民國 84 年我國全民健康保險開辦後，國內許多小型㊩院逐漸陷入經營困 境或歇業的情形。公立㊩療機構過去因虧損，常依賴公務預算補助支持，近年 雖㈲各種改善方案，其結果成效不㆒。個案㊩院位於屏東縣之偏遠鄉村，原以 慢性病、精神病及長期照護為主，是肩負政策任務之公立㊩院。新任院長於 93 年 8 ㈪到任，即面臨 94 年公務預算大幅刪減與健保總額預算支付制度改變 等內外部環境壓力，㊩院即將㈲可能面臨㈶務危機；他為了改善㈶務困境，進 行轉型策略規劃，短期目標要能渡過 94 年的㈶務困境，長期目標要能㉂負盈 虧並發揮㈳區㊩院的功能。本文探討新任院長在各種可能的策略選㊠㆗，如何 進行決策，以再造㊩院。

Ever since the National Health Insurance carried out in Taiwan in 1995, many small hospitals have closed down due to a substantial drop in financial performance. Many public hospitals faced this problem and kept running under regular government budget support for a long time. Therefore, in recent years, various reform schemes have been implemented in different hospitals which led to diverse results. This study investigates and analyzes the process and the results of strategic organizational change in hospitals. The targeted hospital has been established for over 40 years and is located in a remote rural area. This small public hospital is used to mainly provide chronic disease care and nursing care, for veterans and their dependants. In 2005, owing to the budget cut from the government and revised payment system of National Health Insurance, the hospital faced a major financial crisis and left itself no other options but executing a hospital strategic reformation. This new strategy shall aim to develop the ability for the hospital itself to survive the current financial crisis throughout 2005 as its short-term objective, as well as the ability to deal with its own financial affairs and allow the local community hospitals to provide necessary functions as its long-term objective. This paper analyzes how the new superintendent makes decisions among the different strategies available in order to reform, and create a new improved version of the hospital.

由於大環境的變遷，使台灣醫療產業逐漸兩極化，醫院大型化與診所不斷增加，小型醫院卻不斷減少，此種狀況導致社區醫院功能式微，不利轉診制度的發展，另一深層的影響是偏遠地區的社區醫療作業出現缺口，民眾就醫不便，更突顯出這個問題的嚴重性。 社區型的中小型公立醫院近幾年來戮力改善經營，有如委託經營、策略聯盟、醫療支援、改制及裁撤等各種方案已被運用，有些公立醫院的營運狀況確實得到改善，但位於台灣本島偏遠地區的公立醫院似乎尚未見到曙光，就管理的角度而言，值得思考與介入改善。 偏遠地區的社區醫院要提升競爭力，不一定需要很多資金，亦即經營者在參考既有的解決方案之外，可以透過策略規劃進行變革，分析社區需求及醫院能力，調整與發展一般急性病、慢性病、精神病與長期照護的各類服務項目，以方便偏遠地區民眾就醫，提升可近性，建立民衆的信心，不但可以改善醫院的財務問題，亦可以滿足偏遠地區民眾的需求，成為有特色的社區醫院。 同樣地在目前醫療產業的寒冬之際，一般民眾苦於大醫院門診掛不到號與一床難求，而一般中、小型的社區醫院卻面臨經營的困境。一般中、小型的社區醫院，其實運用策略規劃與管理的知識，發揮創意去經營一個社區醫院，發揮社區醫院的功能，是可以找到生存的利基。 由於醫療照護服務的可近性非常重要，健全的中、小型社區醫院不可或缺，是轉診制度的基礎，尤其是在偏遠地區的小型公立醫院還要自負盈虧，經營者的責任不但更重，亦考驗經營者的經營能耐與智慧。個案醫院的變革可供同業與相關產業參考，給學生學習經營實務與做法，亦或能提供為政者思考以改善我國目前的醫療服務現況。