本研究運用交易成本理論與動態競爭觀點，探討不同策略型態（垂直整合、合作與委外經營）對醫院血液透析業務績效之影響，同時本研究預期地區的競爭強度將會干擾此一策略與績效之間的關係。我們蒐集了1,588筆衛生福利部全民健康保險2012年與2013年辦理血液透析業務「區域醫院」與「地區醫院」之策略型態與績效的資料。實證結果顯示，採行合作與委外經營策略者較採行垂直整合策略者有較高的效率，而採行合作策略與委外經營策略兩者間並無顯著差異；採行委外經營策略者較合作策略與垂直整合策略者有較高的品質。以賀芬達指標作為衡量區域競爭強度之代理變數，結果顯示臺灣南區競爭強度最高、中區最低，區域競爭強度對於血液透析業務策略型態與績效間關係，存有調節效果。

This paper adopts transaction cost theory and the competitive dynamics perspective to examine the effects of three operating strategies-namely vertical integration, cooperation, and outsourcing to hemodialysis performance respectively. This study proposes that regional competitive intensity may moderate the strategy-performance relationship. Empirical data are collected from the National Health Insurance Database, which is maintained by Taiwan' s Ministry of Health and Welfare. We obtain 1,588 records from regional and district hospitals, which contain information regarding their hemodialysis-related management strategies and performance outcomes in 2012 and 2013. The results of our empirical analysis indicate that cooperation and outsourcing strategies are more efficient than vertical integration strategies. The difference in efficiency achieved between hospitals adopting the cooperation strategy and outsourcing strategy is insignificant; however, we find that hospitals that adopt the outsourcing strategy tend to provide higher quality in hemodialysis than those that adopt cooperation or vertical integration strategies. Using the Herfindahl-Hirschman index as a proxy for competitive intensity, this investigation reveals that competition is the highest in southern Taiwan and lowest in central Taiwan. The results of this study support the moderating effect of competitive intensity on the strategy-performance relationship of the hemodialysis operations.

血液透析; 策略; 競爭強度; 效率; 品質

hemodialysis; strategy; competitive intensity; efficiency; quality