論文使用權限 Thesis access permission:校內外都一年後公開 withheld
開放時間 Available:
校內 Campus: 已公開 available
校外 Off-campus: 已公開 available
論文名稱 Title |
地區醫院垂直整合護理之家:以資源相依之觀點 Community Hospitals' Vertical Integration into Nursing Facilities: A Resource Dependence Perspective |
||
系所名稱 Department |
|||
畢業學年期 Year, semester |
語文別 Language |
||
學位類別 Degree |
頁數 Number of pages |
63 |
|
研究生 Author |
|||
指導教授 Advisor |
|||
召集委員 Convenor |
|||
口試委員 Advisory Committee |
|||
口試日期 Date of Exam |
2004-07-23 |
繳交日期 Date of Submission |
2004-08-28 |
關鍵字 Keywords |
資源相依理論、護理之家、垂直整合 resource dependence theory, vertical integration, nursing facility |
||
統計 Statistics |
本論文已被瀏覽 5637 次,被下載 1976 次 The thesis/dissertation has been browsed 5637 times, has been downloaded 1976 times. |
中文摘要 |
研究目的 本研究目的在於透過資源相依理論,探討地區醫院垂直整合護理之家的相關環境與組織因素。 資料來源 本研究使用的資料來源有三:中華民國醫院協會所製作的九十一年度台灣地區醫院年鑑、中華民國長期照護專業協會編印的2002年版的台閩地區長期照護資源名冊、以及各縣市政府主計室所公佈的九十一年度人口結構統計資料。 研究設計 本研究採橫斷式設計,研究時間為九十一年。分析單位為地區醫院,樣本數總計達248家。由於依變項為二分法,所以採用羅吉斯迴歸利用SPSS 10.0統計軟體來進行分析。 主要發現 本研究結果發現有提供洗腎和居家護理服務且位於老年人口比例較高和競爭程度較高區域的地區醫院進行垂直整合護理之家的可能性也較高。而佔床率、復健科服務、呼吸治療科服務、高科技設備、醫師病床比率、與護士專科護理師病床比率對於地區醫院是否垂直整合護理之家並沒有顯著的影響。 結論 並非所有的地區醫院都適合垂直整合護理之家。就環境因素而言,位於老年人口比例較高和競爭程度較高區域的地區醫院比較可能進行垂直整合護理之家。而從組織層面來說,有提供洗腎和居家護理服務的地區醫院對於垂直整合護理之家有顯著的影響。 |
Abstract |
Research Objective The purpose of this study is to profile market factors and organizational characteristics associated with community hospitals’ vertical integration into a nursing facility through the lens of resource dependence. Data Sources Data for this study were drawn from three sources: the 2002 secondary data collected by Taiwan Community Hospital Association (TCHA) on a regular yearly basis; the 2001 secondary data compiled by Taiwan Association of Long-Term Care Professionals (TALTCP); and the 2002 area-based population data gathered by Department of Budget, Accounting, and Statistics (DOBAS) in local governments respectively. Study Design This study is a one-year cross-sectional design with community hospitals as the unit of analysis. A sample of 248 community hospitals was the focus of this study. Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was performed using the statistics software, SPSS 10.0. Findings A higher ratio of the elderly, a high degree of competition, and the provision of dialysis and home care services spur community hospitals on to vertical integration into a nursing facility. Occupancy rate, the rehabilitative service, respiratory care service, high technology, the ratio of MDs to staffed beds, as well as the ratio of RNs and LPNs to staffed beds bear no reference to community hospitals’ vertically integrating a nursing facility. Conclusion Not all community hospitals are equally good candidates for stepping into the avenue to nursing facility. Given the environmental factors, community hospitals situated in highly competitive district areas with a higher ratio of the elderly are more likely to vertically integrate a nursing facility. In terms of organizational factors, the provisions of dialysis service and home care service have a significant relationship with the likelihood of vertical integration. |
目次 Table of Contents |
Acknowledgement i Abstract iii Chinese Abstract v Table of Contents vi List of Tables vii List of Figures vii Chapter 1 Introduction 1 Introduction 1 Purpose of the Study 4 Chapter 2 Literature Review 5 The Definition of Hospital-based Nursing Facilities 6 Integration in US Health Care Industry 7 Chapter 3 Theoretical Framework 12 Resource Dependence Theory 12 Conceptual Framework 17 Hypotheses 19 Chapter 4 Methodology 26 Study Design 26 Unit of Analysis 26 Sample 27 Measurement 27 Data sources 33 Data analysis 34 Chapter 5 Results 37 Descriptive Statistics 37 Univariate Statistics 40 Logistic Regression Analysis 42 Chapter 6 Discussion & Conclusion 48 Major Findings and Discussion 48 Study Limitations 53 Implications 54 List of References 56 List of Tables Table 4-1 Variables, Operational Definitions, and Data sources 31 Table 5-1 Descriptive Statistics for the Variables of Interest (n=248) 39 Table 5-2 Univariate Statistics for Vertical Integration (n=248) 42 Table 5-3 Results of Logistic Regression Analysis for Community Hospitals’Vertical Integration into a Nursing Facility 43 Table 5-4 Summary of the Hypotheses and Results 47 List of Figures Figure 3-1 Conceptual Framework 19 |
