The Impact of Transaction Cost on Interorganizational Cooperation–The Case study of Taiwanese Hospitals

[[abstract]]民國八十四年開始實施全民健保，至今給付制度的改變，國內醫療產業面對健保給付不確定下，造成成本的提升。在這種情況下，醫院的醫療部門是否採取跨組合作或是自行營運，這也是醫院經營上面對的難題。且外部組織進行跨組織合作時，會因為人的有限理性，可能會產生投機行為，造成醫院利潤的短少。若此，醫院則會可慮將此部門自行營運，而自行營運需要尋找到合適的專任醫師，但是尋找專任醫師的難易、成本，會影響醫院是否採取跨組織合作。因此本研究希望對於未來有意研究醫療組織合作相關議題者或是能給醫院決策，提供一套初步的評估工具，方便對於醫療跨組織合作或自行開發時的決策做為參考依據。因此，本研究之目的如下： 一、跨組織合作中，進行跨組織合作的部門，有何種特性？ 二、這些特性對跨組織合作的傾向為何？ 研究發現：當醫療部門所呈現的資產專屬性越高時，醫院越可能採取自行營運；且醫院內部的所有醫療部門所呈現的投機行為皆低；環境不確定越高時，醫院越有可能採取自行營運；有些專任醫師和外部組織簽訂合作契約，造成醫院尋找合適的專任人才時，成本相對提升許多，在此情況下，醫院會採取跨組織合作的方式，來減少尋找合適的專任醫師所產生的成本。 關鍵字：交易成本、資產專屬性、投機行為、環境不確定性、搜尋成本、跨組織合作[[abstract]]National Health Insurance was established in 1995, the payment system of National Health Insurance varied. As domestic medical industry needs to face the uncertainty of NHI, the cost of hospital's medical department increases. In this situation, whether to take the way of cross-organizational cooperation or the way of self-operating, turn out to be the difficulty faced by the hospital management. External organizations and inter-organizational cooperation, influenced by the limitation of rationality of human beings, may generate speculative behavior, resulting in shortage of hospital profits, and therefore this sector of the hospital is its own operations, while operating their own need to find a suitable full-time physician. But the difficulty to find full-time physicians and the cost will affect the hospital’s decision to take cross-organizational cooperation. This study aims to future development of related issues of health care organizations or give hospital decision-making, then provide a preliminary assessment tool to facilitate decision process when the medical inter-organizational cooperation, or self-developed, serves as reference basis. Therefore, the purposes of this study are as follows: I.Cross-organizational cooperation, inter-organizational co-operation department, what is the dominating features? II.Those characteristics of cross-organizational cooperation tendency ? The study found that when asset specificity, the higher the medical department presented the hospital the more likely to take its own operations, and all medical departments of the hospital within the present speculative behavior are low. The higher the environmental uncertainty, the hospital is more likely to take their own operations, some full-time physicians and external organizations signed a cooperation contract, causing hospital’s attempt to find suitable full-time personnel, the cost is relatively improves a lot. In this case, the hospital will be taken by way of the cross-organizational cooperation, to reduce the cost of exploring suitable full-time physicians. Keywords：Transaction costs, asset specificity, opportunistic behavior, environmental uncertainty, search costs, cross-organizational cooperation[[note]]碩