انتخاب مکان بهینه برای بیمارستان های تایوان بمنظور تضمین مزیت رقابتی با استفاده از فرایند تحلیل سلسله مراتبی و تحلیل حساسیت

Implementation of the National Health Insurance scheme in Taiwan since 1995 has intensified competition in the local medical sector. Given elevated living standards island wide, Taiwanese residents have become more health conscious and attach increasing importance to quality healthcare, explaining the heightened consumer demand in the quality and scope of medical services. Additionally, the medical service sector has improved its organizational structure and encouraged hospitals to establish management practices that would increase their competitiveness. In such an intensely competitive environment, selecting the optimal location of hospitals to be established is of priority concern. Therefore, this work presents an analytic hierarchy process (AHP)-based evaluation model. Sensitivity analysis is performed in detail by varying the objective factor decision weight, the priority weight of subjective factors and the gain factors. Adopted herein is the renowned diamond model introduced in Porter's The Competitive Advantage of Nations (1990) that influences how competitive advantages, especially with respect to developing and evaluating the objectives of optimal location selection, are related in order to devise a standardized operational procedure. Besides a literature review and interviews with experts, this study also adopts the modified Delphi method, the AHP and the sensitivity analysis to develop an evaluation method for selecting the optimal location of a regional hospital in Taiwan to determine its effectiveness. The proposed evaluation criterion provides a valuable reference for hospital administrators and academics in establishing a standardized means of selecting the optimal location for new medical care facilities.

Implementation of the National Health Insurance scheme in Taiwan since 1995 has intensified competition in the local medical sector. Given elevated living standards islandwide, Taiwanese residents have become more health conscious and attach increasing importance to quality healthcare, explaining the heightened consumer demand in the quality and scope of medical services. Additionally, the medical service sector has improved its organizational structure and encouraged hospitals to establish management practices that would increase their competitiveness. In such an intensely competitive environment, selecting the optimal location of hospitals to be established is of priority concern. In its early stage, linear programming was used to solve location-selection-related problems [1]. For instance, previous studies attempted to locate the optimal position to establish a hospital by utilizing conventional mathematic or statistical methods. In considering where to select a location, besides legislation restrictions, policymakers and business groups seldom consider how selecting the optimal location during the decision-making process could possibly affect its competitiveness. A healthcare program was launched in 1984 to offer medical resources throughout Taiwan proportionately. The Department of Health of the Executive Yuan divides 63 sub-regions into 17 medical areas, with each sub-region to contain a certain number of hospitals, as planned in advance in order to continuously improve healthcare services and living standards. According to the Department of Health, while 18,777 hospitals were operating in 2003, that figure increased to 19,240 in 2004, i.e., an annual increase of more than 2.47%. Additionally, the global aging phenomenon is no exception in Taiwan, with the island officially becoming a rapidly aging society in 1993 according to the World Health Organization definition. Therefore, from a market-demand perspective, Taiwan has enormous growth potential, as evidenced by the establishment of many hospitals and the increasing competitiveness in the medical care sector. Given the oversaturated and fiercely competitive medical service sector, selecting the wrong location for a new hospital could significantly raise operational costs and stymie future growth. Selecting the optimal location for a hospital in terms of competitiveness involves the various hospital types in Taiwan, devising appropriate evaluation criteria and categorizing hospitals according to those evaluation criteria. Location theory has been extensively studied [2]. Despite the considerable attention paid to selecting an optimal location for medical care facilities, establishing a hospital must strictly comply with governmental regulations, often causing decision makers to overlook the importance of selecting an optimal location. Sensitivity analysis is performed in detail by varying the objective factor decision weight, the priority weight of subjective factors and the gain factors. This study adopts the renowned diamond model introduced in Porter's The Competitive Advantage of Nations (1990) that influences how competitive advantages, especially with respect to developing and evaluating the objectives of optimal location selection, are related in order to devise a standardized operational procedure. Besides a literature review and interviews with experts, this study also adopts the modified Delphi method, the analytic hierarchy process (AHP) and the sensitivity analysis to develop an evaluation method for selecting the optimal location of a regional hospital in Taiwan to determine its effectiveness. The proposed evaluation criterion provides a valuable reference for hospital administrators and academics in establishing a standardized means of selecting the optimal location for new medical care facilities.

By adopting the renowned diamond model from Porter's The Competitive Advantage of Nations that attempts to understand how competitive advantages are intricately related, this study develops an evaluation criterion to select the optimal location for new Taiwanese hospitals to be established. The proposed evaluation criterion provides policymakers and academics with recommendations for future development. The objective factor measure is performed for the alternatives by referring the indices of the best indicators worldwide. The subjective factor is measured using AHP. Throughout the analysis, the various criteria and its sub-criteria are identified while considering optimal selection of location to ensure a competitive advantage as a means of setting up hospitals. A detailed sensitivity analysis has already been performed to identify the variation in behavior of the alternatives. The synthesis values of the three location selection areas under six criteria are factor conditions (0.121), demand conditions (0.223), firm strategy, structure and rivalry (0.227), related and supporting industries (0.046), government (0.296) and chance (0.086). Evidently, demand conditions, firm strategy, structure and rivalry and government are high. The proposed criteria can assess the location selection, relativity, demand conditions, firm strategy, structure and rivalry and government assessment of constructing the sub-criteria to assess the focal point under the surface. On the basis of data in Table 15, one of the sub-criteria of the government rank first, while qualifications of the hospital's establishment and the regulations of the established standard rank fourth for promulgating tasks that require a hospital's assessment. The sub-criteria under the firm strategy, structure and rivalry, rank second for policymaker's attitude, rank sixth for the rank of competing hospitals. The sub-criteria under the demand conditions rank third, population age distribution; rank fifth, population density. Synthesis value of three location selection areas under 18 sub-criteria with their order nearly inside 10th the evaluation criterion can be obtained to select the optimal location. The synthesis values of each of the three location selection areas are also called the relative weights by taking some regional hospitals in Taiwan as the research object. Locations in the EDoTC, Taiping City and Dali City are considered, in which the wrap enters constructs under the construction evaluation pattern. The same is true for a situation in which the results are really set up with the present EDoTC. Priorities of the three location selection areas are the locations of the EDoTC, Dali City and Taiping City. For this regional hospital in the case implementation, while setting up the hospital, the three locations considered were taken to construct under the evaluation method. Our results correspond to those of the hospital. The proposed evaluation method can select the optimal location for a new hospital under construction to ensure that it has a competitive advantage once established. Table 15. Synthesis value of three locations selection areas under 18 sub-criteria Criteria Sub-criteria Synthesis value Rank Factor conditions Capital 0.056 8 Labor 0.024 Land 0.041 10 Demand conditions Population number 0.044 9 Population density 0.061 5 Population age distribution 0.118 3 Firm strategy, Management objective 0.038 structure and rivalry Rank of competing hospitals 0.06 6 Policymaker's attitude 0.129 2 Related and supporting industries The medicine practice and the pharmaceutical sector 0.019 Hospital administration sector 0.013 The healthcare sector 0.013 Government Qualifications of the hospital's establishment and the regulations of the established standard 0.167 1 Efforts to promote a medical network 0.058 7 Promulgating tasks that require a hospital's assessment 0.072 4 Chance Violent change in market demand 0.024 Dramatic fluctuations in production costs 0.035 Significant changes in the financial market and the exchange rate 0.027