Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/20842
標題: 市場競爭對醫院績效影響
The Effect of Market Competition on Hospital Performance
作者: 鄭文賢
Cheng, Wen-Xian
關鍵字: market competition
市場競爭
hospital performance
Herfindahl Index
醫院績效
賀芬達指數
出版社: 企業管理學系所
引用: 中文文獻 盧瑞芬、謝啟瑞(1988)。醫療經濟學。Pauly, S. and Rice。台北:學富。 于卓民、巫立宇(2001)。集中度變動之競爭意涵—臺灣前一百大製造業之實證。國立政治大學學報,82,97-123。 王信仁 (1992)。醫學中心與區域醫院之效率評估-資料包絡法之運用。高雄醫學院碩士論文。 田月枝(2000)。市場競爭對醫療費用的影響—以全膝關節置換術為例。陽明大學醫務管理學研究所碩士論文。 朱子斌 (1998)。非都市地區醫院競爭策略之研究:以台中縣大甲地區為例,國立陽明大學醫務管理研究所碩士論文。 朱僑麗、薛亞聖、江東亮 (2000)。醫師人力供給的多寡是否影響被保險人的門診利用-1994 年國民醫療保健調查之發現。中華公共衛生雜誌,19(5),381-388。 江東亮 (1999)。醫療保健政策— 台灣經驗。台北:巨流圖書公司。 江東亮、文羽苹、謝瓊慧 (2001)。醫師與病床供給對醫療費用總額之影響。行政院衛生署八十九年度委託研究計畫期末報告, 江東亮、胡德偉(2000)。美國發展管理式照護的經驗與啟示。中華衛誌19(5),340-55。 余珮琦(2003)。住院醫療服務市場之供給誘發需求現象探討。臺灣大學衛生政策與管理研究所碩士論文。 吳肖琪、吳義勇、未慧凡、林嘉彥、李鐘祥、張錦文、藍忠孚(2002)。我國醫院醫療品質指標使用之情形。醫療品質雜誌2(2)。 吳佳蓉(1996)。台灣地區癌症照護市場分析。陽明大學醫務管理學研究所碩士論文。 李一鑫(2000)。醫院購置高科技醫療儀器與市場結構的關聯。中央大學產業經濟研究所碩士論文。 李孟勤 (1999)。全民健保制度下醫療品質與醫院醫療品質現況調查與分析。國立台灣大學公共衛生研究所碩士論文。 李順安 (1998)。非都市地區醫院門診醫療利用之研究:顧客區隔法之應用。國立陽明大學醫務管理研究所碩士論文。 林四海、楊惠真、陳墩仁、邱惠慈 (2000)。中部地區醫療服務高低利用者之相關因素研究。醫管雜誌,1,57-69。 林秀碧(1997)。醫院服務區域的界定與市場競爭程度之分析—以台中市某區域醫院為例。臺灣大學醫療機構管理研究所碩士論文。 林秀碧、楊銘欽、葉宏明(2001)。醫院服務區域的界定與市場競爭程度之分析—以台中市某區域醫院為例。醫護科技學刊,3(1),67-83。 林恆慶等(2001)。管理式醫療介紹。中華衛誌,20(5),331-336。 金家玉(2000)。市場競爭對醫院產出表現的影響。陽明大學公共衛生研究所碩士論文。 金家玉(2000)。市場競爭對醫院產出表現的影響。陽明大學公共衛生研究所碩士論文。 邱清華、李玉春 (1999)。公共衛生學。台北:華杏出版股份有限公司。 邱惠雀 (1995)。地區醫院人力資源配置與營運績效之相關研究。國立陽明大學醫務管理研究所碩士論文。 洪維河 (2001)。台灣住診市場分析。國立台灣大學衛生政策研究所博士論文。 孫光芬(1990)。醫院的市場研究。醫院雜誌,27(3),258-262。 徐幸妙(1999)。全民健保實施前後臺灣癌症照護市場之變化。陽明大學醫務管理學研究所碩士論文。 張苙雲 (1998)。醫療與社會—醫療社會學的探索。台北:巨流圖書公司。 張慈桂 (1992)。公私人醫院生產力之比較研究。國立陽明大學公共衛生研究所碩士論文。 張鍚惠、王巧雲、蕭家旗 (1998)。我國地區醫院經營效率影響因素之探討。管理評論,17,21-38。 莊漢宗(2001)。新醫院成立對當地醫院之影響-1996-1999 年實證資料分析。臺灣大學醫療機構管理研究所碩士論文。 陳正倉、林惠玲(1997)。台灣產業集中度水準及其變動之研究。經濟論文叢刊,25(3),335-367。 陳佩妮(1996)。醫療品質與經營績效關係之研究-以台北醫療區域各級醫院為例。國立台灣大學公共衛生所醫管組。 陳曉真 (2000)。應用地理資訊系統分析全髖關節置換手術醫療利用之市場競爭。國立陽明大學醫務管理研究所碩士論文。 陳麗娟 (1998 )。台灣省立醫院營運績效與策略之研究。國立陽明大學 公衛研究所碩士論文。 黃伯偉(2003)。市場競爭程度對醫院行為的影響—以昂貴醫療處置採用為例。臺北醫學大學醫務管理學研究所碩士論文。 黃芬芬(1999)。從醫院服務量來看誘發性需求之研究。臺灣大學醫療機構管理研究所碩士論文。 黃賽青 (1998)。醫院生產力的分析研究。台大醫管所碩士論文。 葉鴻興(1999)。醫院策略群與經營績效之研究—以台北市之區域及醫 院為例。中國醫藥學院醫務管理研究所碩士論文 彭彥瑋、陳柏元、彭朱如、林金賢、黃銘章(2005)。醫院策略與環境 外部配適對績效影響之實證研究。醫務管理期刊,6(4),399- 428。 馮茂倉(2003)。牙醫門診總額支付制度對牙醫健保醫療資源分配的影響。高雄醫學大學口腔衛生科學研究所碩士論文。 楊玉冠 (1998)。醫院住院量成長因素分析。國立陽明大學醫務管理研究所碩士論文。 楊漢汨、王美芳 (1992)。我國醫院評鑑工作之回顧與展望。醫院雜院,25,19-94。 楊蕙旭 (1995)。台灣地區醫院生產力之決定因素。國立台灣大學公共衛生研究所醫院管理組碩士論文。 楊麗雪(2001)。西醫基層醫療機構競爭程度與門診醫療費用及次數。臺北護理學院醫護管理研究所碩士論文。 董鈺琪、鍾國彪、張睿詒 (2000)。綜合教學醫院推行品質管理與營運績效之關係研究。中華衛誌,19,221-230。 劉容華(1999)。臺灣小型醫院新設與歇業之影響因素。臺灣大學衛生政策與管理研究所碩士論文。 劉容華、江東亮 (2001)。台灣小型醫院新設與歇業之影響。台灣公共衛生雜誌,20(1),27-33。 劉雅芳 (1993)。從生產效率觀點探討綜合醫院醫護人力比的研究。中國醫藥學院醫務管理學研究所碩士論文, 劉嘉玲(1994)。醫院服務區域的定義與分析—以某地區醫院為例。陽明大學醫務管理研究所碩士論文。 蔡偉德、李一鑫(2002)。醫院非價格性競爭與市場結構:醫院購置高 科技醫療儀器之實證研究。經濟論文30(1),57-78。 劉碧昭 (1991)。教會醫院醫療體係之評估。中國醫藥學院醫務管理研究所碩士論文。 蔡偉德、李一鑫(2002)。醫院非價格性競爭與市場結構:醫院購置高科技醫療儀器之實證研究。經濟論文,30(1),57-78。 鄭守夏 (1987)。台灣地區小型醫療院所生產力之調查研究。國立台灣大學公共衛生學研究所碩士論文。 鄭守夏、劉林義、張毓宏(2001)。新設大型醫院對當地基層診所的影響評估-第一部份:供給與利用的變化。台灣公共衛生雜誌,20(1),52-60。 鄭勝輝 (1994)。從群體生態學的觀點探討醫院環境對其營運績效之影響。國立陽明醫學院醫務管理研究所論文。 盧瑞芬、謝啟瑞(2000)。醫療經濟學。臺北:學富文化。 盧瑞芬、謝啟瑞(2003)。臺灣醫院產業的市場結構與發展管理趨勢分析。經濟論文叢刊,31(1),107-153。 謝琇蓮、江東亮 (1994)。台灣地區醫院歇業及新設之決定因素。中華公共衛生雜誌,13(6),453-458。 藍忠孚、錢慶文 (1991)。省市立醫院生產力之研究— 以DEA 方法研究醫院生產力之運用。行政院衛生署七十九年度委託研究計畫期末報告。 羅紀瓊、石淦生、陳國樑 (1996)。