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題名 我國財團法人醫院債務融資與效率關聯性之探討
作者 簡瑜萱
貢獻者 郭振雄
簡瑜萱
關鍵詞 財團法人醫院
效率
債務融資
社區公益活動
日期 2007
上傳時間 14-Sep-2009 13:39:55 (UTC+8)
摘要 財團法人醫院在台灣醫療服務市場是相當重要的醫療提供者,占國內醫療服務重大比例。全民健康保險制度實施後,由於健保制度免除民眾部分必要負擔費用,誘使醫療服務需求的快速成長,造成醫療資源的浪費,健保局為了控制醫療費用的成長,推行了一系列供給面成本分擔支付制度的醫療改革,醫院在有限的醫療資源下,競爭壓力不斷升高,「效率」變成醫院經營管理的目標。
     醫院間有非價格競爭的行為,醫武競賽造成醫院成本上升,若醫院選擇以負債融通資金,會增加醫院的財務風險,提高發生財務危機的可能性,但傳統財務理論指出公司增加負債額度可提高經營績效。
     本研究採財務比率當作財團法人醫院的效率指標,主要目的在於分析財團法人醫院債務融資與效率間的關聯是否適用傳統財務理論,也就是財團法人醫院負債比率與效率是否為正向關係。利用民國91、92、93年財團法人醫院財務報表與醫療機構現況及醫療服務量統計資料,採用30家財團法人醫院的綜合年度資料為樣本,共82個觀察值,進行實證迴歸分析。
     實證迴歸結果顯示:(1)財團法人醫院負債比率與營運效率、資本投資效率皆顯著負相關,財團法人醫院選擇以負債融通資金無法提升醫院績效,但財團法人醫院負債比率與員工效率顯著正相關。(2)財團法人醫院社區公益活動支出變數與營運效率顯著負相關,財團法人醫院實踐公益目標的同時勢必面臨效率降低的情況。
參考文獻 一、 中文文獻
王姿婷(2005),醫療財團法人機構董事會更換率決定因素之研究,國立政治大學財政學研究所碩士論文。
王媛慧、李文福(2004),我國地區醫院技術效率之研究-DEA方法的應用,經濟研究,第四十卷第一期,頁61-95。
司徒達賢(1999),非營利組織的經營管理,台北:天下文化。
洪國賜、盧聯生(2002),財務報表分析,台北:三民書局
洪榮華、陳香如、王玉珍(2005),公司內部治理機制與公司績效之關係-股權結構與董事會特性的觀點,輔仁管理評論,第十二卷第三期,頁23-40。
洪麗芳(2004),股權結構、財務決策與公司績效關聯性之研究,中原大學會計學研究所碩士論文。
張景年(1997),省立醫院之分配與技術效率評估,中國醫藥學院醫務管理學研究所碩士論文。
張睿詒、侯穎蕙(2001),省立醫院最佳經營典範探討-技術效率、分配效率與整體效率之評估,管理評論,第二十卷第四期,頁1-27。
許守華(2001),財團法人醫院財務績效之評估,國立政治大學財政學研究所碩士論文。
郭振雄、何怡澄(2007),非營利醫院之醫院教研公益活動與治理機制,台灣衛誌,第二卷第二十六期,頁128-139。
郭振雄、何怡澄、羅德城(2006),非營利醫院的負債融資與社區公益活動,台灣衛誌,第六卷第二十五期,頁440-448。
歐進士、林惠美、趙令海(2006),實施全民健康保險對公立醫院經營效率影響之評估,東吳大學會計系2006年會計理論與實務研討會。
盧瑞芬、謝啟瑞(2003),臺灣醫院產業的市場結構與發展趨勢分析,經濟論文叢刊,第三十一卷第一期,頁107-153。
二、 英文文獻
Agrawal, A. and C.R. Knoeber (1996), “Firm performance and mechanisms to control agency problems between managers and shareholders.” Journal of Financial and Quantitative Analysis, 31(3), pp. 377-397.
