- 學位論文
血液透析中心成本分析與經營策略探討
Cost analysis and management strategies for hemodialysis service providers
摘要
世界各先進國家對於如何解決末期腎臟衰竭疾病所造成之財政與社會問題都頭疼萬分，苦思解決之道。但是因為人口老化，再加上嬰兒潮期的人口又開始步入此族群，而更加速國家高齡化的現象；又因腎臟替代療法照護品質的提升，而促使盛行率提高；醫學進步而延長國民平均壽命；與糖尿病、高血壓、血脂肪代謝異常等文明病之盛行，使得此課題更加難以處理。而那一種腎臟替代療法才是正確的方向？假若限於現實環境而必須以血液透析療法為主時，則應該如何運作才是正確的作法？而血液透析醫療服務供應商又應該採行何種策略，才不致在政府推動相關政策的洪流中被淹沒？希望本研究可以提供給相關機構一些值得參考的方向。 本研究以樣本公司十餘家透析中心之1,043位患者臨床資料為分析基礎。採用算術平均法，以比對變數與平均數間之關係而找出其相關性，其結果在每次治療成本上得到以下結論：女性之治療成本大於男性病人；年齡越大治療成本就越高；開始接受透析的歷史越久、越穩定，其治療費用就越低，但是越接近死亡日其治療費用反而升高；患有肝炎或糖尿病等合併症之總治療費用較高，惟有部分合併症患者至其他專科門診拿藥，而顯現出透析治療費用較低的現象；血清白蛋白、血容積檢驗數值越高其透析治療費用越低；都會型中心之醫療費用比鄉村型中心為高，但非醫療費用卻顯示出相反結果，總單次透析治療費用都會型中心較高；以上變動費用可以作為購併『既存單位』評價之參考因子。而固定費用因為設置標準之關係，使人事費用所佔比例很高，所以透析中心之損益平衡點為每月六百人次以上，使得目前國內有20%以上的透析中心低於損益平衡點。政府如要維持品質又想繼續壓縮治療給付，就必須要在規範下，明令重複使用再生人工腎臟為合法、與重新檢討設置標準等配套措施。 本研究以美國USRDS資料庫分析證明，腎臟移植為最佳腎臟替代療法，政府應加強推廣；以存活率而言血液透析療法為次佳腎臟替代療法。為更有效使用社會資源，血液透析療法應以連鎖經營、社區化為未來方向，因連鎖經營較有績效也可確保醫療品質。以購併『既存單位』來擴大經濟規模，全方位管理來增加營運績效，為透析醫療服務供應商永續經營的最佳策略。
並列摘要
End stage renal disease (ESRD) is a medical condition that causes significant financial and social burdens in today’s first world countries, and its management remains challenging. However, our population is aging, rapidly accelerated by the generation of baby boomers; the prevalence of ESRD is on the rise because of the higher quality of care of renal replacement therapy; advances in medicine are extending life expectancies; and the presence of diabetes mellitus、hypertension 、dyslipidemia and other developed world diseases, makes ESRD even more difficult to manage. Which method of renal replacement therapy leads us in the right direction? Supposing hemodialysis was the mainstay treatment how should it be operated? And what sort of strategies should dialysis service providers undertake to be able to withstand relevant political policy amendments? This research paper attempts to provide hemodialysis service providers insightful knowledge in the analysis and management strategies. This study collected clinical data from 1,043patients in over ten sampled dialysis centers. By analysing mathematical means and variables to establish relationship trends, the below conclusions have been reached regarding each treatment costs : the cost per treatment is higher in female patients；increasing age is proportional to increasing treatment cost；the longer, and more stable the period of dialysis, the lower the costs, but there is a contrasting rise in cost approaching time of death ; patients suffering from hepatitis , diabetes mellitus or other combined diseases have higher treatment costs, with the exception of those who fill prescriptions in other outpatient departments, in which case costs of treatment are lower；the higher the Albumin、Hct of lab test data, the lower the costs of dialysis per treatment；urban centers have higher medical expenditures but rural centers have higher non-medical expenses,with total cost of single session dialysis being higher in urban centres. The abovementioned variable expenditures should be considered when merging currently existing dialysis units into a hemodialysis service providing network. Fixed costs, because of set up standards of dialysis unit, have a high proportion of personnel costs, for reaching a break-even point must over 600 patient sessions each month.Currently, about 20% more of hemodialysis centers fall below this break-even ponit. If the government wishes to maintain quality of care and continue suppressing treatment reimbursement fee, there must be regulations revised to allow the reuse of reprocessing dialyzers and reevaluating the set up standards of dialysis center. According to the USRDS (The United States Renal Data System), kidney transplantation is the most effective form of renal replacement therapy, which should be more widely promoted by the government；In terms of survival rates, hemodialysis is placed second in R.R.T. (renal replacement therapy). To allow more effective use of social resources, the future of dialysis treatment should be localized chain-operating dialysis centers, as this is more effective operation and ensures a guaranteed standard of quality care . Merging and acquisition existing hemodialysis units to expand on an economical scale,plus integrate management to improve operating efficiency, is the best longstanding strategy for dialysis service provider.