Abstract
Taiwan’s medical structures have changed dramatically since the establishment of National Health Insurance program in 1995. The structural changes have not only inflicted on the district hospitals especially after the implementation of total budget system, diagnosis related groups system and floating point-value system, but also affected people’s utilization of health care resources. Hence, healthcare reforms and optimization of care services seem to be a topic of concern. Using a qualitative case study approach, we assessed the impact of the ageing population, long-term health care policies and quality of local health care services on the operation of a district hospital in northern Taiwan. In addition, challenges such as competition from other hospitals, lack of non-operating income and insufficient hardware system were also examined. We suggested that the case study hospital should be more district-hospital-focused, combine government long-term healthcare policies into their operational system, increase strategic alliances, strengthen the core of management system, and develop self-pay health-related services. The proposed strategies may serve as a reference for other district hospitals, as well as achieving sustainable management.