醫院效率之衡量—DEA方法之應用。中央研究院經濟研究所經濟論文,24(3), 375-396。 內政部統計處(2001)。統計名詞定義。2001 年11 月25 日摘自內政部 統計資訊網http://www.moi.gov.tw/W3/stat/home.asp 英文文獻 Austin Douglas V. (1988). The Herfindahl-Hirschman index: analyzing its effectiveness. Issues in Bank Regulation, 12(1), 28-32. Ashton, T. and Press, D. (1997). Market concentration in secondary health services under a purchaser-provider split: The New Zealand experience. Health Economics, 6(1), 43-56. Allen, R. (1992). Policy implication of recent hospital competition studies. Journal of Health Economics, 11(3), 347-351. Beckham J.D. (1984). A strategic alternative for community hospital—the principle of peripheral penetration. Journal of health care management, 4, 37-40. Bamezai A., Zwanziger J., Melnick GA.and Mann JM. (1999). Price competition and hospital cost growth in the United States (1989-1994). Health Economics, 8, 233-243. Clement JP. (1997/98). Dynamic cost shifting in hospitals : evidence from the1980s. Inquiry, 34(4), 340-50. Chirikos TN.and White SL. (1987). Competition in health care markets and the development of alternative forms of service delivery. Health policy, 8, 325. Coyne, J.S (1982). Hospital Performance in Muti-Hospital System:A Comparative Study of System and Independent Hospital. Health Service Research, 17(3), 303-329 Carter RB., Massa LJ.and Power ML.( 1997). An examination of the efficiency of proprietary hospital versus non-proprietary hospital ownership structures. Journal of Accounting and Public Policy, 16: 63-87. Dranove D. and Ludwick R. (1999). Competition and pricing by nonprofit hospitals: a reassessment of Lynk’s analysis. Journal of health economics, 18, 87-98. Dranove, D., Shanley, M. and White,W.D.(1993). Price and Concentration in Hospital Markets:The Switch from Patient-Driven to Payer-Driven Competition. Journal of Law and Economics, 36, 179-204. Dranove D. and Shanley M. (1989) . A note on the relational aspects of hospital market definitions. Journal of health economics, 8, 473-478. Dranove, D., Shanley, M., and Simon, C. (1992). Is hospital competition wasteful. The Rand Journal of Economics, 23(2), 247-262. Davis, K.(1971). Relationship of hospital price and costs. Applied Economics, 4,115-125. De Alessi L. (1980). The economics of property rights: a review of the evidence. Research in Law and Economics , 73, 64-81. Elzinga KG. and Hogarty TF. (1973). The problem of geographic market delineation in antimerger suits. Antitrust Bulletin, 18, 45-81. Freidman,B. and Shortell, S.(1998). The Financial Performance of Selected Investor-owned and not-for-profit System Hospitals Before and After Medicare Prospective Payment. Health Service Research, 23, 237-267. Fottler, M.D. (1987). Health Care Organizational Performance: Present and future. Journal of Management, 13(2), 367-391. Fleming, S.T., H.A.Williamson, Jr,L.L.Hicks, and I.Rife. (1995). Rural Hospital Closures and Access to Service .Hospital and Health Services Administration, 40(3), 247-262. Franks, P., Williams, G.C., Zwanziger, J., Mooney, C., and Sorbero,M.(2000). Why do physicians vary so widely in their referral rates. Journal of General Internal Medicine, 15(3), 163-168. Fornier GM., Mitchell JM. (1992). Hospital costs and competition for services: a multiproduct analysis. Review of Economics and Statistic, 74(4), 627-634. Frech III HE. (1996). Competition and Monopoly in Medical Care. Washington. DC: The AEI Press.