臺灣博碩士論文加值系統

Anderson, Banker and Janakiramaan （2003）最早由當期銷售的增減趨勢，探討經理人對資源的自由裁量的成本僵固性模型。Banker, Byzalov, Ciftei and Mashruwala（2014）認為前期銷售的增減變化也會影響經理人對資源調整的裁量權，進而形成成本不對稱性。Chen, Lu and Sougiannis（2012）提出成本不對稱程度也受代理問題中管理者的擴張誘因影響，而Kama and Weiss,（2013）證實自利的經理人面對須滿足盈餘門檻的誘因時，可能在銷售下降時加速削減寬鬆資源進而緩和成本僵固性的現象。台灣全民健康保險自1995年實施，在全民健保支付制度下，台灣醫療財團法人對醫療服務價格無決定權；此外，由於台灣醫療產業為受管制產業，在主管機關對於報導虧損之醫院的高度關切與監督下，台灣醫療財團法人有避免虧損（零盈餘門檻）壓力。因此，對台灣醫療財團法人經理人而言，成本調整可能是醫院維持獲利之重要關鍵，故本論文以台灣醫療財團法人為研究對象，主要探討前期盈虧、零盈餘門檻誘因對台灣醫療財團法人經理人進行資源調整決策時的影響，分析醫療財團法人之成本及其細項在不同的成本不對稱性模型中之適用性，論文包含三項研究目的：第一項目的在以Banker et al.（2014）前期收入為基礎之成本不對稱性模型整合地探討醫療財團法人之成本及其細項的成本不對稱性；第二項目的則以前期盈虧為基礎之成本不對稱性模型探討醫療財團法人之成本及其細項的成本不對稱性；第三項目的則欲瞭解零盈餘門檻誘因如何影響醫療財團法人之成本不對稱性。
論文實證結果發現，台灣醫療財團法人之經理人進行成本調整決策時，可能同時考量前期收入變化及前期盈虧，而影響其成本不對稱性。另外，由於台灣醫療財團法人各費用細項特性存在差異，各費用細項成本不對稱模型之適用情況不同。相較於前期盈虧為基礎，台灣醫療財團法人之經理人對醫務成本中之其他項目與教育研發成本及醫療社會服務支出進行調整決策時，較重視前期收入為基礎之成本不對稱模型。相較於前期收入為基礎，台灣醫療財團法人之經理人對醫務成本中之醫材費與其它非醫務支出進行調整決策時，較重視前期盈虧為基礎之成本不對稱模型。此外，當面對前期有虧損，即使當期收入增加，台灣醫療財團法人之經理人則會全面性地對醫務成本、管理費用、其他非醫務支出、醫務成本中之人事費、藥品費、醫材費與其他項目努力撙節。然而，當存在零盈餘門檻誘因時，經理人將積極縮減其他非醫務支出。

Anderson, Banker and Janakiramaan (2003) find that the relationship between costs and sales is asymmetric because managers deliberately adjust the resources committed to activities. Banker, Byzalov, Ciftei and Mashruwala (2014) conclude that managers consider prior sales change when they adjust resources committed to activities. Chen, Lu and Sougiannis (2012) show that cost asymmetry positively associated with agency problems. Kama and Weiss (2013) find that earnings targets and managerial incentives affect cost asymmetry. The prices for medical services have been highly regulated since the institution of the Taiwan's National Health Insurance system (NHI) in 1995. There is also greater supervision for the hospital reported loss by the regulatory authorities after the implementation of the NHI. Consequently, Taiwan hospitals may have the incentive to meet or beat the specific zero earnings benchmark. This study investigates the applicability of different cost asymmetry models and address three research objectives. First, using the asymmetric cost behavior model, which is based on the moderating effect of prior sales changes, proposed by Banker et al. (2014), I discuss the asymmetry cost issue by examining cost components of Taiwan hospitals. Second, I further examine this issue by using the asymmetric cost behavior model based on the moderating effect of prior net incomes (losses). Third, I study how the incentive to meet or beat the specific zero earnings benchmark affects the discretionary decisions of costs and its components.
Empirical results of the study show that managers consider both prior revenue change and prior net incomes (losses) when they adjust resources committed to activities. More detailed findings are summarized as follows: (1) when managers adjust miscellaneous medical costs, and educational costs and the social service costs within the medical costs, they pay more attention to prior revenue changes than prior net incomes (losses); (2) when managers adjust medical material costs, miscellaneous non-medical expenses, they pay more attention to prior net incomes (losses) than prior revenue changes; (3) when facing prior net losses, managers will cut medical costs, management expenses, miscellaneous non-medical expenses, medical salary costs, medicine costs, medical material costs, miscellaneous medical costs, even if current revenue increases; (4) managers cut more miscellaneous non-medical expenses with the incentive to meet or beat the zero earnings benchmark.

