論病例計酬醫療成本分析－以部腹產為例

本研究係針對一地區醫院，探討目前中央健保局實施五十項論病例計酬制度中，有關剖腹生產之醫療處置、護理照護、住院服務及其他作業管理等項目之成本分析。研究方法係將剖腹生產成本分為用人成本、藥品衛材成本、設備費用、作業費用、行政管理費用及教學研究費用等六大類，並計算每類成本，進行成本效益分析。依三十件具代表性案例分析結果顯示：每一剖腹產平均成本為16,616元，與研究當時健保局支付標準29,230元相較，稅前淨利約為12,614元（標準偏差為4,715元），如不考慮租稅，平均純益率達43%。建議健保局於訂價時，除能反應醫院應有合理利潤外，仍需考量醫院營運時所需之各項財務需求，以利醫院經營發展。另說各項成本分析結果依序為用人成本8,412元（佔總成本51%），藥品衛材成本2,276元(14%)、作業費用2,266元(14%)、行政管理費用1,913元(l1%)、教學研究費用1,109元(6%)及設備費用640元(4%)，前三者合計已達79%，為醫院未來進行成本控制時應注意之管理重點。

關鍵字

成本分析；剖腹生產；論病例計酬

並列摘要

This study was to analyze the cost of obstetrics and gynecology case in a regional teaching hospital. The analytical costs included medical procedures, nursing care, hospitalization and management, which were paid under fifty cases payment system by the National Insurance of Health in Taiwan. Analytical items of the case payment included the personnel, material, operation, research, equipment and administrative fees, etc. The cost-effectiveness was calculated and analyzed. According to the analytical results for thirty representative cases of obstetrics and gynecology in a specific hospital, the average cost per case was NT$16,616. Net profit and average profit main before paying tax under comparing with the payment standards of the National Insurance of Health were NT$12,614 (43%). In order to develop and manage a hospital, we suggested the National Insurance of Health needed to consider the financial demands on hospital charges in addition to the reasonable benefit. Moreover, the costs and percentages for each items were personnel cost: NT$8,412(51%), material cost: NT$2,276(14%), operation cost: NT$2,266(14%), administration cost: NT$1,913(12%), teaching and researching cost: NT$ 1,109(7%) and equipment cost: NT$640(4%), respectively. The percentage of first three items was up to 79%, they were the key points of cost control for hospital management.