民國八十四年三月一日政府開始實施全民健保制度，八十七年健保財務出現虧損，健保局於九十一年七月一日開始實施「總額預算制」，屬於支出總額上限制，造成醫療院所經營上的困難。面對近年來健康照護的環境以極快的速度在改變，醫院經營者必須面對經營成本的降低，醫療服務品質與服務效率的提升，與利潤空間的壓縮之壓力。為有效的經營，醫院管理者必須要有系統的評估本身的核心能力，架構適宜的經營策略，重新詮釋醫院的價值與競爭力。

由柯普朗與諾頓所共同發展出來的平衡計分卡正好可協助組織克服此困難，將組織所擬定的策略「具體化」，以達成組織願景及組織策略的實踐。平衡計分卡所強調的四個構面的因果關係與平衡關係，可成為醫院經營者要在這四個構面之間尋求平衡點的一項管理工具。

本研究藉由「個案研究」的方式，以某區域醫院為研究對象，建構醫院之策略地圖與平衡計分卡；因此，與一家區域教學醫院合作，藉由策略理論研究，特別是SWOT分析、五力分析，結合平衡計分卡四個構面的策略分析架構，以及對個案醫院歷史的探索，台灣醫療產業的分析及台南縣市醫療產業的現況分析，使個案醫院的使命、價值觀與願景更具體化，為個案醫院規劃出四個構面的策略方向。

個案醫院為目前台南頗具規模、設備完善的地區教學醫院，其建院以來一直秉持照顧台南地區民眾的健康為主要責任，而且個案醫院的願景為「永續成長的卓越醫院」，策略為「提供安全的就醫環境、深入社區的醫療服務、病友為尊的照護文化」，個案醫院以此為目標，守護台南地區民眾的健康。

替個案醫院規劃出四個構面的策略方向，分別為：財務面的策略目標是經營基礎的建立、收益改善及成本改善，顧客面的策略目標是患者滿意度提升及開拓顧客來源與維持顧客，內部流程面的策略目標是診療機能及醫療品質向上，學習成長面的策略目標是職員素質提升、醫護人數充足及員工滿意度，整合出個案醫院可行的策略地圖。接著替個案醫院設計平衡計分卡，由策略地圖四構面所形成的策略目標為主，發展出十個策略目標所需要的重要成功因素及其衡量指標，然後，就醫院目前的情況擬定2007年的目標值。因此，縱向的策略理論與歷史背景探索，結合橫向的醫療產業分析，為個案醫院定位出明確的存在價值與核心的優勢能力，進而找出清楚的發展方向。由計分卡的內容可以協助個案醫院發現許多值得重視的問題。以建立與修訂指標監測制度，診斷性的目的居多，未來需要徹底檢討各項缺失，並研擬具體解決方案。

The National Health Insurance program was launched on March 1, 1995. To curb the growth of medical expenses and balance the financial deficiency, the BNHI（Bureau of National Health Insurance）started to implement the global budget payment system on July 1, 2002. This measure set the upper limit of medical expenses. All these policies significantly reduce profit margin of the hospitals.

Balanced Scorecard (BSC) created by Kaplan and Norton in 1990 may be just what these organizations are looking for to overcome the obstacles and to translate strategies into actions through a linkage with performance appraisal. Balanced Scorecard (BSC), which emphasizes the cause-and-effect and balanced relationship of these four perspectives, will become apparent the suitable management tool for hospitals under the current medical care environment.

This dissertation conducts a case study for a regional teaching hospitaland to design the strategy map and the balanced scorecard in a hospital. This research worked with a district teaching hospital. Through combining the theoretical research of strategy, especially SWOT analysis, five strength analysis with balance scorecard four composition analysis of strategies structure, and to case exploration, hospital of history, and the analysis on medical industry of Taiwan and present situation analysis of the medical industry of Tainan. Not only make mission, values, and wish of hospital scene specify, plan strategy directions of four composition for hospital.

The case hospital is a regional teaching hospital with considerable scale, well-appointed of Tainan at present, it is the ultimate liability to adhere to the health of looking after the people of area of Tainan since it set up, and the wishing the scene is for ' the remarkable hospital growing up continuously forever ' of the case hospital, for offer seeking medical advice environmenting, deepenning medical care,culture of looking after putting patient first of the community safe tactics, the case hospital regards this as the goal, defend the health of the people of area of Tainan.

Plan the strategy directions of four composition surfaces for the case hospital, including: The financial portion is managed basic setting-up, income are improved and the cost is improved, the customer portion is patient's satisfaction improve and open up customer's source and maintain customers, the inside portion is to make a diagnosis the function and medical quality upwards, the study and grow up is the staff member's quality improving, doctors and nurses' number abundance and staff's satisfaction,design balance score card for case hospital then, four construct by strategy map strategies surface form goal main fact, develop the important successful factor that ten strategy goals need and weigh the indicator, then, draft the goal value of 2007 in situation of seeking medical advice in the present institute. So, vertical strategy theory and historical background are explored, combine the horizontal medical industry analysis, can orient clear existence value and central advantage ability for the case hospital, and then can find out the clear developing direction. The content that is scorecard can help the case hospital to find a lot of questions that is worth paying attention to. Monitor the system in order to set up and revise the indicator, the diagnosing purpose is in the majority, need to examine every disappearance completely in the future, grind and draft the concrete solution.

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