Page 165 - 32.3

NTU Management Review
Vol. 32 No. 3 Dec. 2022, 155-186
DOI:10.6226/NTUMR.202212_32(3).0005

The Relationship between Strategy and Hemodialysis
Performance: The Moderating Role of Competitive Intensity

醫院血液透析業務採行之策略型態與績效間關係之探討：
競爭強度的干擾角色

Chuan-Hui Chang, Central Division, National Health Insurance Administration
張傳慧 / 中央健康保險署中區業務組
Ming-Chang Huang, Department of Business Administration, National Yunlin University of
Science and Technology
黃銘章 / 國立雲林科技大學企業管理學系
Yu-Ching Chiao, Department of Business Administration, National Chung Hsing University
喬友慶 / 國立中興大學企業管理學系
Blossom Yen-Ju Lin, Department of Medical Humanities and Social Sciences, Chang Gung
University
林妍如 / 長庚大學醫學院醫學系人文及社會醫學科
Received 2021/4, Final revision received 2022/6

Abstract
This paper adopts transaction cost theory and the competitive dynamics perspective to
examine the effects of three operating strategies-namely vertical integration, cooperation,
and outsourcing to hemodialysis performance respectively. This study proposes that
regional competitive intensity may moderate the strategy-performance relationship.
Empirical data are collected from the National Health Insurance Database, which is
maintained by Taiwan’s Ministry of Health and Welfare. We obtain 1,588 records from
regional and district hospitals, which contain information regarding their hemodialysis-
related management strategies and performance outcomes in 2012 and 2013. The results
of our empirical analysis indicate that cooperation and outsourcing strategies are more
efficient than vertical integration strategies. The difference in efficiency achieved between
hospitals adopting the cooperation strategy and outsourcing strategy is insignificant;
however, we find that hospitals that adopt the outsourcing strategy tend to provide
higher quality in hemodialysis than those that adopt cooperation or vertical integration
strategies. Using the Herfindahl-Hirschman index as a proxy for competitive intensity,
this investigation reveals that competition is the highest in southern Taiwan and lowest
in central Taiwan. The results of this study support the moderating effect of competitive
intensity on the strategy-performance relationship of the hemodialysis operations.

【Keywords】hemodialysis, strategy, competitive intensity, efficiency, quality

領域主編：黃心苑教授

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