血液透析單項成本分析之探討－以某醫學中心為例

The Cost Analysis of Hemodialysis in a Medical Center

陳琇玲(Hsiu-Ling Chen)

《中華公共衛生雜誌》 15卷6期 (1996/12) Pp. 497-503

https://doi.org/10.6288/CJPH1996-15-06-01

摘要

中央健康保險局有意實施洗腎定額給付制，北市某醫學中心為了確實了解透析之成本，並提供腎臟學會成本數據，以爭取合理醫療給付，乃進行血液透析單項成本分析研究，探討血液透析單項成本分析的方法，並求取該醫學中心單次血液透析之成本數據。本研究將血液透析單項成本架構細分為變動人力成本（有主治醫師、護理人員、菜事服務費），直接材料成本（有藥品、醫材），因定人力成本（有住院醫師、護理站書記、服務員、清潔服務員），間接材料成本（有口服藥、EPO分攤、及感冒藥）、檢查檢驗成本（分為新透析病患及例行透析病患檢查檢驗成本分攤）、機器設備折舊與保養費、其他支出、分攤成本等大類，並計算每一細項成本。研究結果顯示，其成本數據為每次透析成本3,767元。以保險給付每次透析4,000元，則樣本醫院有6%之利潤，遠低於一般之估計。若包含口服藥、EPO分攤、及感冒藥，則每次透析成本為3,943元，幾乎無利潤。

關鍵字

成本分析 ； 血液透析 ； 醫學中心

並列摘要

The Bureau of National Health Insurance is planning to implement the case payment system for hemodialysis. Since reasonable reimbursement is possible only when actual cost data are fully incorporated, our study was conducted in a medical center in Taipei to investigate these costs. This study aimed to determine the cost per dialysis in the medical center. All possible costs related to the dialysis procedures were included and the time span was for the year 1993. Cost items collected were then divided into eight categories: (1) variable personnel. (2) fixed personnel. (3) direct materials. (4) indirect materials. (5) medical examinations and laboratory tests. (6) depreciation and maintenance. (7) overheads. and (8) allocations. First of all, variable personnel costs included those of physicians , nurses, and drug dispension related manpower. Fixed personnel, on the other hand, included residents, nursing station clerks, attendants, house-keeping staff. Direct materials included drugs and other medical supplies. Furthermore, indirect materials may involve oral drugs, EPO allocations, medicine for cough, etc. Costs originated from medical examinations and laboratory tests were calculated on a per patient basis: differentiation was further made between new patients and routine patients. As for depreciation and maintenance, overheads, and allocations, these were costs with usual accounting definitions. The results of the study showed that the cost per hemodialysis was NT3, 767 in the medical center. Comparing with insurrance payment of NT4,000 per dialysis, there was only 6% profit rate for the hospital, far away from the expectation of the administrators. If oral drugs, EPO allocations, and medicine for cough were included, the cost was raised to NT3,943 per dialysis, with almost no profit for the medical center.

並列關鍵字

cost analysis ； hemodialysis, haemodialysis ； medical center