| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 88 === The National Health Insurance (NHI) has been implemented of Taiwan since 1995. NHI not only reallocates medical resources but also intensifies health care market competition. Therefore, it is important for hospital administrators to adopt new strategies in response to environmental change so that they can maintain their competitive advantages and achieve better performance.
The purpose of this study is to evaluate new competition affects of health care markets and to analyze the impact of case payment system (CPS) on total hip replacement (THR) using NHI claim data base. Two hundred and twenty two hospitals and 5,616 cases have been included in this study (during October 1996 to July1998). By applying geographic information system (GIS) and statistical instruments, results of the study indicate:
1. The study uses the origin-specific gravity model to measure total distance among hospitals and use it as competition variable. This approach makes it clearly to comprehend the competitive advantage of geographic environment through interaction with spatial analysis.
2. Hospitals located in sub-medical areas have higher population density, more THR cases, higher physicians-to-population ratio and acute general beds ratio. It indicates that market forces have an impact between hospital behaviors and medical resources distribution.
3. Factors influencing THR medical utilization include CPS, hospital characteristics, patient characteristics, and distances among hospitals.
Hospital administrators should pay more attention to control medical costs and improve health care quality so that they could enhance hospital competitive advantage.
Key words:
geographic information system (GIS)
competition
total hip replacement (THR)
case payment system (CPS)
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