` Fuchs, VR. (1979). Economics, Health, and Post-Industrial Society. Milbank Memorial Fund Quarterly, 57(2), 153-182 Frech III HE., Mobley LR. (1996). Resolving the impasse on hospital scale economies: a new approach. Applied Economics, 27, 286-96.Garnick, D.W., Luft, H.S., Robinson, J.C., and Tetreault, J. (1987). Appropriate measures of hospital market areas. Health Services Research, 22(1), 67-89. Gift TL., Arnould R. and Debrock L. (2002). Is healthy competition healthy? New evidence of the impact of hospital competition. Inquiry, 39, 45-55. Goody B. (1993). Defining rural hospital markets. Health services research, 28(2),183-200. Grosskoppf S. and Valdmanis V.(1993). Evaluation Hospital Performance With Case-mix-adjusted Outputs. Medical Car, 31, 525-532. Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80, 223-255. Gruca, Nath. (1994). The impact of marketing on hospital performance. Journal of Hospital Market, 8(2), 87-112. Hadley J. and Swartz K.(1989). The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage. Inquiry, 26:35-47. Hartz AJ., Krakauer H., and Kuhn EM. (1989). Hospital Characteristics and Mortality Rates. The New England Journal of Medicine, 321(25), 1720-1725. Jonskow PL. (1980). The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital. Bell Journal Economic, 11, 421-447. Keeler E.B., Melnick G. and Zwanziger J.(1999). The changing effects of competition on non-profit and for-profit hospital pricing behavior. Journal of Health Economics, 18, 69-86. Kessler DP. (2000). McClellan MB. Is hospital competition socially wasteful? Q J Econ, 115, 577-615. Kopit, W. G. and McCann, R. W. (1988). Toward a definitive antitrust standard for nonprofit hospital mergers. Journal of Health Politics, Policy and Law, 13(4), 635-663. Luft H S, Robonson J C, Garnick D W, Maerki S C, and McPhee S J (1986). The Role of Specialized Clinical services in Competition among Hospitals. Inquiry, 23, 83-94 . Lynk WJ. (1995). Nonprofit hospital mergers and the exercise of market power. Journal of law and economics, 38, 437-461. Luft HS., Garnick DW. and Robinson JC.(1987). Tetreault J., Appropriate measures of hospital market area, Health Services Research, 22(1), 69-89. Luft HS. (1988). How hospital competition fueled the medical arms race. Trustee, 41(7), 18. Long MJ., Chesney JD. and Fleming ST. (1990). A Reassessment of Hospital Product and Productivity Changes Over Time. Health Care Financing Review, 11(4), 69-77. Melnick G, J. Zwanziger, A. Bamezai, and R. Pattison(1992). The effects of market structure and bargaining position on hospital prices. Journal of Health Economics, 11, 421-47. Manheim LM., Bazzoli GJ. and Sohn MW.(1994). Local hospital competition in large metropolitan areas. Journal of Economics and Management Strategy, 3, 143-167. Miller RA. (1982). The Herfindahl-Hirschman index as a market structure variable: an exposition for antitrust practitioners. The Antitrust Bulletin, 27, 593-618. Morrisey MA. (2001). Competition in hospital and health insurance markets: a review and research agenda. Health Services Research, 36(2), 191-221. Manheim LM., Bazzoli GJ. and Sohn MW.