參考文獻 References |
Aldrich, H. (1979). Organizations and Environment. New Jersey: Prentice-Hall. Balsano, A., & Fowler, F.J. (1993). Subacute care as a new source of revenue. Healthcare Financial Management, 47(7), 56-62. Banaszak-Holl, J., Zinn, J., & Mor, V. (1996). The impact of market and organizational characteristics on nursing care facility service innovation: A Resource Dependence Perspective. Health Services Research, 31(1), 97-117. Beekun, R., & Ginn, G. (1993). Business strategy and inter-organizational linkages within the acute care hospital industry. Human Relations, 46(11), 1291-1304. Blau, P. M. (1964). Exchange and power in social life. New York: Wiley. Bureau of National Health Insurance (2000). Retrieved July 15, 2004, from http://www.nhi.gov.tw/20download/download_6-1.htm Burns, L. R. & Pauly, M. V. (2002). Integrated delivery networks: A detour on the road to integrated health care? Health Affairs, 21(4), 128-139. Chen, M. H., Chang, V. H. C., & Chen, R. C. (2004). Hospital strategic alliance-A case study of ATHCA. Hospital, 37(1), 43-52. Clement, J. P (1987). Does hospital diversification improve financial outcomes? Medical Care, 988-1001. Clement, J. P. (1988). Vertical integration and diversification of acute care hospitals: Conceptual definitions. Hospital & Health Services Administration, 33(1), 99-110. Clement, J. P., Smith, D. G., & Wheeler, R. C. (1994). What do we want and what do we get from not-for-profit hospitals? Hospital & Health Services Administration, 39(2), 159-178. Cleverley, W. O., & Harvey, R. K. (1992). Critical strategies for successful rural hospitals. Health Care Management Review, 17(1), 27-33. Cody, M. (1996). Vertical integration strategies: Revenue effects in hospital and Medicare markets. Hospital & Health Services Administration, 41(3), 343-357. Conrad, D. A., & Dowling, W. L. (1990). Vertical integration in health services: Theory and managerial implications. Health Care Management Review, 15(4), 9-22. Conrad, D. A. (1993). Coordinating patient care services in regional health systems: The challenge of clinical integration. Hospital & Health Services administration, 38(4), 491-508. Conrad, D. A., & Shortell, S. M. (1996). Integrated health systems: Promise and performance. Frontiers of Health Services Management, 13(1), 3-40. Council for Economic Planning and Development (2002). [Population Estimation among 2002-2051 in Taiwan]. Retrieved July17, 2004, from http://www.cepd.gov.tw/manpower/Population/report.pdf Dansky, K. H., Milliron, M., & Gamm, L. (1996). Understanding hospital referrals to home health agencies. Hospital & Health Services Administration, 41(3), 331-342. D’Aunno, T. A., & Zuckerman, H. S. (1987). The Emergence of Hospital Federations: An Integration of Perspectives from Organizational Theory. Medical Care Review, 44(2), 323-343. Department of Health (2003). Retrieved July 17, 2004, from http://www.doh.gov.tw/statistic/index.htm Department of Health (2004). Retrieved June 25, 2004, from http://www.ltcpa.org.tw/ DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American Sociological Review, 48, 147-160. Drucker, P.F. (1970). Technology, Management, and Society. New York: Harper & Row. Dowling, W. L. (1995). Strategic alliances as a structure for integrated delivery systems. In A. D. Kaluzny, H. S. Zuckerman, and T. C. Ricketts(Ed.), Partners for the Dance: Farming Strategic Alliance in Health Care. Michigan: Health Administration Press. Emerson, R. M. (1962). Power-dependence relations. American Sociological Review, 27, 31-41. Gamm, L. D., Kassab, C. D., Brannon, S. D., & Fennell, M. L. (1996). Linkage strategies of rural hospitals: Independent hospital, local health system, and/or externally linked facility. Hospital & Health Services Administration, 41(2), 236-254. Gillies, R. R., Shortell, S. M., & Young, G. J. (1997). Best