Bazzoli, G.J. and W.O. Cleverley (1994), “Hospital bankruptcies: an exploration of potential causes and consequences.” Health Care Management Review, 19(3), pp. 41-51.
Berger, P.G., E. Ofek, and D.L. Yermack (1997), “Managerial entrenchment and capital structure decisions.” Journal of Finance, 52(4), pp. 1411-1438.
Callen, J.L. and H. Falk (1993), “Agency and efficiency in nonprofit organizations: the case of specific health focus charities.” Accounting Review, 68(1), pp. 48-65.
Cleverly, W.O. (1995), “Understanding your hospital’s true financial position and changing it.” Health Care Management Review, 20(2), pp. 62-73.
Ferrier, G.D. and V. Valdmanis (1996), “Rural hospital performance and its correlates.” The Journal of Productivity Analysis, 7, pp. 63-80.
Frank R.G. and D.S. Salkever (1994), “Nonprofit organizations in the health sector.” The Journal of Economic Perspectives, 8(4), pp. 129-144.
Harrison, J.P. and C. Sexton (2006), “The improving efficiency frontier of religious not-for-profit hospitals.” Hospital Topics, 84(1), pp. 2-10.
Helmig, B. and I. Lapsley (2001), “On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study.” Health Services Management Research, 14(4), pp. 263-274.
Jensen, M.C. (1986), “Agency costs of free cash flow, corporate finance, and takeovers.” American Economic Review, 76(2), pp. 323-329.
Jensen, M.C. (1989), “Eclipse of the public corporation.” Harvard Business Review, 67(5), pp. 61-74.
Kuo, N.W., C.H. Tang, C.M. Yang, and J.S. Chen (2000), “Determinants of hospital efficiency- an application of data envelopment analysis.” New Taipei Journal of Medicine, 2, pp. 27-38.
Magnus, S.A., J.R.C. Wheeler, and D.G. Smith (2004), “The association of debt financing with not-for-profit hospitals’ operational and capital-investment efficiency.” Journal of Health Care Finance, 30(4), pp. 33-45.
Magnus, S.A., J.R.C. Wheeler, and D.G. Smith (2004), “The association of debt financing with not-for-profit hospitals’ provision of uncompensated care.” Journal of Health Care Finance, 30(4), pp. 46-58.
McConnell, J.J. and H. Servaes (1990), “Additional evidence on equity ownership and corporate value.” Journal of Financial Economics, 27, pp. 595-612.
McGuire, T.G. (2000), “Physician agency.” in Handbook of Health Economics, 1A, eds. A.J. Culyer and J.P. Newhouse (Elsevier Science, North Holland).
Needleman, J. (2001), “The role of nonprofits in health care.” Journal of Health Politics, Policy and Law, 26(5), pp. 1113-30.
Newhouse, J.P. (1970), “Toward a theory of nonprofit institution: an economic model of a hospital.” American Economic Review, 60, pp. 64-74.
Ozcan, Y.A., R.D. Luke, and C. Haksever (1992), “Ownership and organizational performance: a comparision of technical efficiency across hospital types.” Medical Care, 30(9), pp. 781-794.
Rose-Ackerman, S. (1996), ‘‘Altruism, nonprofits, and economic theory.’’ Journal of Economic Literature, 34(2), pp. 701–728.
Vogel, W.B., B. Langland-Orban, and L.C. Gapenski (1993), ”Factors influencing high and low profitability among hospitals.” Health Care Management Review, 18(2), pp. 15-26.
White, K.R. and Y.A. Ozcan (1996), “Church ownership and hospital efficiency.” Hospital & Health Services Administration, 41(3), pp. 297-310.
Young, G.J. and K.R. Desai (1999), “Nonprofit hospital conversions and community benefits: new evidence from three states.” Health Affairs, 18(5), pp. 146-155.
