| Summary: | 博士 === 國立中正大學 === 政治學所 === 96 === The application of public outsourcing in Taiwan’s local public hospitals has showed the linking of New Public Management and urban governance. From the decades, the public-private collaboration is not only to resolve the deficiency of local fiscal, but also is an important tool to promote the quality of local public medical service. For example, there are eight local hospitals which are contracted by private corporate hospitals. On the one hand, the most famous case is Tainan City Hospital, since 1987, which is contracted by private Show Chwan Hospital. Show Chwan Hospital did a great performance to maintain the operation of Tainan City Hospital. On the other hand, one of the major medical reforms, the public hospitals merger- Taipei City Hospital, Kaoshiung Municipal United Hospital and Taipei County Hospital which have been carried out since 2003.
Except that, the public hospitals owned by the Department of Health, Executive Yuan, were hardly transferring to private management in the past decade. In 2004, the Department of Health decided to use new management strategies including regional alliance, medical resource sharing, coalition etc.
Methods of case studies and in-depth interview are adopted to collect empirical data for this study. The results of three public hospital’s organizational changes provide the comparable basis between quasi-market mechanism and administrative performance management. Based on the interviews, this study attempts to explain the variation between large-scale incremental and small-scale incremental changes, too.
All three typical public hospital innovations occurred in domestically, including local hospitals and central hospitals, have all pointed to the importance of economics of scale and of medical quality improvements in response to the institutional changes and market competition. The result proves that the critics regard the New Public Management by mimicking market-like mechanism. This study suggests that the hospital merger and hospital alliance could be the innovative alternatives to the status quo. The public hospital reform in this study can be dubbed as “New Wine in Old Bottles”.
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