| Summary: | 博士 === 國立臺灣大學 === 會計學系研究所 === 86 === The main purpose of the dissertation is to examine the efficiency effects
of implementing management control systems for hospitals in Taiwan. This
study consists of two independent chapters. Chapter 1 examines the effects of
implementing responsibility centers, total quality management, and physician
fee programs on cross-hospital technical efficiency by applying the Data
Envelopment Analysis (DEA). Using data collected from 90 questionnaires sent
to hospital executives, we find hospitals that have implemented the above-
mentioned management control systems are more efficient than those that do
not, based on asymptotic DEA-based tests. The heteroscedastic multi-tobit
model is also used to better control for the effects of other relevant
variables. Without considering for the time-lagged effect, in the multi-tobit
analysis we find that only physician fee program has a significant effect on
hospital efficiency. As initiating management control systems can be a time-
consuming task, we also consider the time-lagged effect by restricting our
observations to hospitals that have implemented the management control
systems for at least two years. The results indicate that average efficiency
in the hospitals that have implemented responsibility centers or physician
fee programs for at least two years is significantly higher than those that
do not. In contrast, total quality management still has an insignificant
effect on hospital efficiency. In addition, we also consider the differential
effects of implementing responsibility centers with or without integrating
the system with incentive programs associated with departmental profits for
physicians. We find hospitals that have implemented responsibility centers
integrated with incentive programs for physicians perform better than
hospitals that are without responsibility centers. We also find that average
efficiency in the hospitals that have implemented responsibility centers
integrated with incentive programs for physicians is significant higher than
those that implemented responsibility centers without associated formal
performance evaluation schemes.
In chapter 2, we use field data from a large public teaching hospital in
Taiwan to test for efficiency gains resulting from the introduction of a
physician compensation program (PCP), which is based on responsibility
centers system. Our objective is to identify whether an increase in
operational efficiency is evident for 58 departments in the 5 months
following the introduction of the program (the post-PCP period) relative to
the corresponding 5 months in the previous year (the pre-PCP period) for the
sample hospital. The DEA is also invoked to measure the operational
efficiency of each department in the hospital over the two periods. We first
use asymptotic DEA-based tests to examine whether differences in efficiency
scores between the two periods are significant. The chapter finds that
average efficiency in the post-PCP period is significantly higher than that
in the pre-PCP period. Then, a multi-factor tobit model is used to examine
factors that might explain the observed efficiency. We find that average
efficiency in the post-PCP period is still higher, after controlling for
other related factors. The findings suggest that to achieve an increase in
hospital efficiency, responsibility centers should be integrated with
physician compensation programs. In addition, we find that the average of
physicians'' seniority and percentage of physicians'' service time in the
department are positively associated with efficiency. Finally, departments
with higher profits and smaller size are also associated with higher
efficiency.
|
|---|
