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    题名: 醫院外包決策與承包商資源關聯性之研究-- 以醫療服務集團為例
    How Outsourcing Decisions of Hospitals Relating to the Resources of Contractors-- The Case of a Medical Services Business Group
    作者: 賴晏敏
    Lai, Yen-Min
    贡献者: 于卓民
    Yu, Chwo-Ming
    賴晏敏
    Lai, Yen-Min
    关键词: 醫療服務產業
    外包
    承包商
    價值活動
    medical service industries
    outsource
    contractors
    value-activities
    日期: 2020
    上传时间: 2020-07-01 14:04:33 (UTC+8)
    摘要: 隨著1995年3月實施全民健康保險後，制定醫療服務價格的權力由醫療服務提供者移轉至中央健康保險局，且逐年改革支付制度，讓醫療服務提供者承擔更多的財務風險，因此造成醫院紛紛將醫療業務(如醫療儀器、洗腎、呼吸照護病房與檢驗)和非醫療核心業務(除診斷、治療、核心護理之外)外包，以減少成本，專注於核心醫療專業的經營，提升病患的服務品質。多數研究以醫院的角度出發，而本研究以承包商的角度出發，主要目的在探討與醫院活動外包有關的因素，由於醫院有不同的外包動機與活動特性，並且承包商有不同的資源與能力，承包商該如何管理所承包的活動以達到承包的績效，同時擴大服務的客戶(醫院)數目，此為本研究的目的。
    本研究根據文獻整理、與承包商創辦人及參與各活動之高階主管深入訪談(合計十一個個案)，發現醫院皆是為了減少成本，提升服務品質而選擇外包給醫療專業廠商。對於與醫院活動外包有關的因素，本研究獲得以下結論：
    1. 醫療業務皆以醫院為中心，但不同的業務委外活動的經營特性與承包管理的重點不同：醫療用品門市與健保藥局以人與店面位置為主要，需有專業的護理背景或是藥師服務，及提供多品項予病患選擇；洗滌布服租賃與物流則以廠房設備及作業流程的效率為主要，投資金額高且勞力密集，需設備與醫院資訊系統串聯；商場則是以服務品質、招商能力及商場環境為主要，其建置成本相當高。
    2. 承包商憑藉著創辦人已從事醫療後勤服務行業多年的經驗，院方信任其能力，而給予非核心醫療業務的承包機會，從開在院內醫療用品門市出發，提供病患住院中、出院後及一般民眾的各種不同的專業相關護理服務。
    3. 與院方多年的合作與良好關係培養後，創辦人了解醫院的運作，觀察到其他需求與商機，因此慢慢將服務拓展至其他價值活動，即以醫院為中心延伸至洗衣、健保藥局、商場、物流的價值活動，建置了洗衣廠、物流中心等，也與多家醫院承包多項業務。由於累積了各價值活動的不同的資源與能力，成為院方協力好夥伴，一起努力提升醫療服務品質。
    本研究也提出對於此承包商開拓業務的建議，以及其他業者意圖從事這行業的建議。
    With the implementation of Universal Health Insurance in March 1995, the power to set prices for medical services has been transferred from hospitals and clinics to the Central Health Insurance Bureau, and the payment system’s yearly reforms have resulted in more financial risks for hospitals and clinics. As a result, hospitals have outsourced medical services (such as medical equipment, kidney dialysis, respiratory care wards and inspections) and non-medical core businesses (services excluding diagnosis, treatment, and core care) to reduce costs and focus on core medical operations and improve patient service quality. Most studies are done from the perspective of hospitals whereas this study is from the perspective of the contractors.
    The main purpose of this study is to explore the factors that affect outsourcing of hospital activities. Every hospital has their own characteristics, and every contractor has different resources and capabilities. How a contractor manages the contracted activities to achieve the expected results while expanding the number of hospitals served is the purpose of this study. Based on literature review and in-depth interviews with the founder of a contractor, and its senior executives participating in various activities (a total of eleven cases), this study found that hospitals chose to outsource to reduce costs and improve service quality. As for the factors that influence the outsourcing of hospital activities, this study has the following findings:
    1. Medical services are all centered on hospitals, but the operating characteristics and focus of each outsourced business is different. Medical supplies stores and health insurance pharmacies are mainly based store location and staff. Staff with medical backgrounds or professional pharmacists, and multiple medications must be available. Medical textiles leasing and logistics services are mainly based on the efficiency of equipment and operating processes. The required equipment and integration into hospital information systems makes it a large investment and labor intensive. Shopping malls have high construction costs, and rely on service quality, environment, and ability to attract stores.
    2. The contractor relies on its founder`s many years of experience in the medical logistics service industry, and the hospital’s trust in its capabilities to obtain outsourcing opportunities for non-core medical services. Starting with the medical supplies store in the hospital, they provide a variety of professional care services for patients at various stages during their hospital stay as well as for the general public.
    3. After many years of cooperation and good relations with the hospital, the contractor obtains a complete understanding of their operations. Seeing other needs and business opportunities, the contractor gradually expanded to other value activities such as medical textiles leasing, health care pharmacy, food court, logistics services via relevant investments such as laundry facilities, logistics centers etc., and also contracted a number of businesses with many other hospitals. By accumulating different resources and capabilities for various value activities, they became an important partner to the hospital, improving the quality of medical services to patients.
