台灣促參醫院營運模式及其投資效益之探討

目前醫療服務因醫療政策、環境以及民眾對醫療服務品質期望增加的影響，醫療產業競爭日益激烈，私人及財團醫院改以企業化的方式經營。而公立醫院因資金不足、受法令規章限制，已無法滿足民眾對醫療的需求，但是基於公共衛生政策的推行與醫療資源分配不均等因素，公立醫院仍有其存在之必要。促進民間參與公共建設(PPP)，是將傳統由政府舉辦的公共建設，開放給民間來興建及營運，2000年公布實施促參法至今，已有多家私人及財團體系經營促參醫院。本論文針對依據促參法得標二家以上促參醫院的五大醫療體系做為研究對象，針對促參醫院進行個案介紹以及財務報表的經營與獲利能力面向的投資效益分析。研究結果發現目前執行中的促參模式多為BOT，其次為ROT、OT或兼採BOT方式辦理。促參委外最久的台南市立醫院，已營運長達34年之久，是台灣首家公辦民營及採用促參法的醫院，歷經四次簽約中有二次產生續約爭議。財務分析中，雙和醫院的獲利最高，已連續三年整體結餘新台幣5億元以上；而區域醫院等級的高雄市立大同醫院2019年醫務利益率高達16%，為促參醫院中投資效益最高；而效益較差的是合約效期只剩下一年的萬芳醫學中心，醫務利益率為負3.9%，且已連續二年醫務結餘呈現赤字。促參醫院對醫療服務提升、促進經濟發展、緩解政府財政壓力的成效顯著，建議未來擴展成為健康醫療產業結合的智慧城市，串聯醫療、長照護理、生技醫材、觀光醫療，發展國際醫療市場，而達到民眾、政府、民間機構三贏的社會經濟發展目標，完善台灣各地區的醫療網路。

As competition in the intensified medical industry, private and consortium hospitals are operating in a more change of enterprising into corporate . Even in the lack of funds and limited use of hospital beds, public hospital still have the responsibility to implement public health polices, to distribute medical resources evenly. Public-private-partnership (PPP) is a traditional government run project that has been opened to the private sector for construction and operation.This study includes five medical systems that have won the bid and commissioned to operate at least more than two hospitals. From eight financial statements, this study analyze the efficiency of the investment. We find that the most used models currently being implemented are BOT (Build-Operate-Transfer), ROT (Rehabilitate-Operate-Transfer) and OT (Operate-Transfer). The first public-private partnership and ROT for hospital in Taiwan is Tainan Municipal Hospital which has been in service for 34 years. The hospital has made the highest profit with more than $ NT 500 million annually for three consecutive years is Shung-Ho Hospital in New Taipei . The operating profit margin of 6% at Kaosung Municipal Ta-Tung Hospital was the highest investment benefit among PPP hospitals in 2019 profitability analysis. The less profitable one with a negative 3.9% of profit margin and a deficit financial balance for two consecutive year is Taipei Municipal Wanfang Hospital. To improve the medical services, to promote economic development and to ease the financial pressure of government by the PPP hospital have been achieved remarkly.Advice for future expansion into a smart city of healthcare industry, the linkings of medical care, long-term medical care, biotechnology, medical tourism and developing international medical markets are mandatory.Finally, we can achieve the so called win-win policy with socio-economic development of the people, the government and private organization as well as the importment of medical network in counties and cities of Taiwan.