| Summary: | 博士 === 國立高雄第一科技大學 === 管理研究所 === 98 === The focus of this study is to investigate the agency problem of the global budget system of National Health Insurance and hospital governance in Taiwan. Little domestic literature has focused on this area and hence the biased, one-sided and incomplete observation of the healthcare system, which impeded the clarification of the root of the problem and the nature of this phenomenon. This study aimed at analyzing the interaction between stakeholders (Bureau of National Health Insurance and medical service providers) and portraying the real facts regarding the hospital governance of medical service providers under such budget system from a broad-spectrum perspective. The purpose of study was to break away from the constraints under the current theory. On the other hand, it was anticipated that effective description and elaboration on the practical phenomenon can be provided and a framework involving practical questions of conceptual aspects and the thought pattern of hospital owners will be constructed.
In terms of the empirical aspect of this study, both (1) qualitative in-depth individual interview and (2) quantitative questionnaire methods were adopted in order to cover both the essence of questions as well as the generality of research findings when investigating such exploratory research topic. The primary objective of the in-depth interview was to verify the explanatory power of the primitive framework from the practical point of view and to hypothesize the correlation of agency hazard, agency problem, agency cost, and hospital governance based on the theory in order to provide a reference for variable measurement and questionnaire design for subsequent quantitative research.
In terms of the empirical aspect of the quantitative study, multiple regression analysis were utilized. For the agency problem, the empirical result identified a positive correlation between the risk aversion of agency hazard and agency problem. Second of all, the agency cost referred to the audit and monitoring costs of the Bureau of the National Health Insurance to prevent hospitals from deviating from the goal of the National Health Insurance policy. The results showed that agency cost would indeed interfere with the intervention to modulate the agency problems such as ignorance of medical ethics.
In terms of hospital governance, empirical results indicated that financial disclosure and transparency would negatively modulate agency problems arising from private-interest behavior at a statistically significant level. Variables of medical quality enhancement and comprehensive monitoring system in different models helped modulate the agency problems due to the ignorance of medical ethics and medical profession. This result suggested that hospital governance was effective in reducing agency problems. Based on this perspective, comprehensive hospital governance can achieve the effect of internal control and prevention of management fraud, facilitate the transparency of financial status, and establish the management goal, which would help reduce the severity of agency problems.
The method adopted in this study differed from other previous studies. Most scholars explored agency problems using literature analysis or study case approach in the past while the current study investigated the agency theory and global budget system using in-depth interview and quantitative analysis of questionnaires. Overall, the major contribution of this study was conceptualization of agency problems and other potential factors that might arise from the National Health Insurance system using the essence and nature of the agency theory. On the other hand, the study furthered the practical observation and conducted a large-sample-size empirical analysis which more clearly categorized the agency problems under the global budget system of the National Health Insurance in Taiwan and identified the correlation with the corresponding concepts. More importantly, the study incorporated hospital governance into the study scope, which will help academic research related to medical management view the nature and importance of hospital governance.
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