準市場機制與區域治理─以秀傳醫院、署立醫院及台北市立醫院之執行經驗為例

Abstract

台灣公立醫院的委外經營，近年來已逐漸展現豐碩成果，以許多地方政府所屬醫院為例，透過公私協力的方式，不僅解決地方財政不足以提供優良醫護人力資源及解決醫療服務品質的困境，現在更成為地方財政挹注的來源之一。但此一模式卻無法適用在台灣各地的署立醫院，導致從二○○四年起，衛生署改採多元的醫院經營改革策略，並以「行政績效管理」為核心，取代自一九九○年代以來的公辦民營政策，強調區域治理的結盟模式，每區擇一績效優良的醫院作為總院，其餘為結盟醫院，藉由資源共享、技術交流、聯合行銷等方式，提升營運效率並降低管理成本。由以上可知，新公共管理理論在公立醫院的委外辦理上，並非放諸四海而皆準，適用上仍有許多限制，因此，公共部門對於公立醫院這種肩負一定程度公共責任的醫療與衛生保健服務者，應否委外，仍應就特性及歷史脈絡，漸進改革其經營管理策略，而非一味強以改革之名，進行全面激進的制度變革。本文以秀傳醫院成功的公辦民營經驗，以及署立醫院、台北市立醫院等改採行政管理績效的過程，進行對照比較，來檢視公立醫院契約委外的限制與範圍，並透過案例進一步省思準市場機制的應用及可行性。

The application of quasi-market mechanism in Taiwan’s local public hospitals has been proved to have the possibility and the good performance. The public-private collaboration is not only to resolve the deficiency of local fiscal and promote the quality of the local medical service, but also is an important tool to increase local income today. For example, Tainan City Hospital is the first successful case, which is contracted by private Show Chwan Hospital. However, the public hospitals owned by the Department of Health, Executive Yuan, were hardly transferring to private management past decade. Except that, the reorganization of Taipei City Hospital in 2005 offered a good contrast to the former two cases. This study explores the differences between local public hospitals and central public hospitals, especially from 2004, the Department of Health decided to use new management performance strategies including regional governance, medical resource sharing, coalition etc. The result of else changes provide the comparable basis between quasi-market mechanism and administrative performance management. The three cases demonstrate the possibility and limit of contracting-out or quasi-market mechanism. This proves that the critics regard the New Public Management by mimicking market-like mechanism.