公立医院委外与城市理-台南市立医院第三期公办民营为例.docVIP

公立醫院委外與城市治理－台南市立醫院第三期公辦民營為例 陳金哲( 台灣公立醫院委外經營的成功案例，多數集中在地方政府所屬醫院，總計有八家地方公立醫院委託私人醫院及法人進行「公辦民營」。其中台南市立醫院，首開風氣之先，在1987年委託彰化秀傳醫院「公辦民營」，迄今已逾二十年，不僅是先驅，也有指標性。然而第三期委外過程，卻因優先續約權問題，引發台南市政府與秀傳醫院之間的爭議，雙方經歷「司法訴訟」、「社區民眾的聲援」、「議會密集質詢」、「第二期契約延約，至完成招商」等。雖然，最後仍由秀傳醫院取得委辦權，但整個招商過程及最後結果，相當程度上是有助於累積地方公共事務委外經營的經驗及知識，並擴大公共管理的視野。本研究透過深度訪談及議會議事錄等文獻為基礎，並汲取其他個案的執行經驗，作為分析秀傳醫療法人在台南市立醫院第三期委外計畫所面臨的挑戰。尤其新公共管理與城市治理兩者結合後，所產生的委外決策模式變化，已為公私協力模式注入新的元素，而政治與行政的相互依存關係，也格外引人注目。前述這些轉變或新現象，均是本文所關注的焦點，可提供更精緻的指標內容，作為當代都市公共管理的參考。 關鍵詞：公辦民營、都市治理、個案研究、網絡治理、健康城市 Public Outsourcing and Urban Governance in Taiwan: The Case Study of Tainan Municipal Hospital Chin-Cher Chen( Abstract 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. One of these cases , Tainan Municipal Hospital, since 1987, which is contracted by private Show Chwan Hospital that did a great performance to maintain the operation of Tainan Municipal Hospital in the past two decades. Yet, as the third long term contracting-out proclamation ended in 2007, Show Chwan medical corporation couldn’t go on owning the advantage of new contract. It appears that the new public outsouring of Tainan municipal hospital is aware of potential for conflict. Based on the in-depth interviews and documents of City assembly, this study delineates the new development of a public–private synergy in urban governance between Tainan municipal and Show Chwan medical corporation . Obviously, this case illustrates how the involvement of a private hospital by quasi-market mechanism management might face the challenges of urban politics. Advanced analysis, this study demonst