描述 碩士
國立政治大學
財政研究所
94255008
96
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0094255008
資料類型 thesis
dc.contributor.advisor 郭振雄zh_TW
dc.contributor.author (Authors) 簡瑜萱zh_TW
dc.creator (作者) 簡瑜萱zh_TW
dc.date (日期) 2007en_US
dc.date.accessioned 14-Sep-2009 13:39:55 (UTC+8)-
dc.date.available 14-Sep-2009 13:39:55 (UTC+8)-
dc.date.issued (上傳時間) 14-Sep-2009 13:39:55 (UTC+8)-
dc.identifier (Other Identifiers) G0094255008en_US
dc.identifier.uri (URI) https://nccur.lib.nccu.edu.tw/handle/140.119/32321-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 財政研究所zh_TW
dc.description (描述) 94255008zh_TW
dc.description (描述) 96zh_TW
dc.description.abstract (摘要) 財團法人醫院在台灣醫療服務市場是相當重要的醫療提供者,占國內醫療服務重大比例。全民健康保險制度實施後,由於健保制度免除民眾部分必要負擔費用,誘使醫療服務需求的快速成長,造成醫療資源的浪費,健保局為了控制醫療費用的成長,推行了一系列供給面成本分擔支付制度的醫療改革,醫院在有限的醫療資源下,競爭壓力不斷升高,「效率」變成醫院經營管理的目標。
     醫院間有非價格競爭的行為,醫武競賽造成醫院成本上升,若醫院選擇以負債融通資金,會增加醫院的財務風險,提高發生財務危機的可能性,但傳統財務理論指出公司增加負債額度可提高經營績效。
     本研究採財務比率當作財團法人醫院的效率指標,主要目的在於分析財團法人醫院債務融資與效率間的關聯是否適用傳統財務理論,也就是財團法人醫院負債比率與效率是否為正向關係。利用民國91、92、93年財團法人醫院財務報表與醫療機構現況及醫療服務量統計資料,採用30家財團法人醫院的綜合年度資料為樣本,共82個觀察值,進行實證迴歸分析。
     實證迴歸結果顯示:(1)財團法人醫院負債比率與營運效率、資本投資效率皆顯著負相關,財團法人醫院選擇以負債融通資金無法提升醫院績效,但財團法人醫院負債比率與員工效率顯著正相關。(2)財團法人醫院社區公益活動支出變數與營運效率顯著負相關,財團法人醫院實踐公益目標的同時勢必面臨效率降低的情況。
zh_TW
dc.description.tableofcontents 第壹章 緒論 1
     第一節 研究背景 1
     第二節 研究動機與目的 4
     第三節 研究架構 7
     第貳章 文獻回顧 9
     第一節 非營利醫院存在之原因與使命 9
     第二節 資料包絡分析法評估醫院之效率 16
     第三節 負債融資對醫院的影響 19
     第四節 其他影響醫院經營之因素 25
     第五節 文獻回顧小結 28
     第參章 研究方法 30
     第一節 資料來源 30
     第二節 實證變數與假說 30
     第三節 實證模型 35
     第肆章 實證迴歸結果 36
     第一節 迴歸分析 36
     第二節 敏感度分析 45
     第三節 迴歸結果小結 45
     第伍章 結論與限制 49
     第一節 結論與建議 49
     第二節 研究限制與延伸 50
     參考文獻 52
     附錄 56
zh_TW
dc.language.iso en_US-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0094255008en_US
dc.subject (關鍵詞) 財團法人醫院zh_TW
dc.subject (關鍵詞) 效率zh_TW
dc.subject (關鍵詞) 債務融資zh_TW
dc.subject (關鍵詞) 社區公益活動zh_TW
dc.title (題名) 我國財團法人醫院債務融資與效率關聯性之探討zh_TW
dc.type (資料類型) thesisen
dc.relation.reference (參考文獻) 一、 中文文獻zh_TW
dc.relation.reference (參考文獻) 王姿婷(2005),醫療財團法人機構董事會更換率決定因素之研究,國立政治大學財政學研究所碩士論文。zh_TW
dc.relation.reference (參考文獻) 王媛慧、李文福(2004),我國地區醫院技術效率之研究-DEA方法的應用,經濟研究,第四十卷第一期,頁61-95。zh_TW
dc.relation.reference (參考文獻) 司徒達賢(1999),非營利組織的經營管理,台北:天下文化。zh_TW
dc.relation.reference (參考文獻) 洪國賜、盧聯生(2002),財務報表分析,台北:三民書局zh_TW
dc.relation.reference (參考文獻) 洪榮華、陳香如、王玉珍(2005),公司內部治理機制與公司績效之關係-股權結構與董事會特性的觀點,輔仁管理評論,第十二卷第三期,頁23-40。zh_TW
dc.relation.reference (參考文獻) 洪麗芳(2004),股權結構、財務決策與公司績效關聯性之研究,中原大學會計學研究所碩士論文。zh_TW