    This study also offers suggestions for the contractor and those seeking to engage in similar business opportunities.
    參考文獻: 中文文獻：
    1. 王棋(2001)，醫院外包管理構築模式之研究：整合性觀點，國立中山大學人力資源管理研究所碩士論文。
    2. 朱子斌(2006)，醫院外包作業理論與實務，臺北醫學大學進修推廣部。
    3. 行政院衛生署(2011)，衛生醫療設施委外政策及機制，台北：行政院衛生署。
    4. 吳思華(2000)，策略九說─策略思考的本質，台北：臉譜出版社。
    5. 吳國基(1993)，醫院業務外包之研究，中國醫藥學院醫務管理研究所碩士論文。
    6. 李妮真(1995)，醫院因應全民健康保險之可能策略調查研究，國立台灣大學公共衛生學研究所碩士論文。
    7. 林建良、賴梅君、康慈欣、陳權楊(2001)，外包關係管理之維護-以衛署豐原醫院為例，國立雲林科技大學企業管理系實務專題，頁20-30。
    8. 金瑗琪(2013)，醫院品質管理部門採行外包策略之研究─以南部某地區醫院為例，崑山科技大學企業管理系碩士論文。
    9. 許振邦(2004)，採購與供應管理，外包策略與自製或外購之決定，台北：智勝文化。
    10. 傅振焜(1994)，後資本主義社會（Peter F. Drucker原著），臺北：時報文化。
    11. 彭朱如(1998)，醫療產業中跨組織合作關係類型與管理機制之研究，國立政治大學企業管理博士論文。
    12. 葉匡時、蔡敦浩、周德光(1993)，策略聯盟的發展策略―交易成本的觀點，管理評論，12卷，頁99-117。
    13. 劉晟熙(1998)，外包成功關鍵因素之探討，國立政治大學企業管理研究所碩士論文。
    14. 蔡雅芳、胡哲生(2005)，組織內部與外部價值活動之交易互動－價值鏈觀點，管理學報，22卷，6期，727-742。
    15. 衛生福利部(2010)，「醫療機構業務外包作業指引」，台北：衛署醫字第 0990202981 號公告。
    16. 衛生福利部新聞(2010)，「醫療核心業務不得外包，衛生署將列入醫院評鑑」，取自https://www.mohw.gov.tw/cp-3161-26366-1.html。

    英文文獻：
    1. Arnold, Ulli (2000), New dimensions of outsourcing: a combination of transaction cost economics and the core competencies concept, European Journal of Purchasing & Supply Management, 6(1), pp. 23-29.
    2. Barney, J. (1991), Firm resources and sustained competitive advantage, Journal of management, 17(1), pp. 99-120.
    3. Benson, J. (1994), Health care exces must re-engineer themselves to keep pace with industry, Health Care Strategic Management, pp. 14-15.
    4. Cheon, Myun J., Grover, V. & Teng, James T.C. (1995), Theoretical perspectives on the outsourcing of information systems, Journal of Information Technology, 10(4), pp. 209-219.
    5. Coase, R. H. (1937), The Nature of the Firm, Econimica, New Series, 4(16), pp. 386-405
    6. Hudak, R. P., Brooke P. P. Jr., Finstuen, K. & Riley, P. (1993), Health care administration in the year 2000：practioners, view of future issues and job requirements, Hospital & Health Service Administration, 38(2), pp. 181-195.
    7. Koopmans, Tjalling C. (1963), On the Concept of Optimal Economic Growth, New Heaven, CN: Yale University.
    8. Moschuris, Socrates J. & Kondylis, Michael N. (2008), Outsourcing in hospitals, Health Management Organization, Promoting Management, 10(1), pp. 1-3
    9. Moschuris, Socrates J. (2015), Decision-making criteria in tactical make-or-buy issues: an empirical analysis, EuroMed Journal of Business, 10(1), pp 2-20.
    10. North, D. (1994), Economic performance through time, The American Economic Review, 84(3), pp. 359-368.
    11. Phoenix Health Systems (2006), 75% of Hospitals are Outsourcing IT Functions. Why?, Phoenix, AZ: Health Systems.
    https://www.phoenixhealth.com/it-outsourcing-2/hospitals-are-outsourcing-it-functions-why/
    12. Porter, Michael E. (1985), Competitive advantage: creating and sustaining superior performance, NY: Free Press.
    13. Sheehan, Norman T. & Foss, Nicolai J. (2009), Exploring the roots of Porter’s activity-based view, Journal of Strategy and Management, 2(3), pp. 3-8.
    14. Walker, Gordon & Weber, David (1984), A transaction cost approach to make-or-buy decisions, Administrative Science Quarterly, 29(3), pp. 373-391.
    15. Wernerfelt, B. (1984), A resource-based view of the firm, Strategic Management Journal, 5(2), pp. 171-180.
    16. Williamson, Oliver E. (1975), Markets and hierarchies: analysis and implications, New York: The Free Press.
    17. Williamson, Oliver E. (1985), The economic institutions of capitalism: firms, markets, relational contracting, New York: The Free Press.
    描述: 碩士
    國立政治大學
    企業管理研究所(MBA學位學程)
    107363059
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0107363059
    数据类型: thesis
    DOI: 10.6814/NCCU202000601
    显示于类别:[企業管理研究所（MBA學位學程）] 學位論文

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