(1994). Local hospital competition in large metropolitan areas. Journal of Economics & Management Strategy, 3, 143-167. Noether M. (1988). Competition among hospitals. Journal of Health Economics,7(3), 259-84. Nguyen NX. and Derrick FW. (1994). Hospital markets and competition: implication for antitrust policy. Health Care Management Review, 19(1), 34-43. Propper C. (1996). Market structure and prices: The responses of hospitals in the UK National Health Service to competition. Journal of Public Economics, 61, 307-55. Phibbs C.S. and Robinson J.C. (1993). A variable-radius measure of local hospital market structure. Health Services Research, 28(3), 313-24. Pabón Lasso, Hipólito. (1986). Evaluating hospital performance through simultaneous application of several indicators. Bulletin of the Pan American Health Organization, 20(4):341-357. Paul, J. (1980). The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital. Bell Journal of Economics, 11,421-447. Rivers PA. and Bae S.(1999). Hospital competition in major U.S. metropolitan areas: an empirical evidence. Journal of Socio-Economics, 28, 597-606. Robinson, J.C. and Luft, H.S. (1985). The impact of hospital market structure on patient volume, average length of stay, and the cost of care. Journal of Health Economics, 4, 333-56. Robinson JC.( 1988). Hospital quality competition and the economics of imperfect information. Milbank Quarterly; 66(3), 465-481. Robinson JC. and Luft HS.(1987). Competition and the cost of hospital care, 1972 to 1982. Journal of the American Medical Association, 257(23), 3241-5. Robinson J. and Luft HS. (1987). Competition and the cost of hospital care, 1972-1982. Journal of the American Medical Association, 257(23), 3241-3245. Robinson J. and Luft HS. (1988). Competition, regulation, and hospital costs, 1982-1986. Journal of the American Medical Association, 260(18), 2676-81. Robinson JC., Garnick DW. and MePhee SJ.(1987). Market and regulatory influences on the availability of coronary angioplasty and bypass surgery in U.S. hospitals. New England Journal of medicine, 317(2), 85-90 . Shortell, S.M., E.M.Morrison and B. Friedman.(1992). Strategic Choices for America''s Hospital: Managing Change in Turbulent Times. San Francisco:Jossey-Bass. Succi, M., Lee, Shoou-Yih D. and Alexander, J. A. (1997). Effects of market postion and competition on rural hospital closures. Health Services Research, 31(6), 679-699. Shortell, S. and Hughes, E.F.X. (1988). The effects of regulation, competition, and ownership on mortality rates among hospital inpatients. New England Journal of Medicine, 318(17), 1100-1107. Samuelson PA. and Nordhaus WD.(1985). Economics. Singapore: McGraw-Hill Book Company. Shepherd WG. (1997). The Economics of Industrial Organization: Analysis, Markets,Policies. New Jersey: Prentice-Hall. Sleuwaegen Leo E., De Bondt, Raymond. and Dehandschutter, WV (1989). The Herfindahl index and concentration ratios revisited. Antitrust Bulletin, 34(3), 625-40. Succi, M., Lee, Shoou-Yih D. and Alexander, J. A. (1997). Effects of market postion and competition on rural hospital closures. Health Services Research, 31(6), 679-699. Sherman HD.(1984). Hospital efficiency measurement and evaluation empirical test of a new technique. Medical Care, 22(10), 922-938. Topping, S., Carroll, C.A. and Lindley, J.T.