dc.relation.reference (參考文獻) 張景年(1997),省立醫院之分配與技術效率評估,中國醫藥學院醫務管理學研究所碩士論文。zh_TW
dc.relation.reference (參考文獻) 張睿詒、侯穎蕙(2001),省立醫院最佳經營典範探討-技術效率、分配效率與整體效率之評估,管理評論,第二十卷第四期,頁1-27。zh_TW
dc.relation.reference (參考文獻) 許守華(2001),財團法人醫院財務績效之評估,國立政治大學財政學研究所碩士論文。zh_TW
dc.relation.reference (參考文獻) 郭振雄、何怡澄(2007),非營利醫院之醫院教研公益活動與治理機制,台灣衛誌,第二卷第二十六期,頁128-139。zh_TW
dc.relation.reference (參考文獻) 郭振雄、何怡澄、羅德城(2006),非營利醫院的負債融資與社區公益活動,台灣衛誌,第六卷第二十五期,頁440-448。zh_TW
dc.relation.reference (參考文獻) 歐進士、林惠美、趙令海(2006),實施全民健康保險對公立醫院經營效率影響之評估,東吳大學會計系2006年會計理論與實務研討會。zh_TW
dc.relation.reference (參考文獻) 盧瑞芬、謝啟瑞(2003),臺灣醫院產業的市場結構與發展趨勢分析,經濟論文叢刊,第三十一卷第一期,頁107-153。zh_TW
dc.relation.reference (參考文獻) 二、 英文文獻zh_TW
dc.relation.reference (參考文獻) Agrawal, A. and C.R. Knoeber (1996), “Firm performance and mechanisms to control agency problems between managers and shareholders.” Journal of Financial and Quantitative Analysis, 31(3), pp. 377-397.zh_TW
dc.relation.reference (參考文獻) Bazzoli, G.J. and W.O. Cleverley (1994), “Hospital bankruptcies: an exploration of potential causes and consequences.” Health Care Management Review, 19(3), pp. 41-51.zh_TW
dc.relation.reference (參考文獻) Berger, P.G., E. Ofek, and D.L. Yermack (1997), “Managerial entrenchment and capital structure decisions.” Journal of Finance, 52(4), pp. 1411-1438.zh_TW
dc.relation.reference (參考文獻) Callen, J.L. and H. Falk (1993), “Agency and efficiency in nonprofit organizations: the case of specific health focus charities.” Accounting Review, 68(1), pp. 48-65.zh_TW
dc.relation.reference (參考文獻) Cleverly, W.O. (1995), “Understanding your hospital’s true financial position and changing it.” Health Care Management Review, 20(2), pp. 62-73.zh_TW
dc.relation.reference (參考文獻) Ferrier, G.D. and V. Valdmanis (1996), “Rural hospital performance and its correlates.” The Journal of Productivity Analysis, 7, pp. 63-80.zh_TW
dc.relation.reference (參考文獻) Frank R.G. and D.S. Salkever (1994), “Nonprofit organizations in the health sector.” The Journal of Economic Perspectives, 8(4), pp. 129-144.zh_TW
dc.relation.reference (參考文獻) Harrison, J.P. and C. Sexton (2006), “The improving efficiency frontier of religious not-for-profit hospitals.” Hospital Topics, 84(1), pp. 2-10.zh_TW
dc.relation.reference (參考文獻) Helmig, B. and I. Lapsley (2001), “On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study.” Health Services Management Research, 14(4), pp. 263-274.zh_TW
dc.relation.reference (參考文獻) Jensen, M.C. (1986), “Agency costs of free cash flow, corporate finance, and takeovers.” American Economic Review, 76(2), pp. 323-329.zh_TW
