Empirical Studies on the Efficiency Effects of Implementing Management Control Systems for Hospitals in Taiwan

• Main Authors: Chu, Hsuan-lien, 朱炫璉
• Other Authors: Liu Shuen-zen
• Format: Others
• Language: en_US
• Published: 1998
• Online Access: http://ndltd.ncl.edu.tw/handle/96096179951317600867

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.