平衡計分卡應用現況與精進策略之探討-以南部某洗腎診所為例

自全民健康保險於1995年開辦以來，由於經濟的繁榮、醫療的發達，就醫的便利與民眾自我意識的提升，醫療品質已逐漸成為醫界關注的焦點。根據衛生福利部中央健康保險署的統計，2018年健保在慢性腎臟病的花費高達513億元，占健保總額近7％。而同年美國腎臟數據系統公佈的年報也指出，台灣的末期腎病無論是發生率 (493人百萬人口/年) 或盛行率(3,392人/百萬人口)都是高居世界第一。儘管政府付出許多努力致力於延緩慢性腎臟病的病程，及降低末期腎臟病的發生，國內仍有將近9萬的洗腎人口(包含血液透析8.2萬人，腹膜透析6490人)必須透過腎臟替代療法才得以延續生命。由於血液透析在國內是多數末期腎病患者選擇的治療方式，其高昂的醫療費用也造成台灣健保支出的巨大負擔。血液透析醫療院所面對日趨嚴格的健保規範、激烈的同業競爭、病患個人權益的重視、及衛生署與健保局不斷地削減給付金額，如何達到永續經營及持續高品質的醫療照護日益困難。為了因應現今多變的經營環境與醫療品質的要求，已有醫界藉由平衡計分卡的應用，透過財務、顧客、內部流程、學習與成長四個構面的分析，有效轉化醫療院所的核心能力，找出關鍵績效指標的衡量制度，建立適切的經營策略以提升營運的績效與品質。本研究以南部某血液透析診所為例，透過平衡計分卡的應用後各項指標的改善情形及專家深度訪談提供的精進建議，研究結果也點出血液透析醫療產業競爭的關鍵成功因素，可做為相關血液透析醫療院所面對健保困境時的參考。

關鍵字

血液透析；平衡計分卡；關鍵績效指標；專家深度訪談

並列摘要

Since the launch of National Health Insurance in 1995, the quality of medical care has gradually become the focus of attention in the medical community due to the prosperity of the economy, the development of medical care, the convenience of medical treatment and the improvement of people's self-awareness. According to the annual report of National Health Insurance, the cost of health insurance for chronic kidney disease in 2018 was as high as 51.3 billion New Taiwan Dollar (NTD), accounting for nearly 7% of total health insurance. In the same year, the annual report published by the US Renal Data System (USRDS) also pointed out that either the incidence rate (493 people million people per year) or the prevalence rate (3,392 People per million people) of End Stage Renal Disease (ESRD) in Taiwan was among the highest in the world. Although the government has made many efforts to delay the deterioration of chronic kidney disease and reduce the incidence of end-stage renal disease, there are still nearly 90,000 dialysis patients (including 82,000 hemodialysis patients and 6,490 peritoneal dialysis patients) who need renal replacement therapy to survive. Because of hemodialysis is the treatment of choice for most patients with end-stage renal disease in Taiwan, its high medical costs have also caused a huge burden on Taiwan's health insurance expenditures. Hemodialysis medical institutions are facing increasingly strict health insurance regulations, fierce competition in the industry, the importance of patients' personal rights, and the continuous reduction of reimbursement of medical expenses by the Department of Health and the Health Insurance Bureau. How to achieve sustainable company operation and continuous high-quality medical services is difficult. In response to today's changing business environment and medical quality requirements, the application of balanced scorecards has been introduced. Through the analysis of four perspectives of finance, customers, internal business processes, learning and growth, it effectively transforms the core capabilities of hemodialysis medical institutions, finds out the measurement system of key performance indicators, and establishes appropriate business strategies to improve the operational performance and quality of hemodialysis medical institutions. With the improvement of various indicators after the implementation of the balanced scorecard in a hemodialysis clinics in southern Taiwan and suggestions of experts in depth review, the research results point to the key success factors for competition in the hemodialysis medical industry. When the relevant hemodialysis medical institution faces medical care difficulties, the clinic's competitive advantage can be used as a reference.