病人為中心之醫學影像儲存與傳輸系統（PACS）成本效果分析 －以台灣某醫學中心為例

Cost-effectiveness Analysis of a Patient Centered Picture Archiving and Communication System (PACS) – A Case Study of a Medical Center in Taiwan

李淑芬(Shu-Fen Li)

指導教授 ： 薛亞聖

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.10258

摘要

目前國內對PACS系統建置成本與效果的研究，大多集中在技術領域及各醫院資訊部門的建置報告，缺乏以管理科學的成本與效果角度並輔以數量方法的深入研究，故本研究目的在瞭解建置PACS系統的成本，比較PACS系統與傳統膠片系統間成本之差異，及兩種系統的成本何時能達到無差異。另一方面，則為測量與評估PACS系統前後，個案醫院有關醫療服務與醫學教學研究二方面效果之改變為何。
　　以回溯性個案研究法與問卷調查法，搜集個案醫院的相關營運成本、設備項目、各種影像檢查服務量、人力及空間坪數等成本有關資料，並從該院過去相關品管活動及用問卷調查等方法來搜集效果方面的資料，以進行成本效果分析。分析結果分為二部份，第一是成本的分析結果，第二則是PACS所達成的效果結果。
　　結果發現當折現率為3%，檢查量以一年23.4萬次的胸腔X光檢查量(當量)時，個案醫院在傳統膠片期及實施PACS第一年的年成本分別為17,697.4萬元及19,935.0萬元，實施PACS後使固定成本增加70.4%，變動成本則減少1.4%。如果固定檢查量為每年23.4萬次的「胸腔X光檢查」(當量)時，則每個產能成本在實施PACS比傳統膠片期的淨平均成本可節省95.6元。如果年檢查量固定成長率愈高，則實施PACS與傳統膠片期的總年成本達相等年數會愈短。整體而言，PACS實施後相關影像作業空間及人力均會節省。亦可提供多面向的效果，包括時間效果、品質指標效果、服務與教學研究效果，包括可使病人等候時間由26.2分鐘減少至6.5分鐘，減低35.24%的重照率，減少膠片的使用，減少病患幅射線暴露，避免病人健康危害，又可減少大量膠片及廢水，避免環境污染。
　　雖然PACS系統的建置成本不低，但可達成許多方面的效果，所獲得如病人安全、減少廢水及膠片等效果，而且，未來建置PACS系統的成本愈趨降低下，所獲得的成本效果將會更加具有效益，本研究的結果及成本效果分析模式，應可供醫院管理者及未來相關研究之參考。

關鍵字

醫學影像儲存與傳輸系統 ； 成本效果分析 ； 以病人為中心

並列摘要

Presently in Taiwan, most research papers regarding the cost effectiveness of establishing PACS have focused primarily on the technical field and establishment reports from major hospital’s information departments. As such, they have failed to conduct in-depth analysis from a cost effective perspective and by applying mathematical methods. Therefore, the purpose of this paper is to deconstruct the costs of establishing PACS, to compare the cost differences between PACS and traditional film system, and to consider when the total costs of these two systems will equal. In addition, this paper aims at measuring and evaluating changes in effectiveness regarding medical services, education, and case research before and after PACS are established.
　　Applying the methods of retrospective case study and questionnaire survey, this paper conducts cost benefit analysis by using data on the hospital’s management costs, equipments items, image examination volume, manpower and space etc. and the effectiveness data was collected from the hospital’s past quality control activities and questionnaire survey. The conclusion consists of two parts, one on the result of cost analysis, the other on the effectiveness of PACS.
　　Supposing the discount rate is 3% and the yearly chest X-ray examination volume is 234,000 times, the yearly cost of the traditional film period equals to NTD $176,974,000 and the PACS’s first year cost equals to NTD $199,350,000 of the hospital. After implementing PACS,the fixed cost was increased by 70.4% and the variable cost was reduced by 1.4%. Supposing a constant chest X-ray examination volume to be 234,000 times per year, the average unit cost of using PACS will be NTD $95.6 less than using traditional film. If the yearly X-ray examination volume increased by a constant rate, the years required when cumulative yearly cost of PACS and traditional film equal will be shorten.
Overall, the implementation of PACS can save image operating space and manpower. Effectiveness can also be achieved in many aspects including time effectiveness, quality index effectiveness, as well as effectiveness in service, education and research. For example, the waiting time of patient was reduced from26.2 to 6.5 minutes, the re-examination rate was reduced by 35.24%, film usage and waste water production were decreased avoiding environmental contamination, radiation exposure of patients was decreased imposing less hazard to health.
　　Although the construction cost of PACS was high, effectiveness can be achieved in many aspects such as safety of patients, reduction of waste water and film. Furthermore, with the decrease of construction cost of PACS, more cost effectiveness will be obtained. The results and cost effectiveness analysis model in this research can served as reference material for future research on hospital management.

並列關鍵字

Patient Centered ； Picture Archiving and Communication System (PACS) ； Cost-effectiveness Analysis

參考文獻

3. 王怡心，”管理會計”，三民書局，1993。

5. 李超群、張寶源、李世傑、王魯發、陳碧蓮、楊芷絜，”無片化醫院建立與評值”，慈濟護理雜誌：1（4），2002，p.27-34。

10. 張美彥、張政彥，”台北榮總放射線部推展無片化作業的心路歷程”，中華民國醫事放射師公會全國聯合會會刊：2003，p.22-25。

6. 沈戊忠、黃麒昌、楊榮林，”一家醫學中心六個月間無片化的經過”，中華放射醫誌：28，2003，p.237-242。

25. 廖椿華，”醫學影像處理系統儲存安全與傳輸效率之研究-以某醫學中心級醫院為例”，台中健康暨管理學院資訊科技與管理研究所碩士論文，2003。