公務制度下醫院藥品購辦與消耗相關管理效果影響之評估───以高雄市政府衛生局所屬公立醫院藥品庫存管理為例

本研究的動機乃希望以個案研究方式，運用存貨理論於藥品存貨上來建立一最佳管理模式。以高雄市五家公立醫院90/1/1∼91/12/31藥品之購辦及消耗月報研究資料。㈠首先以ABC 存貨分析方法將藥品分類，再決定存貨成本並選取一適宜之需求預測方式。㈡以資料包絡法（data envelop analysis）找出五家醫院相對效率比較高的為E醫院與D醫院。㈢以複迴歸分析尋找共變項解釋適於各類存貨⑴如何降低總品項達到以量制價及⑵如何找到降低平均月平均庫存金額(元)之管理方式。研究結果顯示，㈠五家醫院Ａ類藥品佔了平均藥品總出庫金額之80 ﹪，卻只佔20﹪的品項，若Ａ類藥品加上Ｂ類藥品佔了藥品總出庫金額之 95.53 ﹪，卻只佔41.13 ﹪的項目數，需以重點管理觀念來管理。Ａ、Ｂ類存貨適用經濟訂購量結合再訂購點（EOQ/ROP）模式，Ｃ類則以複倉法結合定期訂購法管理。針對控制前置日數而研擬的方案，以結合經濟訂購量模式並控制前置日數變異之方案管理績效最佳。㈡以最小投入得到相同產出，採取CCR模式將可控輸入變項挑選總品項數，輸出變項為月平均庫存金額及月平均購入金額時，結果為：在比較其餘A、C等二家醫院而言，顯示位於包絡線上之D醫院及E醫院為相對有效率的醫院。五家醫院應加強改善之總體建議，包括總品項數減少8.57%，月平均庫存金額減少73.84%，平均月購入金額增加17.59%。㈢控制其餘共變項後，以複迴歸分析向後法產出最適解釋變項作為藥品存貨管理績效評估的預測因子。⑴結果顯示當控制其他變項後，總品項數之總變異數可被平均月購入金額（元）解釋89.6%（R2 =0.896），方程式為：總品項數＝75.043＋.00003683×平均月購入金額（元）。⑵控制其他變項後，月平均庫存金額(元)可完全被平均月購入金額（元）、最高庫存量（天）及全年度未曾使用之品項數所解釋（R2 =1.000）：月平均庫存金額（元）＝8778394.574-197475.518×最高庫存量（天）＋432942.915×全年度未曾使用之品項數＋.373×平均月購入金額（元）。建議個案醫院對藥品應採重點管理： A 、B 類藥品應嚴密監控，運用EOQ/ROP模式訂定經濟採購量、安全存量、請購點，並應儘量減少存貨量；對於 C類藥品則採取固定訂購期間模式管理（當結算庫存量低於（或等於）最低存量時，此時將發出請購資訊，此時採購量等於下列方程式：採購量＝最低存量＋設定採購量－在庫數量－前一批在途數量。）。在採購作業上，建議應訂定採購作業工作手冊、聯標採購案件適度授權，以縮短前置時間及控制前置時間穩定性、未參加聯標之藥品則應控制採購流程時間。在藥庫管理方面，應推動藥庫管理電腦化作業、定期盤點各病房護理站藥品存量，作為藥品發放控制之依據。本研究最大價值即對於個案醫院之藥品存貨管理作一診斷，建議改善方案，期使管理作業更加合理化。

關鍵字

藥品週轉率；購備時間；同等品

並列摘要

This study aims at assessing the effectiveness of facilitating an integrated system of professional development model in a very effective management medicine inventory of Kaohsiung Municipal Hospitals. The database of medicine purchasing and inventory has been collected from 1/1/2001 to 12/31/2002 . First of all , Presenting ABC Inventory Analysis with the classification of medicine held in inventory according to the specified valuation criterion, then, searching for a good way to run . Second, Finding the best performance evaluation of the medicine purchasing and inventory management of Kaohsiung Municipal Hospitals are E hospital & D hospital by Data Envelop Analysis . Third , Using multiple regression, the estimates (coefficients and constant) can be used to construct a prediction equation and generate predicted scores on a variable for further analysis ⑴ how to minimize No. of all items？ ⑵ how to find the best way to minimize the cost of inventory？ Results of the study suggest that ，㈠ The average cost of item A medicine by ABC Inventory Analysis of 5 Kaohsiung Municipal Hospitals reveals “ 20-80 rules“ ,by adding item B medicine shows 41.13﹪items ,but 95.53﹪money. By EOQ/ROP method ,item A & B medicine can fit the model .By two-bin system ,the item C medicine fit the model too. By the time when every hospital has an integrated system of professional development model , incorporated with other management skills, effectiveness of this model on cost containment may be more significant . ㈡ Data envelop analysis (DEA), which can provide better understanding of the efficiency of academic research libraries. this method, with proper model of library inputs and outputs, tells us the best practices in the peer groups as well as the technical efficiency score for each library, As such, it is the tightest non-decreasing concave function that provides an envelop to the data. Hence, With CCR model （the minimal input：No. of all items，the outputs are average monthly cost of medicine inventory & average monthly cost of purchasing medicine.）. E hospital & D hospital on the Function(x) are often called the relative technical efficiencies. In other words, to retain efficiency , by reducing 8.57% No.of all items, cutting 73.84% average monthly cost of medicine inventory，increasing 17.59% average monthly cost of purchasing medicine are very effective. ㈢ By multiple linear regressin , when controlling other covaviates，⑴ Knowing average monthly cost of purchasing medicine explains almost 89.6% of the variability of No.of all items. The equation is：No.of all items.＝75.043＋.00003683 × average monthly costing of the purchasing medicine. Knowing average monthly cost of purchasing medicine ； the largest inventory and items that never used in one year can completly explains almost 100% of the variability of the average monthly cost of medicine inventory . The equation is：average monthly cost of medicine inventory＝8778394.574-197475.518 × the largest inventory＋432942.915 × items that never used in one year＋ .373 × average monthly cost of purchasing medicine. Therefore, the suggestion of ABC Inventory Analysis is proved to be a very effective cost containment strategy for medicine management. Using EOQ/ROP model of Item A、Item B in buying medicine . Item C takes two-bin system method by a time period. The equation is：purchasing amount＝the least inventory＋ setting purchasing amount－inventory amount－the amount of last lot number by ordering.）.In purchasing medicine’s procedure , the suggestion is book of the standard of procedure of medicine purchasing and inventory management , grouping purchasing cases should be properly authorized , shorting the lead time in order to controlling the stable lead time , controlling the purchasing period of non-grouping purchasing medicine. In the management of medicine inventory, both of computerizing the medicine inventory , for controlling of all medicine and counting the amount of medicine inventory at nursing station is necessary . Afterall , in order to rationalizing the management of purchasing medicine and inventory , The larger valuations of this study have faced more restrictions are the programs to diagnosis of the example of Kaohsiung Municipal Hospitals . Therefore, this study is proved to be a very effective cost containment strategy for medicine inventory management .