全民健康保險從1995年實施至今已達14年之久，健保局已成為全國醫院的單一支付者，又各醫療院所營收來源約80%來自於健保局，故其健保政策影響各大醫療院所甚鉅。
總額預算支付制度實施至今已有六年之久，資料也較為完整。筆者透過資料包絡分析法三段模型，藉由環境變數的調整(扣除人口數、競爭程度、層級、權屬別之影響)，從實施前四年(1998~2001)至實施後五年(2004~2008)來探討總額預算支付制度實施前後之經營效率。
經環境變數調整後，95%醫院皆處於規模報酬遞增階段，需要增加投入或合併或策略聯盟，以達最適經營效率。在醫學中心、區域教學醫院、地區教學醫院方面，經環境變數調整後，各層級間經營效率無顯著差異，但各層級內，在實施總額預算支付制度後，醫學中心經營效率有顯著差異，由敘述統計上顯示其經營效率降低，而區域教學醫院與地區教學醫院之經營效率較無顯著的改變。在權屬別上，公立醫院顯示實施前後經營效率無差異，但私立醫院在實施後效率有顯著降低。
在Malmquist生產力分析上，從年度來看，技術效率變動率每年變動幅度不大，總生產力變動率的變動主要來自於生產技術變動率之變動，總生產力變動率在2001年~2004年達到高峰後，下降至趨近於1，生產力呈現微幅進步；從各院來看，1998~2008年間，99%醫院之總生產力變動率皆大於一，顯示各醫院總生產力呈現微幅進步的狀態。

National Health Insurance (NHI) in Taiwan has been implemented for 14 years. The Bureau of National Health Insurance has become the single payer in the hospital industries. The hospital revenues are almost 80% from NHI so that the National Health Insurance policy has huge influence to Taiwan’s hospitals.
The global budget payment system has been implemented for 6 years and the data are complete. We want to use the data from Department of Health in Taiwan, before (1998~2001) and after (2004~2007) implementation the global budget payment system, and analyze the impact in Taiwan’s educational hospital performance through Data Envelopment Analysis (DEA) three-stage model which is adjusted by the environment variables (numbers of population, the level of competition, hospital level, ownership).
After the environment variables adjusting, 95% hospitals are placed in the increased return to scale and need to increase their inputs to achieve their opportune scale. After examining the hypotheses, their performance is no obvious difference in the implement of the Global Budget payment system between the hospital levels. In the hospital levels, there is obvious difference in the medical center. From the statement statistic, the medical centers’ performance is decreasing after the implement of the Global Budget payment system. But, there is no obvious difference in the regional education hospitals and local ones. In the ownership, there is obvious decreasing in the private hospitals’ performance after implement of the Global Budget payment system.
In the Malmquist Productivity Index, efficiency change’s range is small so that total factor productivity change comes from the technical change in the horizontal analysis. The total factor productivity change achieves the top during 2001 to 2004 and decreased to 1. The productivity progresses slowly. In the vertical analysis, 99% hospitals’ total factor productivity change is greater than 1. That means each hospital’s productivity progresses

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