practices in managing organized delivery systems. Hospital & Health Services Administration, 42(3), 299-321. Gillies, R. R., Shortell, S. M., Anderson, D. A., Mitchell, J. B., & Morgan, J. B. (1993). Conceptualizing and measuring integration: Findings from the health systems integration study. Hospital & Health Services Administration, 38(4), 467-489. Ginsburg, A., & Buchholtz, A. (1990). Converting to for-profit status: Corporate responsiveness to radical change. Academy of Management Journal, 33(3), 445-477. Goldsmith, J. (1989). A radical prescription for hospitals. Harvard Business Review, 89(3), 104-111. Gray, B. H. (1993). Ownership matters: Health reform and the future of nonprofit health care. Inquiry, 30(4), 352-361. Greene, J. (1994). Merger monopolies. Modern Healthcare, 24(49), 38-48. Greening, D. W., & Gray, B. (1994). Testing a model of organizational response to social and political issues. Academy of Management Journal, 37(3), 467-498. Harrigan, K. R. (1984). Formulating vertical integration strategies. Academy of Management Journal, 9(3), 638-652. Hurst, J. (1992). The Reform of Health Care: A Comparative Analysis of Seven OECD countries. Paris: OECD. Hrebeniak, L., & Joyce, W. (1985). Organizational adaptation: Strategic choice and environmental determinism. Administrative Science Quarterly, 30, 336-349. Jacobs, D. (1974). Dependence and vulnerability: An exchange approach to the control of organizations. Administrative Science Quarterly, 19, 45-49. Johnson, D. E. L. (1993). Integrated systems face major 1 hurdles, regulations. Health Care Strategic Management, 11(10), 2-3. Johnston, R., & Lawrence, P. R. (1988). Beyond vertical integration-the rise of the value-adding partnership. Harvard Business Review, 66(4), 94-101. Kaluzny, A. D., McLaughlin, C. P., & Jaeger, B. J. (1993). TQM and a managerial innovation: Research and implications. Health Services Management Review, 6(2), 78-88. Karrer-Rueedi, E. (1997). Adaptation to change: Vertical and horizontal integration in the drug industry. European Management Journal, 15(4), 461-469. Katz, D., & Kahn, R. L. (1966). The Social Psychology of Organizations. New York: Wiley. Lawrence, P. R., & Lorsch, J. W. (1967). Organization and Environment: Managing Differentiation and Integration. Boston: Harvard University Press. Lehrman, S., & Shore, K. K. (1998). Hospitals’ vertical integration into skilled nursing: A rational approach to controlling transaction costs. Inquiry, 35(3), 303-314. Luke, R. D., & Olden, P. (1995). Foundations of market restructuring: Local hospital cluster and HMO infiltration. Medical Interface, 8(9), 71-75. Luke, R. D., Ozcan, Y. A., & Olden, P. C. (1995). Local Markets and Systems: Hospital Consolidations in Metropolitan Areas. Health Services Research, 30(4), 555-575. Marcus, A. (1988). Responses to externally induced innovation: Their effects on organizational performance. Strategic Management Journal, 9, 387-402. Mick, S. S. (1990). Explaining vertical integration in health care: An analysis and synthesis of transaction-cost economics and strategic management theory. pp. 207-240 In S. S. Mick and Associates (Ed.), Innovations in Health Care Delivery. Ministry of the Interior (2003). Retrieved June 25, 2004, from http://www.moi.gov.tw/stat/index.asp Oliver, C. (1990). Determinants of interorganizational relationships: Integration and future directions. Academy of Management Review, 15(2), 241-265. Oliver, C. (1991). Strategic responses to institutional processes. Academy of Management Review, 16(1), 145-179. Pfeffer, J. (1982). Organizations and Organizational Theory. Boston: Pitman. Pfeffer, J., & Salancik, G.R. (1978). The External Control of Organizations: A Resource Dependence Perspective. New York: Harper & Row. Porter, M.E. (1980). Competitive Strategy: Techniques for Analyzing Industries and Competitors. New York: Free Press. Provan, K. G. (1980). Board power and organizational effectiveness among human service agencies. Academy of Management Journal, 23(2), 221-236. Provan, K. G., Beyer, J. M., & Kruytbosch, C. (1980). Environmental linkages and power