「公辦民營」是社會福利民營化主要的供應方式，也是為國內公立醫院解決經營上困境最主要的替代方案，除考量經營型態，為保持競爭性和維持稱職的勞動力，組織氣候亦是管理團隊考慮量的重點。醫師在傳統社會中，享有崇高的社會地位，但由於杜會經濟結構的變遷以及觀念改變，醫師的社會地位己不如往昔，面對醫療環境與健康保險制度的急遽改變，是否會影響醫師對組織的組織承諾? 由於醫療生態的變化以及公辦民營的競爭，各市立醫院面對提升醫療品質及經營效率與會計成本的壓力，醫院的環境與員工的組織承諾必然有所影響與變化。行政院主計處官員表示，40歲以上中年失業人數近年來有迅速攀升的現象，中年失業在家庭及社會上會導致嚴重的後果，因此本研究亦針對各市立醫院40歲以上中年員工在整體大環境的影響，不同的組織氣候，由於年齡層的不同對組織承諾的影響作探討。所以本研究主要探討在上述三種不同的經營背景及醫療環境下，公辦民營與公立市立醫院、醫師及非醫師以及中高齡與年輕的員工之間組織氣候與組織承諾的相互影響關係，以為經營者與人力資源管理學術之參考。 本研究以高雄市四家市立醫院(其中一家為公辦民營醫院，其餘三家為公立市立醫院)之全體職員工為研究對象，採全面普查方式，共發出1，424份問卷，有效問卷為1，082份，有效回收率達75.98%。 經由變異數、因素分析及層級迴歸分析，分析結果顯示，年齡層的不同在組織氣候及組織承諾皆有顯著性的差異存在，在組織氣候由於個人屬性的不同對組織承諾亦呈現顯著的影響;本研究發現公辦民營醫院的員工對組織氣偉及組織承諾的認知皆高於公立醫院，從統計資料上亦發現績效較好，是值得管理階層省思的。

The privatization is the main provided mode for the public welfare's privatization and the most major substitute for solving the predicament of the public hospitals. Because of the idea of the operating style and keeping the competitiveness, and holding the labor competent for the job, the organizational climate is the weight-bearing point of the manager team to consider. The doctors have the high social status in the traditional society, but for the change of the economic structure and the transformation of the concept, the doctors' social status is less than the past. TO face the rapid change of the environment of the medical treatment and the system of the health insurance doesn't influence the doctors' organizational commitment? The officer of the Directorate General of Budget Accounting and Statistics Executive Yuan indicates that the unemployment of the over 40-year-old raised, the mid-life unemployment result in the serious outcome; the research also aim to the employees that over 40 years old who in the different organizational climate and influence their organizational commitment. This study includes four municipal hospitals' employees (One is the privatized municipal hospital, the others are municipal hospitals), A self-reported questionnaire was sent to all employees in these four hospitals. 1,424 employees received the questionnaire, 1,082 (75.98%) employees responded. From the ANOV A, factor analysis and multiple regression analysis, our result indicate that there are significant difference in organizational climate and organizational commitment among different ages, there are significant effect on the organizational commitment in the different demographics; the .study also finds that the employees of the privatized municipal hospital whose perception of the organizational commitment and organizational climate are higher than those who work for the municipal hospitals. From the information we also find their performances are better than the public hospitals'. It's worth thinking for the managers.