建置管理決策之作業基礎成本與管理系統 —某醫學中心精神醫學部職能治療室 與個案管理室為例

Establishing an Activity-Based Costing and Management System for Management Decisions： An Example of Occupational Therapy and Case management units in Psychiatry Department in a Medical Center

謝佳蓉(Chia-lung Shieh)

指導教授 ： 張睿詒

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2005年)

https://doi.org/10.6342/NTU.2005.10435

摘要

為了有效控制醫療費用的成長，我國全民健康保險已於九十一年七月一日起全面實施總額預算支付制度；也正式宣佈邁向醫療機構成本管理的新紀元—醫療院所如何在收入難以大幅成長的限制下，能永續經營並具有競爭的優勢，因此成本管理與控制已成為當前醫療機構管理者最重要的課題之一。
目前國內大部分的醫院所採用的成本系統為傳統責任中心制之成本會計系統，僅能提供計算至部門層級的成本，再加上缺乏因果關係的分攤基礎，不但無法精確的呈現醫院各部門所提供的產品成本，更可能造成部門間成本交叉補貼的現象，進而扭曲成本資訊。而作業基礎成本制不僅可以提供有關服務層級的成本資訊外，且以因果關係為基礎，正確計算產品成本，其分析可幫助醫院釐清作業、資源及最終產品的關係，此系統所產生的資訊更可以支援管理者所需。
精神科部門是屬於人力密集的單位，其服務的目的在於透過不同的臨床專業人士提供專業的各項服務、治療、諮詢與衛教。醫院在面臨競爭激烈的環境下，為因應各種不同支付標準，精神科部門精神必需發展一套能清楚評估各種專業人力的價值與效率的成本管理系統。若以傳統的成本制度或標準成本法，皆無法反映各項服務的實際成本，對管理上的助益實在有限。
故本研究採個案研究法，並選擇某醫學中心的精神醫學部中職能治療室與個案管理室建構其成本分析與決策資訊。經由對個案醫院職能治療室與個案管理室實際規劃與分析，可得以下結果：（一）確認職能治療室與個案管理室共有11項產品及10項作業分別為職能治療室與個案管理室之團體治療作業、個別治療作業、病歷記錄作業、行政準備作業、職能治療室教學作業與個案管理室交通往返作業；（二）其資源消耗情形，以人事費用佔本研究界定範圍45.6%最多，部門分攤費用佔31.6%次之，全院分攤費用佔19.4%，耗材成本佔3.4%；（三）職能治療室各項作業消耗資源情形，以「團體治療」作業佔研究界定範圍總成本20.5%最高，；「病歷記錄」作業為15.2%次之，「個別治療」作業9.8%；「行政與準備」作業為0.9%；「教學研究」作業0.1%；（四）個案管理室各項作業消耗資源情形，以「行政與準備」作業佔研究界定範圍總成本19.2%最多，「病歷記錄」作業為14.5%次之；「團體治療」作業成本8.7%；「個別治療」作業為10.6%；「交通往返」作業0.5%（五）職能治療師的產能利用率為83.4%，個案管理師的產能利用率為49.2%。
本研究可得以下結論：（一）ABC/M可提供個案醫院精神醫學部中有關職能治療室與個案管理室財務方面的訊息，藉由服務層級的成本資訊，瞭解職能治療室與個案管理室資源耗用的情形，以進一步作為成本管理與發現成本改善的機會。如所有產品中以居家訪視產品虧損的最為嚴重，透過作業流程進一步分析原因發現因出訪交通工具不便性，造成行政作業成本過高；（二）藉由此系統提供非財務性資訊，有助於精神科部門評估職能治療師與個案管理師的價值與管理。如透過產能利用分析得知個案管理師的產能偏低，進而改善其產能利用；（三）ABC/M可清楚的顯示間接費用的組成結構，協助精神科部門達到成本改善的目的；如發現資源成本中部門分攤成本偏高，原因為空間設備攤提過高所致，並可針對其問題改善空間的使用；（四）對於精神科部門所重視產能評估、空間利用等部分，ABC/M可提供精神科部門決策參考的資訊。如：個案管理師藉由改善居家訪視的交通工具後，除了產能提升外，還可以增加該項產品的業務量，也可提高顧客滿意度。

關鍵字

作業基礎成本管理 ； 精神科

並列摘要

In order to control the expenditures of the National Health Insurance, many policies to contain the supply and demand of health care have been in effect, and the reimbursement system was directed into an overall global budget mechanism in July 2002. Therefore, with the constraint on the growth of hospital’s revenues, cost management has become one of the most important issues facing hospital managers in Taiwan.

The traditional cost accounting system, widely used by domestic hospitals, is based on responsibility centers and can only calculate the cost of the department level. Due to lake of cause-effect relationships, it does not reasonably reflect the actual cost and cause cross subsidization among departments. It may thus end up leading to wrong decisions for the management. With ABC/M’s cause-effect basis, all costs and the relationships among products, activities and resources could be clearly developed; therefore, such information could serve as valuable reference in making decisions.

A psychiatry department serves different client groups and has various professionals. It is faced with increasing financial challenges and must be equipped with systems to evaluate the contributions of different professionals. Therefore, to construct a suitable cost management system for Psychiatry department is inevitable. However, due to the variety and variability consuming human resource and capital, either the traditional accounting system or standard costing system could not reflect the actual costs of services provided by a psychiatry department and is thus of limited assistance to hospital mangers.

Based on the ABC/M principles, the objective of this research is to establish a costing and management model for a psychiatry department of occupational therapy and case management units in a medical center. The data were collected for six months, from January to June, 2004. Results can be summarized as followed:
1. Occupational therapy and case management units provide eleven products and ten activities.
2. 45.6% of personal costs, 31.6% of costs are department overhead, 19.4% of costs are hospital overhead allocated, and 3.4% of costs are related to materials.
3. The group therapy is the largest activity costs (20.5%), followed by the recording activity (15.2%), and individual therapy (9.8%) in the occupational therapy unit.
4. The administration and preparation activity is the largest activity costs (19.2%), followed by the recording activity (14.5%), and group therapy (8.7%) in the case management unit.
5. The human workload is 83.4% of the occupational therapy unit and 49.2% of the case management unit.

The conclusion of this study as the following:
1. ABC/M can provide service-level cost and the assist the psychiatry department to conduct cost management.
2. ABC/M can help manager to capacity management and performance evaluation.
3. ABC/M can clearly delineate and assist cost control.
4. ABC/M could provide valuable information for managers for their decision-making reference.

並列關鍵字

Activity-Based Costing and Management ； Psychiatry Department

參考文獻

錢慶文，作業基礎成本制度在醫院成本會計之應用。醫院，27（3）：1-7，1994。

吳雪穎，建立細菌持續性改善之成本系統—以某醫學中心為例。台灣大學醫療機構管理研究所碩士論文，2005。

周建民，醫療部門資源耗用分析與成本管理系統之建立—以某醫學中心胸腔內科為例。台灣大學醫療機構管理研究所碩士論文，2004。

Baker J. Activity-Based Costing and Activity-Based Management for Health Care. USA :Aspen Publishers,Inc.,1998.

Brimson J. Activity Accounting：An Activity-Based Costing Approach. Canada：John Wiley & Sons,Inc.,1991.