| Summary: | 博士 === 國立臺灣大學 === 衛生政策與管理研究所 === 89 === The Analysis of Inpatient Care Markets in Taiwan
Hong Wei-Her
Attention has been increasingly paid to studies of healthcare market as market-oriented healthcare reforms have been introduced into many countries. Though regulatory healthcare policies still dominates in Taiwan, Department of Health has moved gradually toward the liberalization of healthcare market, and the National Health Insurance is proposing a multiple carriers reform. The thesis attempts to investigate the inpatient care market in Taiwan including three studies: (1) to define the geographic location of inpatient care market of Taiwan; (2) to examine the technical efficiency of inpatient care market in Taiwan and its determinants; and (3) to examine the technical efficiency of individual hospital in Taiwan and its determinants. The objectives, methods, and main results of each study are summarized as follow:
I. Defining Inpatient Care Markets in Taiwan
Objectives: To define the geographic location of inpatient care markets in Taiwan.
Methods: Based on data from the Patient Survey in Hospitals and Clinics in Taiwan Area in 1994 and 1995, a patient-flow matrix by township was constructed. A township without hospital was assigned to one of its neighborhood townships that provided the most of inpatient care to its residents; and all the townships providing inpatient care were referred to as a primary inpatient space. Then a two-stage pseudo-centroid cluster analysis technique was used to group primary inpatient spaces into different inpatient care markets. The first stage was to cluster the primary inpatient spaces in a living-zone into inter- and intra-living-zone clusters; and the second stage to cluster the inter- and intra-living-zone clusters for the whole Taiwan into inpatient care markets.
Results: A total of 48 local inpatient markets were defined with additional 9 free primary inpatient spaces. On average, each local inpatient market was comprised of 7 townships with a population of 430,000, and 11 accredited hospitals with a total of 1,700 beds (or approximately 5 beds per 1,000 population). Besides, for an average local market, the Herfindahl index was 0.37 and the cross-boundary admission rate was 45%.
Conclusions: The natural transaction areas of inpatient care in Taiwan were presented.
II. The Evaluation of Operating Efficiency of Local Inpatient Markets in Taiwan
Objectives: To explore relationship between the market structure and technical efficiency of local inpatient markets.
Methods: The unit of analysis was the local inpatient market. Secondary data of 551 accredited hospitals came from the Annual National Hospital Survey of 1995. The input variables included total beds, ICU beds, number of doctors, and number of nurses; and the output variables total patient days, ICU patient days, and hospitalized surgical operations. The multi-factor efficiency model of data envelopment analysis was used to measure the technical efficiency of local inpatient markets. Multiple regression analysis was used to explore the relationship between market structure and technical efficiency of local inpatient market.
Results: On average, the multi-factor efficiency score of local inpatient market in Taiwan was 0.715±0.263, with a range from 0.111 to 1.131. The Pearson correlation coefficients of technical efficiency to population size, Herfindahl index, share of private hospital beds, and share of regional hospital/medical center beds were all statistically significant. However, results from the multiple regression analysis showed that the significant association between technical efficiency with population size and share of private hospital beds disappeared after adjusting for share of regional hospital/medical center beds and the Herfindahl index.
Conclusions: Share of large hospital beds and the Herfindahl index were critical in determining the technical efficiency of local inpatient market.
III. Market Characteristics, Organizational Characteristics and Operation Efficiency of Teaching Hospitals
Objectives: To examine the relationships between technical efficiency of teaching hospitals, and their organizational characteristics and market characteristics.
Methods: Data of 101 general teaching hospitals from the Annual National Hospital Survey of 1995 were used. The input variables included total beds, ICU beds, number of doctors and number of nurses; and output variables total inpatient days, ICU inpatient days and number of surgical operations. The multi-factor efficiency model of data envelopment analysis was used to measure the technical efficiency, followed with multiple regression analysis to explore into hospital technical efficiency and organizational and market characteristics.
Results: On average, the multi-factors efficiency score of general teaching hospital in Taiwan was 0.703±0.215, with a range from 0.174 to 1.284. Results from multiple regression analysis indicated that higher technical efficiency was associated with regional hospitals and medical centers, private hospitals, hospitals with higher market share, and hospitals with higher surgical operation rate. But technical efficiency was not significantly associated with population size and Herfindahl index.
Conclusions: Organizational characteristics were more important than market characteristics in determining the technical efficiency of teaching hospital in Taiwan.
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