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NTU Management Review Vol. 32 No. 3 Dec. 2022

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

Chuan-Hui Chang, Central Division, National Health Insurance Administration
Ming-Chang Huang, Department of Business Administration, National Yunlin University of Science
and Technology
Yu-Ching Chiao, Department of Business Administration, National Chung Hsing University
Blossom Yen-Ju Lin, Department of Medical Humanities and Social Sciences, Chang Gung
University

1. Purpose/Objective

In response to changes in Taiwan’s National Health Insurance policy, since 1995,

some hospitals have adopted both non-equity collaboration (namely outsourcing)
and equity collaboration strategy in operations related to clinical services, such as
physiological examination, radiation therapy, hemodialysis, and lithotripsy. Vertical
integration, outsourcing (Borowska, Augustynowicz, Bobiński, Waszkiewicz, and Czerw,
2020; Danvers and Nikolov, 2010; Macinati and Young, 2009), and equity collaboration

(Büchner, Hinz, and Schreyögg, 2015; Cuellar and Gertler, 2006; Meijboom, de Haan,
and Verheyen, 2004; Zinn, Proenca, and Rosko, 1997; Yu and Chen, 2013) have become
the three major strategies employed by hospitals in the operation of clinical services.

Although some studies have explored the relationship between the operating strategies and
performance of health-care institutions, the theoretical arguments and empirical findings
of such studies remain mixed. The relationship between the strategy and performance of
each hospital is an unanswered and debated question. Understanding why some hospitals
are superior to others in their department operation is critical in medical management and

strategic management.
After systematically reviewing relevant literature, this study affirms the following
research gaps. First, although hospital performance is a multidimensional construct that

includes both efficiency and health-care quality, previous health management studies may
have overemphasized efficiency and overlooked the effects of management strategies on
health-care quality. Second, competitive intensity may moderate the strategy-performance
relationship. Drawing on transaction cost economics theory, the resource-based view,

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