公立醫院採購建議

Analysis and Recommendations for the Purchosing System of Public Hospitals

黃世權(Shih-Chuan Huang)

指導教授 ： 白佳原

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2016年)

摘要

100年署醫弊案發生後，行政院衛生署第一階段五大改革首要即檢討所屬醫院採購權限與程序。100年3月31日召開「研商署立醫院醫療業務外包及採購案件之改善對策」會議。100年4月14日召開「研商所屬醫院辦理重大採購案件應行注意事項」會議。100年6月7日正式頒布。另有後續策進作為與本研究有關之所屬醫院聯合採購及採購價格資料庫建置。
本研究經半結構性訪談衛生福利部附屬醫療及社會福利機構管理會資財組專員、臺中榮民總醫院嘉義分院院秘書室主任、衛生福利部臺中醫院總務(採購)及政風人員…等，就作業現況分析及給予相關建議。接受訪談人員表示受限衛生福利部所屬醫療機構辦理重大採購案件應行注意事項導致採購期程過長，採購效率不佳，制度短期內亦不易改變。採購價格資料庫部分採購人員表示對醫院訂定底價及降低採購成本有幫助，使用介面不友善則影響使用意願。聯合採購部分，表示應先行整合規格，確認有聯合採購效益後再行辦理。

相關建議如下：
一、與衛生福利部所屬醫療機構辦理重大採購案件應行注意事項有關建議：
(一)審慎篩選初審委員，避免醫院接受不當審查。
(二)採購評選委員會外聘委員規範回歸政府採購法辦理。
(三)兼顧所屬醫院需求與監督功能。
(四)一般例行性勞務外包案免送管理會審議。
(五)簡化送審流程，避免自辦短期契。
(六)約因應及整體檢視重新檢討，提升採購效率。
二、價格資料庫建置建議：
(一)縮短採購價格資料庫其他公立醫院資料匯入時間。
(二)改善資料庫環境可近性有利所屬醫院利用。
(三)列管文件上傳品質，確保資料可用。
三、聯合採購建議：
(一)設置聯合採購中心，專職專責。
(二)落實輪辦模式，確保經驗傳承。
(三)規格整合提前至編列預算前辦理。
(四)案件分配力求公平。
(五)未具聯合採購效益案件回歸各院自行辦理。
(六)提升採購效率及提升衛材聯標決標品項佔醫院使用品項比率。
四、其他建議：
(一)加強使用單位廣義採購人員法治及採購專業觀念。
(二)引進物流觀念，降低醫院成本。

透過本研究之建議，也將另行循所屬醫院相關會議提出，期可改變相關作業流程，以利提升採購效率及競爭力。

關鍵字

署醫弊案 ； 重大採購 ； 價格資料庫 ； 聯合採購

並列摘要

After exposing the case of corruption cheating in 2011, the first part of what the Department of Health, Executive Yuan needed to do was to evaluate the authority and the procedure of purchasing. The bureau held a meeting on Discussing the countermeasure of improving the hospital business outsourcing and purchasing_on March 31, 2011 and a meeting on Discussing the matters of what the hospitals need to pay attention to when it come to a major purchase on April 14, 2011. It made the official announcement regarding Discussing the matters of what the hospitals need to pay attention to when it come to a major purchase on June 7, 2011. There was also a follow up for building up the database of the consortium purchasing and the purchasing price of hospitals of Ministry of Health and Welfare.
This research is based on a semi structured interview. I have interviewed the staff at the Property Management Section of the Hospital and Social Welfare Organizations Administration Commission, Ministry of Health and Welfare, the director at the Secretary Office of Chiayi Branch Taichung Veterans Genaral Hospital, the General Affairs staff at Taichung Hospital, Ministry of Health and Welfare, and the staff at the Department of Civil Service Ethics. The staff has analyzed and given suggestions according to the current situation. The staff has indicated that due to the requirements of the Hospital Organizations Administration Commission, under the Ministry of Health and Welfare, the time of processing the purchases is too long, the efficiency is too slow and the systems are not easily changed in a short period of time. With regard to the purchasing price database, the buyers indicated that it is helpful for the hospitals to set the base price and to lower the cost. However it is not user-friendly which affects users to use the database. As for consortium purchasing, the interviewees indicated that the buyer should evaluate the items and confirm that it is a worthwhile purchase before processing it.
The related suggestions are as below:
I.Suggestions for handling purchasing cases for the hospitals of the Ministry of Health and Welfare
1.careful choosing of committee members at the first trial to avoid improper evaluation
2.reinstate government regulations for the choosing of procurement evaluation committees
3.look after both the needs of the hospitals of the Ministry of Health and Welfare and supervising those hospitals
4.cease sending the regular labor cases to the administration for evaluation
5.simplify the evaluation procedure, to avoid purposely lowering the total amount in order to evaluate the case by their own committee
6.evaluate the policy and entire system in order to upgrade the efficiency of purchasing
II.Suggestions to setting up the price database
1.shorten the time for keying in the purchase price database and other public hospital data
2.improve the accessibility of the database for the usage of the hospitals of Ministry of Health and Welfare
3.install quality control of uploaded documents, to insure the data is usable
III.Suggestions to Consortium Purchasing
1.set up the consortium purchasing center in order to do single duty and single responsibility
2.carry out turn-taking mode, to insure passing on the experiments
3.do the specification concordance before the budget planning
4.be fair when distributing tasks
5.return the case back to its hospital when it is not benefitted by consortium purchasing
6.increase the purchasing efficiency and the ratio of the expendable supplies in the consortium tendering of the number of items that are in use at the hospital
IV.Other Suggestions
1.enhance the professional concept of the law and procurement
2.introduce the concept of distribution in order to lower the cost to the hospital
Through this research, I will also propose the idea at meetings at other hospitals of the Ministry of Health and Welfare in the hope it can change the related operating procedures in order to upgrade purchasing efficiency and competitiveness.

並列關鍵字

cheating cases of the hospitals of Ministry of Health and Welfare ； major purchase ； database of price ； consortium purchasing

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