in resource-dependence relations between organizations. Administrative Science Quarterly, 25, 200-225. Qaseem, A. (2003). The Impact of the Balanced Budget Act of 1997 on the Supply of Subacute Care Services by Nursing Homes: A Longitudinal Analysis of Industry Response. Unpublished doctoral dissertation, The Pennsylvania State University, University Park, Pennsylvania. Robinson, J. C., & Casalino, L. P. (1996). Vertical integration and organizational networks in health care. Health Affairs, 15(1), 7-23. Scherer, F. M. (1980). Industrial Market Structure and Economic Performance. Boston: Houghton Mifflin. Scott, R. W. (1987). Organizations: Rational, Natural, and Open Systems. New York: Prentice-Hall. Sheppard, J. P. (1995). A resource dependence approach to organizational failure. Social Science Research, 24, 28-62. Shortell, S. M., Gillies, R. R., & Anderson, D. A. (1994). The new world of management care: Creating organized delivery systems. Health Affairs, 13(5), 46-64. Shortell, S. M., Morrison, E. M., & Hughes, S. (1989). The keys to successful diversification: Lessons from leading hospital systems. Hospital and Health Services Administration, 34(4), 471-492. Song, Y. Ⅱ (1995). Strategic alliances in the hospitals industry: A fusion of institutional and resource dependence views. Academy of Management Journal, 271-275. Teece, D. J. (1982). Towards an economic theory of the multiproduct firm. Journal of Economic Behavior and Organization. 3, 39-63. Thompson, J. D. (1967). Organizations in Action. New York: McGraw-Hill. Ulrich, D., & Barney, J. B. (1984). Perspectives in organizations: Resource dependence, efficiency, and population. Academy of Management Review, 9(3), 471-481. Van de Ven, W. P. M. M. (1995). Regulated competition in health care: With or without a global budget? European Economic Review, 39, 786-794. Varian, H. R. (1992). Microeconomic Analysis. New York: Norton. Vickers, J., & Waterson, M. (1991). Vertical relationships: An introduction. The Journal of Industrial Economics, 39(5), 445-450. Wernerfelt, B., & Karnani, A. (1987). Competitive strategy under uncertainty. Strategic Management Journal, 8, 187-194. Wheeler, J. R. C., Burkhardt, J., Alexander, J. A., & Magnus, S. A. (1999). Financial and organizational determinants of hospital diversification into subacute care. Health Services Research, 34(1), 61-81. Yang, H. C., & Suan, B. Y. (1999a). [An examination of public-hospital-based nursing homes]. Hospital, 32(2), 57-65. Yang, H. C., & Suan, B. Y. (1999b). [An introduction of private-hospital-based nursing homes: An example of Cardinal Tien Hospital]. Hospital, 32(3), 59-66. Yeh, H. M., Lin, H. P, Wu, C. C., Huang, X. Y., & Yeh, E. Y. T. (2000). Home care in Taiwan, past and future. Show-Chwan Medical Journal, 2(3), 111-115. Yeh, S. C. J. (1997). Subacute Care in Skilled Nursing Facilities as an Adaptive Response to the New Healthcare Environment. Unpublished doctoral dissertation, Virginia Commonwealth University, Richmond, Virginia. Zinn, J. S., Mor, V., Castle, N., Intrator, O., & Brannon, D. (1999). Organizational and environmental factors associated with nursing home participation in managed care. Health Services Research, 33(6), 1753-1767. Zinn, J. S., Weech, R. J., & Brannon, D. (1998). Resource dependence and institutional elements in nursing home TQM adoption. Health Services Research, 33(2), 261-273. Zuckerman, H. S., & D’Aunno, T. A. (1990). Hospital alliances: Cooperative strategy in a competitive environment. Health Care Management Review, 15(2), 21-30. Zuckerman, H. S., D’Aunno, T. A., & Vaughan, T. E. (1990). The Strategies and autonomy of university hospitals in competitive environments. Hospital and Health Services Administration, 35(1), 103-120. |
電子全文 Fulltext |
本電子全文僅授權使用者為學術研究之目的,進行個人非營利性質之檢索、閱讀、列印。請遵守中華民國著作權法之相關規定,切勿任意重製、散佈、改作、轉貼、播送,以免觸法。 論文使用權限 Thesis access permission:校內外都一年後公開 withheld 開放時間 Available: 校內 Campus: 已公開 available 校外 Off-campus: 已公開 available |
紙本論文 Printed copies |
紙本論文的公開資訊在102學年度以後相對較為完整。如果需要查詢101學年度以前的紙本論文公開資訊,請聯繫圖資處紙本論文服務櫃台。如有不便之處敬請見諒。 開放時間 available 已公開 available |
QR Code |