| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 99 === Objectives Since the implementation of National Health Insurance in 1995, the health care environment in Taiwan has changed dramatically with increased competition among hospitals. Hospital managers suffer more severe pressure and a higher demand for their operational management. Therefore, more and more healthcare-related services are considered to be outsourced, especially in the domain of DoH hospitals. This study was aimed to examine the effectiveness of outsourcing management and the relationship between outsourcing strategy and outsourcing performance.
Methods The 28 DoH-affiliated hospitals are the targeted research population. A structured questionnaire was developed and distributed to the operation and management departments within each hospital to collect outsourcing-related information, such as outsourcing strategies and operational effectiveness (cost control, transaction cost and service quality). SPSS 12.0 for Windows was used to provide statistical analyses. Of the 840 questionnaires distributed to 506 persons within 24 hospitals, 461valid questionnaires were collected with a response rate of 60.45%.
Results The results indicate that there were 23 outsourcing services in 28 hospitals with 52.17% related to general affairs and 47.8% related to medical services. Infectious wastes removal (95.83%) and general wastes removal (91.67%) ranked the top two services in general affairs while extracorporeal shock wave lithotripsy (29.17%), nursing home (20.86%), health exam center (20.83%) and respiratory care ward (20.83%) were the top three in medical services. Regional hospitals were more likely to outsource than district and psychiatric hospitals. Psychiatric hospitals (F=9.27, p< 0.001) responded with a better cost control in outsourcing effectiveness. The scores of management strategy were significantly different in “incentive” (F = 3.62, p= 0.028) and “punishment” (F= 4.23, p= 0.015). There also existed significant difference in “cost control” (t= 2.20, p= 0.029), “transaction cost” (t= 2.89, p= 0.004) and “service quality” (t= 3.96, p< 0.001) among outsourcing administrators. Besides, “process surveillance,” “control and punishment,” and “trust and corporation” had a positive correlation with cost control (r=0.336, r=0.229, r=0.235); “process surveillance,” “control and incentive,” “control and punishment,” “trust and corporation,” and “information rational” had a positive correlation with service quality (r=0.431, r=0.129, r=0.329, r=0.261, r=0.256); and, “result surveillance” was negatively related to service quality (r=-0.101). The regression analysis modeling implied that strategic management and outsourcing administrators had positively influence on cost control, transaction cost and service quality with an adjusted R square (Adj. R2 ) equal to 0.120, 0.169 and 0.207, respectively.
Conclusions Outsourcing strategies were thoroughly adopted among DOH hospitals. In addition to the traditional non-core healthcare services, some core health services were being turned into outsourcing targets as well. The major concern for outsourcing is cost down (73.3%). District hospitals (33.3%) preferred to outsource medical services to expand their scope in lack of resource. Their primary management strategies included “process surveillance,” “information rational,” “trust and cooperation,” and “outcome surveillance,” with an expectation of positive influence on cost control, transaction cost, and service quality.
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