總額支付制度實施後醫院的適應策略分析

Objectives: The current study aimed to explore adaptation strategies utilized by Taiwan's hospitals under the global budget system and examine the factors which influence the types of adaptation strategies among the various hospitals. Methods: The study population included all 462 district (and higher level) hospitals in Taiwan using 2004 data. Structured questionnaires were mailed to the responsible management personnel for the hospitals in late March 2005. After two rounds of mailing, the final effective sample size was 194, with an effective response rate of 42.0%. Results: The results of factor analysis identified two types of adaptation strategies: 1) market-oriented strategy and 2) resource-based. The total explained variance by the two factors was 64.02%. Moreover, the sample hospitals were more likely to execute market-oriented strategies. Predictive factors of a hospital carrying out market-oriented strategies included hospital ownership, the level of the hospital, and the hospital's teaching status. Conclusions: The empirical research has demonstrated that Taiwan's hospitals employ adaptation strategies which are market-oriented and resource-based under the global budget system, and the former strategy is more prevalent. Moreover, hospital characteristics are related to a hospital's adoption of market-oriented strategies.