目標：醫院對外在環境改變而採取的因應行為（策略）和醫院的營運績效息息相關，尤其在競爭非常激烈的醫療市場上，愈快能針對外在環境改變而加以有效因應的醫院，通常也愈能在市場上維持競爭優勢，創造出比較好的績效。根據國內外許多研究醫院策略行為的文獻顯示，評估醫院對外在環境改變立即反應的結果（反應的速度）是評估醫院管理能力的一種很好的方法。因此本研究主要的目的就是要藉研究論病例計酬制度的實施（外在環境改變）來研究不同性質的醫院其因應外在環境改變的管理能力。方法：在以民國八十六年七月至十二月中央健康保險局台北分局特約醫療院所申報3,209例Appendectomy之資料為例。結果：透過美國Medicare DRG分類後分析發現，區域醫院和財團法人醫院因應外在環境變化的能力比其他性質的醫院好。此外，在論病例計酬制度實施三個月後，並無證據顯示在不同性質的醫院之間有所謂不當的轉介病患的行為。結論：論病例計酬制度因具有在短期之內刺激醫療院所降低健保住院醫療支出的功能，各醫院應該改善其管理能力，以因應未來全民健保論病例計酬制度的全面實施。

Objectives: How a hospital can adjust in response to environmental changes has been proved to be strongly associated with its financial performance. In a very competitive health care market, those hospitals that can adjust their behavior quickly to accomodate environmental changes usually can keep their competitive advantage and achieve better performance. According to the literature, evaluating the pace of a hospital effectively responding to its environmental change is very useful in assessing its managerial competence. Therefore, the objective of this study was to assess the managerial competence of different hospitals by their response to the environmental change of a Case Payment System (CPS) adopted by the National Health Insurance program. Methods: Included in the study were 3209 appendectomy cases occurring either before or within 3 months after the implementation the CPS in 1997. These cases were grouped into Medicare DRGs (Diagnostic Related Groups) before they were analyzed. Results: Results of this study indicated that regional hospitals and not-for-profit hospitals were more competent in adjusting to this new environmental change. Moreover, there was no evidence of unethical case dumping among the different types of hospitals. Conclusions: Since NHI will adopt CPS in paying all its inpatient services in the future, all hospitals should improve their managerial competence to face future environmental changes. Conclusions: Since NHI will adopt CPS in paying all its inpatient services in the future, all hospitals should improve their managerial competence to face future evritonmental changes.

管理能力 ； 論病例計酬制度 ； 醫院特質

Managerial competence, Case Payment System, Hospital types