本研究探討全民健康保險支付制度的演進對於醫院生產效率的影響。全民健保實施以來，支付制度是影響醫院收入的主要來源，其制度的設計，對於醫院生產行為具有不同的經濟誘因。全民健保實施後，支付制度主要以論量計酬為主，在論量計酬下，醫院的收入完全取決於醫療服務量的多寡，而且醫療服務的單位價格不受服務量多寡而改變，這將造成醫院提供較多醫療服務量的誘因。之後全民健保於民國九十一年實施總額支付，而在總額支付下，醫院的收入不完全與醫療服務量成正向關係，並且醫療給付的點值將隨醫療服務量的增加而遞減，這將使得醫院必須慎選產出水準與要素投入，因此醫院生產效率在總額支付下可能會有所提升。本研究使用民國八十四年至九十三年醫院醫療服務量及醫療機構現況資料作為實證研究的基礎，以各類門診、住院人次等為醫院生產的產出，醫護人員數、病床數等為醫院生產的投入，利用資料包絡法探究醫院生產效率的變化—民國八十四年至九十三年支付制度的變化對當期生產效率的影響。由於觀察期間中，醫院的生產效率可能因技術進步而改變，因此我們必須將技術進步的效果加以排除，單就支付制度改變對於醫院生產效率的影響。藉由實證結果我們發現醫院的生產效率的確在總額支付下有所提升。其結果有助於了解支付制度的變革對於醫院生產效率之影響。

This paper examines the impact of the National Health Insurance (NHI) payment system reform on hospital efficiency. In the past, the NHI payment is fee for service. Under this system, hospitals have incentive to offer more and unnecessary medical service which lead to production inefficiency. Recently, the global budget replaces fee for service in NHI. The global budget will reduce the negative effect of hospital efficiency because it corrects the undesirable behavior. The dataset used in proving this are “Statistics for Medical Institution and Hospital Medical Services”from 1995 to 2004. We use the Malmquist productivity index to estimate the change of hospital efficiency. Results indicate the hospital efficiency experienced a positive and significant improvement by global budget than fee for service

參考文獻
中文部份
1. 李文福、王媛慧(1998)，「台灣地區公私立醫學中心與區域醫院生產力變動之研究—無母數Malmquist指數之應用」，經濟論文26(3)，p243-269。
2. 李玉春（1998），「全民健保支付制度實施現況檢討與改革方向建議」，政策月刊，p.14-16。
3. 孫遜（2004），「資料包絡分析法—理論與應用」，揚智文化出版。
4. 陳耀東（2004），「全民健保不同支付制度對醫師執業行為之影響及比較」，管理學報21(2)，p 237-255。
5. 蔡偉德（2000），「全民健康保險論量計酬支付制度與醫院生產效率」，國家科學委員會專案研究計畫報告。
6. 羅紀瓊、石淦生、陳國樑(1996)，「醫院效率之衡量—DEA方法之應用」，經濟論文24(3)，p375-396。
英文部分
1. Biorn, E., Hagen, T. P., Iverson, T., and Magnussen, J.（2003）, “The Effect of Activity-Based Financing on Hospital Efficiency：A Panel Data Analysis of DEA Efficiency Scores 1992—2000”, Health Care Management Science, Vol.6 pp.271-283.
2. Chen, S. （2005）, “Productivity Changes in Taiwanese Hospitals and the National Health Insurance”, Service Industries Journal, accepted by April 2005.
3. Coelli, T.（1996）, A Data Envelopment Analysis (Computer) Program, CEPA working paper.
4. Charnes, A., Cooper W. W., and Rhodes, E. L.（1978）, “Measuring the efficiency of decision making units”, European Journal of Operational Research, pp.429-444.
5. Dusansky, R. and Wilson, P. W.（1994），“Technical Efficiency in the Decentralized Care of the Developmentally Disabled”, The Review of Economics and Statistics, Vol.76, No.2, pp.340-345.
6. Eakin, B. Kelly（1991）, “Allocative Inefficiency in the Production of Hospital Service”, Southern Economic Journal, Vol.58, No.1, pp.240-248.
7. Fan, C., Chen, K., and Kan, K.（1998）, “The design of payment for physicians under global budget–an experimental study”, Journal of Economics Behavior ＆ Organization, Vol. 34, pp.295-311.
8. Fare, R., S. Grosskopf, B. Lindgren and P. Ross（1989）,“Productivity Development in Swedish Hospitals：A Malmquist Output Index Approach,” in A. Charnes, W.W. Cooper, A.Y. Lewin, and L.M. Seiford（eds.）, Data Envelopment Analysis：Theory, Methodology and Applications, Boston：Kluwer Academic Publisher, 1994.
9. Godsen, T., Pedersen, L., and Torgerson, D.（1999）,“How should we pay doctors? A systematic review of salary payments and their effect on doctor behaviour.”, QJM : monthly journal of the Association of Physicians, Vol. 92 (1), pp. 47-55.
10. Greene, W. H.（2003）, Econometric Analysis, Prentice Hall USR, NJ07458.
11. Hickson, G. B., Altemeier, W. A. and Perrin, J. M. (1987), “Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in Randomized Prospective Study”, Pediatrics , Vol.80, September 1987, pp344-50.
12. Hsueh, Y., Lee, S., and Huang, Y.（2004）, “Effect of Global Budgeting on the Distribution of Dentist and Use of Dental Care in Taiwan”, Health Service Research, Vol.39, Iss.6 part 2, pp.2135-53.
13. Register, A., and Bruning, R.（1987）, “Profit Incentives and Technical Efficiency in the Production”, Southern Economic Journal, Vol.53, No.4, pp.899-914.
14. Shumeli, A., Israeli, O., and Israeli A.（2002）, “The effect of introducing prospective payment to general hospitals on length of stay, quality of care, and hospitals’ income: the early experience of Israel”, Social Science and Medicine, Vol.55, Iss.6, pp.981-989.
15. Stearns, Sally C., Wolfe, Barbara L., and Kindig, David A.（1992）, “Physician Responses to Fee-for-Service and Capitation Payment”, Inquiry, Vol. 29, pp. 416-25.
16. Tobin, J.（1958）, “Estimation of Relationship for Limited Dependent Variables”, Economertica, Vol.26, pp.24-36.
17. Wang, B. B.（2001）, “Managed Care, Vertical Integration Strategies and Hospital Performance”, Health Care Management Science, Vol.4, pp. 181-191.