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

strategies (10.738) and equity collaboration strategy (10.710). However, the difference
in quality between the hospitals employing vertical integration strategies and equity
collaboration strategies is insignificant.
Besides, the interaction between competitive intensity and strategy exerts a

significant effect on efficiency (F = 21.110, p < 0.001). Lower competitive intensity
strengthens the positive relationship between equity collaboration strategies and efficiency.
The interaction between competitive intensity and strategy also exerts a significant effect

on health-care quality (F = 7.452, p < 0.001). When competitive intensity is high, hospitals
adopting vertical integration strategies can yield superior performance in terms of health-
care quality.

4. Research Limitations/Implications

This study has some implications for hospital and health-care management. First, this
study evaluates the effect of strategy on efficiency and health-care quality simultaneously.

Most hospitals in Taiwan employ the vertical integration strategy to operate hemodialysis
services, which has led to the impact of strategy on health-care quality being overlooked
in prior studies. The mixed theoretical arguments and empirical results presented in
previous studies cannot provide clear answers regarding the questions of when hospitals
should adopt either outsourcing or equity collaboration strategies and whether these

outsourcing and equity collaboration strategies enhance or limit the efficiency and health-
care quality of hospitals. Our empirical results show that collaborative strategies, namely
equity collaboration and non-equity collaboration (outsourcing), can improve a hospital’s
efficiency and health-care quality; the results therefore have practical implications for

hospitals looking to adopt managerial strategies for their clinical operations that will allow
them to maximize efficiency and health-care quality simultaneously.
Second, the differences in the medical resources available in different regions of
Taiwan affect the degree of competitive intensity in such regions. The results of this

study suggest that competitive intensity moderates the strategy-performance relationship.
In some regions with high competition intensity, larger hospitals adopt the vertical
integration strategy to provide dialysis services by establishing or collaborating or merging
with smaller hospitals to form hospital agglomerations. Agglomerations are conducive

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