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作業基礎成本法與相對值單位法之成本結構相關性比較-以牙科60項處置為例

Contrasting Cost Conponents of ABC and RVU for 60 Dental Procedures

摘要


目標:比較作業基礎成本法(the activity-based costing method, ABC)及相對值單位法(the relative value unit method, RVU)分析牙科處置所獲得結果之相關性,以提供醫院及衛生主管機關選擇成本分析方法之參考。方法:以前人利用ABC及RVU二種方法,分析牙科成本或投入資源相對值所獲得結果(ABC研究與RVU研究),探討二個研究60個可對應處置,區分牙體復形科、根管治療科、牙周病學科、口腔外科四科,其醫師成本、耗材成本、其它執業成本、總成本之Spearman’s rho相關。並且將二個研究結果分別與92年健保支付標準進行Spearman’s rho檢測。結果: ABC研究與RVU研究結果,不論在醫師成本、耗材成本、其它執業成本、或總成本四個構面,相關性均達顯著(p<0.01)。口腔外科四個構面相關性更高,根管治療科四個構面卻均未達顯著相關。二個研究結果之各構面中,「醫師成本」與「總成本」相關性均高,其次為「其它執業成本」,「耗材成本」相關性最低。二個研究結果均分別與92年健保支付標準呈顯著且高度相關(p<0.01)。結論:(1)ABC研究與RVU研究結果在四個構面(醫師、耗材、其它執業成本、總成本)之成本與相對值排序關係一致,尤其是醫師成本及總成本。(2)不論ABC研究或RVU研究,健保支付標準足以反應牙科處置投入資源相對性的排序關係。(3)雖然無法判定ABC與RVU的優劣,但是二個研究結果的高度相關,顯示醫療機構及衛生主管機構可以依據可投入資源多寡,以及目的不同,來選擇成本分析方法。

並列摘要


Objectives: The purpose of this study was to compare the correlation of cost datas for 60 dental procedures between the activity-based costing method (ABC) and the relative value unit method (RVU). This may serve as a reference for choosing the optimum cost method for hospitals or government health departments. Methods: From previous research (ABC study and RVU study), 60 procedures from four dental specialities (Operative Dentistry, Endodontics, Periodontics, and Oral Surgery) could be found correspondingly. The correlation between two studies in terms of physicians’ cost, medical material cost, other practice cost, and the total cost were compared by Spearmen’s3 + rho. The correlation between the total cost of each of the two studies and the reimbursement given by the National Health Insurance (NHI) were also compared. Results: The cost datas of ABC and RVU studies correlated significantly with each other (p<0.01) in respect to physicians’ cost, medical material cost, other practice cost, and total cost. The costs of Oral Surgery had the best correlation of the four specialties with the lowest one being Endodontics. On the four dimensions, physicians’ cost and total cost had the best correlation. Other practice cost was second, and medical material cost was the lowest. The total cost of ABC study or RVU study was significantly correlated with the reimbursement given by NHI. Conclusions: The sequencial relationship of costs between ABC and RVU were similar, especially in terms of physicians’ cost and total cost. (2) The reimbursement given by NHI can respond to the costs of ABC study or RVU study. (3) In respect to the high correlation between two studies, though one cannot judge which one is better, we suggest hospitals or governments adopt the cost method according to the resouces which can be utilized.

參考文獻


黃昱瞳(2001)。全民健保實施牙醫總額預算制度對醫療資源分佈的影響評估。國立台北護理學院醫護管理研究所。
中央健康保險局
行政院衛生署
中央健康保險
(1995)。行政院衛生署中央健康保險局。台北:中央健康保險局。

被引用紀錄


游麗穎(2010)。血液透析與腹膜透析之成本分析與管理:作業基礎方法之應用〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2010.02321
詹貴川(2016)。經皮冠狀動脈介入性治療之醫療成本效益分析及相關因素探討〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-2608201616430900

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