(1989). The Effects of PPS on the Performance of Investor-Owned Multi-hospital systems : An event study. Paper presented at the Southern Management Meeting. Town R. and Vistnes G. (2001). Hospital competition in HMO networks. Journal of health economics, 20(5), 733-53. Valdmanis V. (1990). Ownership and Technical Efficiency of Hospital. Medical Care, 28, 552. White, S. L. and Chirikos, T. N. (1988). Measuring hospital competition. Medical care, 26(3), 256-262. Wooley M.J. (1989). The competitive effects of horizontal mergers in the hospital industry. Journal of health economics, 8, 271-92. Wilson GW. and Jadlow JM.(1982). Competition, profit incentives, and technical efficiency in the provision of nuclear medicine services. Bell Journal of Economics, 13(2), 472-82. Zwanziger, J., Mukamel D.B. and Indridason, I. (2002). Use of resident-origin data to define nursing home market boundaries. Inquiry, 39(1), 56-66. Zwanziger J. and Melnick GA. (1998). The effects of hospital competition and the Medicare PPS program on hospital cost behavior in California. Journal of Health Economics, 7, 301-320. Zwanziger J, Melnick G. and Eyre KM.( 1994). Hospital and antitrust: defining markets, setting standards. Journal of Health Politics, Policy and Law, 19, 423-447. Zwanziger J, Melnick GA. and Bamezai A. (2000). Can cost shifting continue in a price competitive environment? Health Economics, 9(3), 211-26.
摘要: It is obvious that competition will affect the hospital performance from the literature review; however, the direction of the effect is still undecided, which shows a gap entailing a further digging up. This thesis is trying to elaborate the relationship between them by using Herfindahl Index as the proxy of competition among the hospitals based on the data from annual national hospital survey between 1999 and 2007. The empirical results show that the competition among the hospitals in Taichung City, Taitung County, Kaohsiung County, and Taipei County, is getting more intensive during the period between 2002 and 2004. Herfindahl Index is increasing over time for each segment, showing the tendency of centralization. This study also found that the more intensive the competition, the worse the operating performance, and the better the medial quality. According to this result, each hospital may respond to the environment based on the extent of competition, and consequently develop an appropriate strategy to survive. Similarly, policy-makers could consider what kind of policy may create an environment with moderate competition under which hospitals can not only have good operating performance but also maintain the medical quality, a situation with three-way win for government, hospitals and patients.
由國內、外研究可知,醫療市場的競爭對醫院績效可能會造成影響,但其影響的方向為何則尚未有定論,需要更進一步的去分析、瞭解。本研究藉由民國88年至96年「行政院衛生署醫院服務量統計暨現況調查」長達九年的次級資料,發現台中市、台東縣、高雄縣、台北縣,這四縣市在民國91年至93年競爭程度有較大的波動,並且趨向於更加競爭。大體而言,各醫療市場內賀芬達指數均隨時間推移而增加,這顯示台灣醫療市場普遍而言有集中化的趨勢。本研究並以賀芬達指數作為主要變項,檢視醫療市場競爭程度與醫院績效之間的關係,藉由經緯資料分析法發現醫療市場越競爭,醫院營運績效表現越不佳,而醫療品質則會向上提升。建議醫療院所有必要根據自己所處市場的競爭程度,回應環境,有所作為,才能在產業中穩健發展、永續經營。建議衛生政策制定者在政策制定的同時,也應思考怎麼樣的政策、法規,能促使市場有良好、適度的競爭氛圍,才能提升醫療院所營運績效,更能保障民眾就醫品質權利,創造政府、醫院、社會大眾三贏的局面。
URI: http://hdl.handle.net/11455/20842
其他識別: U0005-1207200923071400
文章連結: http://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0005-1207200923071400
Appears in Collections:企業管理學系所

文件中的檔案:

取得全文請前往華藝線上圖書館



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.