醫療服務業之成本模式探討-以H醫院為例

Probing into Mode of Cost Accounting of Health Service Industry-Taking H-Hospital as an Example

黃芳美(Fang-Mei Huang)

指導教授 ： 鍾彩焱

元智大學/管理學院/管理研究所/碩士(2008年)

摘要

健保給付制度的改變讓醫療保健產業的經營日益艱辛，除了健保給付制度的變化，消費者意識抬頭，醫療產業營運面臨提升醫療品質與降低營運成本的雙重挑戰。
醫療業成本結構較為複雜，但為因應醫療環境的改變，多數醫院均已積極建構責任會計制度。除責任會計管理制度可顯示部門績效外，透過作業制成本概念，深入瞭解各科室各項作業之成本流程，把有效運作、高品質、低成本等三項環節融入未來的醫療服務中。過去醫療服務業建立的成本系統一般為財務報告為主的成本系統，此階段的系統係根據成本中心來追蹤成本，因而與作業及流程無關，且過度著重責任會計。作業基礎成本系統主要以作業成本動因來分攤商品成本，正可以補足傳統成本制度的不足。
本研究分成兩階段來探討個案醫院之成本會計制度：第一階段為探討個案醫院應用責任會計制度，將每項成本依傳統分攤制度歸入放射科，並計算出部門之經營績效。第二階段為瞭解個案醫院放射科之作業流程，建構ABC各項成本資訊，分析放射科各項作業之成本，進而與傳統分攤制度作一比較。藉由分析比較，發現成本是否有不合理現象，並設法改善不合理之成本。
本次研究顯示以作業基礎成本制度及傳統分攤制度計算出產品成本及損益確有極大之差異，是故個案醫院可藉由產品成本之計算推展其他單位產品之效益，未來若能與績效評核制度結合，更能完整呈現個案醫院之經營績效。

關鍵字

傳統成本制 、作業基礎成本制

並列摘要

Due to the change of health services payments of National Health Insurance System, it makes the medical treatment and health care industry more difficult to run the business day by day. Except for the change of health services payments system, high customer satisfaction also makes medical treatment and health care industry faces the double challenges to improve medical treatment quality and reduce operating cost.
Medical treatment industry cost structure is complicated. However, due to the change of medical environment, most hospitals have already built responsibility accounting system actively. Except that responsibility accounting system can show department's performance but also trough activity-based cost concept can deeply understand the cost process of every department’s work, incorporate three elements, such as effective operation, high quality, and low cost, etc. in the medical care in the future. The cost system which the medical care industry set-up is generally a financial report system in the past, the system at this stage is to track cost according to cost center, therefore it is irrelevant with activity and process and focus on a responsibility accounting excessively. Activity-based costing system apportions merchandise cost by activity cost factor mainly which can make up the deficiency of the traditional cost system.
This research divides two stages to investigate hospital cost accounting system: the first stage discusses the responsibility accounting system of case hospital, and allocates each cost to the radiology department by traditional apportionment way and calculate out the management performance of the department. The second stage is to understand the activity process of case hospital radiology department. To build-up every ABC cost information, analyze the cost of every work of the radiology department, and then compare with traditional apportionment system. Compared by analyzing to find out whether there are unreasonable situation in the cost, and try to improve the unreasonable cost.
This research shows that there are great differences in calculating product cost and profit between activity-based cost system and traditional apportionment system. Therefore, we can promote to get other department’s unit product profit through the case hospital’s product cost calculation. If can combine with performance evaluation system in the future, it can be completely present the management performance of the case hospital.

並列關鍵字

traditional cost accounting, activity-based cost accounting

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