dc.relation.reference (參考文獻) Jensen, M.C. (1989), “Eclipse of the public corporation.” Harvard Business Review, 67(5), pp. 61-74.zh_TW
dc.relation.reference (參考文獻) Kuo, N.W., C.H. Tang, C.M. Yang, and J.S. Chen (2000), “Determinants of hospital efficiency- an application of data envelopment analysis.” New Taipei Journal of Medicine, 2, pp. 27-38.zh_TW
dc.relation.reference (參考文獻) Magnus, S.A., J.R.C. Wheeler, and D.G. Smith (2004), “The association of debt financing with not-for-profit hospitals’ operational and capital-investment efficiency.” Journal of Health Care Finance, 30(4), pp. 33-45.zh_TW
dc.relation.reference (參考文獻) Magnus, S.A., J.R.C. Wheeler, and D.G. Smith (2004), “The association of debt financing with not-for-profit hospitals’ provision of uncompensated care.” Journal of Health Care Finance, 30(4), pp. 46-58.zh_TW
dc.relation.reference (參考文獻) McConnell, J.J. and H. Servaes (1990), “Additional evidence on equity ownership and corporate value.” Journal of Financial Economics, 27, pp. 595-612.zh_TW
dc.relation.reference (參考文獻) McGuire, T.G. (2000), “Physician agency.” in Handbook of Health Economics, 1A, eds. A.J. Culyer and J.P. Newhouse (Elsevier Science, North Holland).zh_TW
dc.relation.reference (參考文獻) Needleman, J. (2001), “The role of nonprofits in health care.” Journal of Health Politics, Policy and Law, 26(5), pp. 1113-30.zh_TW
dc.relation.reference (參考文獻) Newhouse, J.P. (1970), “Toward a theory of nonprofit institution: an economic model of a hospital.” American Economic Review, 60, pp. 64-74.zh_TW
dc.relation.reference (參考文獻) Ozcan, Y.A., R.D. Luke, and C. Haksever (1992), “Ownership and organizational performance: a comparision of technical efficiency across hospital types.” Medical Care, 30(9), pp. 781-794.zh_TW
dc.relation.reference (參考文獻) Rose-Ackerman, S. (1996), ‘‘Altruism, nonprofits, and economic theory.’’ Journal of Economic Literature, 34(2), pp. 701–728.zh_TW
dc.relation.reference (參考文獻) Vogel, W.B., B. Langland-Orban, and L.C. Gapenski (1993), ”Factors influencing high and low profitability among hospitals.” Health Care Management Review, 18(2), pp. 15-26.zh_TW
dc.relation.reference (參考文獻) White, K.R. and Y.A. Ozcan (1996), “Church ownership and hospital efficiency.” Hospital & Health Services Administration, 41(3), pp. 297-310.zh_TW
dc.relation.reference (參考文獻) Young, G.J. and K.R. Desai (1999), “Nonprofit hospital conversions and community benefits: new evidence from three states.” Health Affairs, 18(5), pp. 146-155.zh_TW