目 錄
第一章 緒論
第一節 研究動機與目的………………………………………………………… 1
第二節 論文架構………………………………………………………………… 6
第二章 文獻探討與假說發展
第一節 全民健康保險制度……………………………………………………… 7
第二節 醫療財團法人零盈餘門檻誘因 ……………………………………… 12
第三節 台灣醫療財團法人成本特性 ………………………………………… 19
第四節 成本不對稱性 ………………………………………………………… 20
第三章 假說發展
第一節 加入前期收入變化之成本不對稱性 ………………………………… 24
第二節 加入前期盈虧之成本不對稱性 ……………………………………… 26
第三節 考量零盈餘門檻誘因之成本不對稱性 ……………………………… 28
第四章 研究設計與方法
第一節 研究樣本 ……………………………………………………………… 30
第二節 變數定義與研究模型 ………………………………………………… 32
第五章 實證結果
第一節 敘述性統計分析 ……………………………………………………… 38
第二節 迴歸分析 ……………………………………………………………… 42
第三節 額外測試 ……………………………………………………………… 55
第五章 結論
第一節 研究結論 ……………………………………………………………… 62
第二節 研究限制 ……………………………………………………………… 65
參考文獻………………………………………………………………………… 66

圖 目 錄
圖1 研究架構流程圖…………………………………………………………… 06
圖2 年盈餘次數分配圖………………………………………………………… 17

表 目 錄
表1 各國醫療服務類型與特色一覽表…………………………………………07
表2 全民健康保險改革與藥價調整歷程表……………………………………10
表3 年盈餘次數分配表與統計測試……………………………………………17
表4 醫療財團法人名稱醫療財團法人名稱、營運現況及權屬類型一覽表…31
表5 模型(2)係數彙整表……………………………………………………… 34
表6 模型(3)係數彙整表……………………………………………………… 35
表7 模型(4)係數彙整表……………………………………………………… 36
表8 模型(5)係數彙整表……………………………………………………… 37
表9 當期健保收入增減與前期健保收入增減當期健保收入增減與前期健保
收入增減、前期盈餘盈虧之交叉分析 ……………………………………… 38
表10 變數敘述性統計..……………………………………………………… 39
表11 歷年各項費用佔健保總收入比率彙整表……………………………… 40
表12 年盈餘與權屬類型交叉分析 …………………………………………… 41
表13 加入前期收入變化(Banker et al. (2014)模型)之成本不對稱性
模型實證結果…………………………………………………………………… 43
表14 加入前期盈虧之成本不對稱性模型實證結果 ………………………… 46
表15 考量盈餘管理誘因之成本不對稱性模型實證結果-加入前期收入變化
之成本不對稱性模型…………………………………………………………… 48
表16 考量盈餘管理誘因之成本不對稱性模型實證結果-加入前期盈虧之成
本不對稱性模型………………………………………………………………… 52
表17 研究實證結果彙整表 …………………………………………………… 53
表18 同時檢測前期收入變化與前期盈虧對成本不對稱之影響 …………… 57
表19 模型(7)係數彙整表……………………………………………………… 59
表20 當期與落後期零盈餘門檻誘因對成本僵固性之影響 ………………… 61

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