醫院貴重醫療儀器之管理及採購決策

Purchase Decision Making and Management of Precious Medical Equipments

魏毓芬(Wei,Yuh Fen)

指導教授 ： 簡禎富

國立清華大學/工學院/工業工程與工程管理學系/碩士(2016年)

摘要

隨著國人對疾病的預防保健意識抬頭與社會保險制度的普及，民眾對就醫品質的要求越來越高，選擇性也越來越多。因此，醫院面對競爭壓力，在精進人員服務品質與醫療技術的同時，因應市場需求，也紛紛投資引進新穎而貴重的儀器設備。依據中央健康保險署（簡稱健保署）所公布的資料顯示，高資本支出的醫療儀器如電腦斷層攝影機（Computerized Tomography, CT）與磁振造影掃描儀（Magnetic Resonance Imaging, MRI）的使用佔健保給付醫療費用中的最大宗，且逐年遞增，盡管健保署的總額支付制度提高了給付門檻，醫院仍不惜成本大舉投注資金採購並定期汰換貴重醫療儀器，以因應治療需求並提高疾病的診斷率，爭取民眾就醫信心，主要還能快速累進醫院營收，平衡支出維持營運。
醫院的醫療設備資源種類繁多，屬於貴重醫療儀器價格昂貴且不在少數，無論是在新機採購或是汰舊換新、及後續維護與保養合約的選購方案上，每年都將耗費醫院許多的成本預算。目前，甚少有相關論著是以醫療設備資源管理的角度進一步探討儀器設備採購的需求與決策。
本研究目的係導入「全面資源管理」的概念，建立貴重醫療儀器資源管理架構，探討醫院對醫療設備資源的投資決策，透過PDCA循環改善架構持續監控貴重醫療儀器於臨床的使用效益，讓醫療單位能及時調整資源使用策略或改善服務流程，甚至用以評定貴重醫療儀器採購的時機。本文以某區域醫院磁振造影機之綜合效率評估（OEE），及後續結合紫式決策分析架構以簡易多屬性評等技術（SMART）作為新機採購之系統性分析，證實對貴重醫療儀器的管理及使用效能具有不錯的監督效果，有助醫院提升醫療照護品質，強化競爭力。

關鍵字

全面資源管理 ； PDCA循環 ； 紫式決策分析架構 ； 簡易多屬性評等技術

並列摘要

With the raising awareness of disease prevention and healthcare as well as the popularization of social security, people in Taiwan tend to seek for higher quality of medication. For these reasons, more selections of medical treatments appeared to fulfill the mass. Due to the competitive pressure, hospitals have not only improved their service and medical technology, but also many new and valuable equipment were invested and introduced to medical treatments. According to the statistics of National Health Insurance Administration (NHI) for high capital expenditure equipments including CT (Computerized Tomography) and MRI (Magnetic Resonance Imaging) stands for the largest proportion of our health insurance expense and is increasing annually. Despite that NHI has establish the policy of global budget system to raise the payment condition, hospitals still regularly eliminate and purchase valuable equipment at no cost in order to meet the needs of medical treatment and to improve the accuracy of medical detective rate. For this way, hospitals can not only gain the trust of people but also mainly to increase their revenue in a more rapid way and balance between expenditure.
There are great varieties of medical equipment in a hospital and many of them are valuable equipment. Every year, great amount of budget will be spent on the purchase of new equipment and signing maintenance contracts. Up to now, few thesis focus on the management or the decision making of purchasing medical equipment.
This study aims to apply the concept of Total Resource Management (TRM) to build up the structure of resource managing and the decision making of investing medical equipment in hospitals. By PCDA cycle, we can continuously control the efficiency of valuable equipment upon its clinical usage. Medical departments can promptly adjust their strategies of resource using and improve their services and furthermore, to evaluate the right timing for purchasing valuable equipment. Then, we will focus on the overall benefit evaluation for MRI machines in a specific regional hospital. By applying Simple Multi-Attribute Ranking Technique (SMART) in UNISON Decision Analysis Framework, we are able to analyze the purchase of new machines in a more systematic way. Form this study, we will find out positive effects for valuable equipment management as well as improving the quality of medical treatments in the hospitals to increase competitiveness.

並列關鍵字

Total Resource Management ； PCDA cycle ； UNISON Decision Analysis Framework ； Simple Multi-Attribute Ranking Technique

參考文獻

王乃弘（1999），民眾就醫選擇之研究－分析層級程序法之應用，中華公共衛生雜誌，Vol.18,No.2，頁138-151。

申斯靜（2005），以病人安全為中心之醫療設備管理，慈濟醫學雜誌 ， 17卷4_S期，頁35 – 39。

李隆生（1999），影響醫院購置昂貴醫療儀器決策之因素－以台南高雄兩地醫院為例，中華公共衛生雜誌，Vol.18,No.5，頁327-33。

楊明璧、吳信宏（2002），臺灣貴重儀器投資及更新之決策模式，醫務管理期刊，Vol.3,No.3，頁81-103。

郭美利（2012），醫院全面資源管理之研究，國立清華大學工業工程與工程管理學系碩士論文。