建立細菌室持續性改善之成本系統―以某醫學中心為例

Developing a Continuous Improvement Costing System in a Medical Center's Microbiology Laboratory

吳雪穎(Hsueh-Yin Wu)

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.2005.10350

摘要

前言：近年來，健保支付制度朝向前瞻式預算之發展，醫療照護的財務風險漸漸轉移至醫療提供者。醫院要在如此財務困難的環境下，又必須提供患者高品質的照護，管理者紛紛要求各部門自行做好成本管理及持續品質改進。細菌組是檢驗部門中一個較偏向客製化生產方式的工作單位，耗用大量人力從事細菌培養，相對於其他部門，檢驗結果有無長菌不僅深切影響病患疾病的治療方向，且所耗用的資源差異很大。然而過去大多數醫院所用之傳統成本方法產生之報表係以部門別而非流程分析為主，並未能呈現出此類檢驗成本的差異性。而ABC/M強調從流程觀點，藉由分析流程及其組成之作業，使管理者了解成本流向，以及流程改善之機會，故本研究欲藉由作業基礎成本與管理（ABC/M）之新成本管理工具，以某醫學中心檢驗部門細菌組為對象，建構一套提供流程與作業持續改善之成本管理系統，以提昇該部門的成本管理。
材料與方法：本研究為一個案研究，以台北地區某財團法人醫學中心檢驗科細菌室為研究對象。個案醫院病床總數約800床，佔床率約為九成。研究資料取自該院89年之會計報表及細菌室當年之檢體總量。研究範圍包括細菌檢驗前之收受檢體、檢體處理，檢驗中之種菌培養、菌種鑑定、藥物敏感試驗、確認結果，及檢驗後之發報告等作業流程。並以ABC/M之架構從事流程與成本分析。
結果：個案醫院細菌室於89年全年檢體量有26884件，共耗用成本8,035,219元，其中以試藥耗材費用佔總成本最多，佔57.5%，其次為人力成本，佔39.2%，各項作業成本分別為「準備與行政作業」，佔總成本7.00%，檢驗中之「培養檢體」作業佔50.97%，「一般細菌鑑定」作業佔27.10%，「抗藥試驗」作業佔7.28%，「黴菌鑑定」作業僅佔0.20 %，其他作業如「教學研究」佔3.83%及「品管」作業佔0.27 %，由作業成本可得知細菌檢驗作業資源耗用於各類檢體之分布，亦可瞭解各項檢驗之單位成本及其獲利情形，並分析資源浪費與成本改善機會
結論：本研究利用ABC/M成本方法建構一可衡量客製化之累加成本系統，藉由此系統之流程與作業分析所產生之資訊，使用於持續性改善之工作，包括降低內外部品質失敗成本，增加作業效率，以及檢驗利用效能改善。

關鍵字

作業基礎成本管理

並列摘要

National health insurance policy has been developed toward prospective payment systems these years. The financial risk has been gradually transferred to those who provide health care. Under these harsh circumstances, hospitals also have to offer patients high quality care. Thus, hospital managers request every department to control cost and keep improving quality as well as possible. The microbiology laboratory is the work unit which more relates to the production way of job-shop. Comparing it to other departments, it consumes a large amount of manpower on cultivating microorganisms. The results coming up with bacteria or no bacteria affect not only the cure way on diseases of patients but also the consumption of resources.
For years, most hospitals used the traditional cost accounting system which emphasized on differentiating department profits rather than analyzing working process. ABC/M（activity-based costing and management）system however put emphases on the view of process. It lets managers understand the flow of costs and the improvement opportunities of process by analyzing activities in the process. Thus, this study tried to construct a cost management system which is able to provide improvement opportunities of process and activities by means of ABC/M application. It took an clinical laboratory department as the subject and tried to advance its cost management.
This is a case study. The subject of the study was a microbiology laboratory of a medical center in Taipei. The data were collected from the accounting report of 2000 of the hospital and the total amount of specimens received in the laboratory. This hospital contained about 800 beds with an occupied rate of 90%. The research method was applying the framework of ABC/M to analyze the microbiology laboratory operation activities and the related costs. Based on the ABC/M principles, 7 activities were defined in the laboratory.
The results show that while reagents and materials accounted for 57.5% of the total cost, labor and allocated overhead accounted for 39.2% and 3%, respectively. As for activity cost, specimen culture and bacteria identification activities consumed the major portion of the total cost at 51% and 27%. Antibiotic susceptibility testing, administrating and preparing, teaching and research, quality control, and fungal identification were all less than 10%. We also obtained the total costs and every single test cost of different kind specimens respectively, including revenue, costs, and gross profits. Through analyzing the cost information and standard operating procedures of the laboratory, we found the failure cost because of improper use of blood culture and excessive resource consumption in bacteria identification（ID）procedure.
For lowering failure cost and improving ID procedure, we implemented continuous quality improvement strategies—including education training course and taking QCC action. After that, the failure cost decreased to 4.5% of the next year from 15.3% of the previous year, and saved bacteria ID cost about NT$ 90,000/y by changing Aci. baumannii ID SOP.
The conclusion of this study was to prove：first, we applied ABC/M to construct an additive cost system which can more precisely measure cost of the customized products in the microbiology laboratory. Second, by using this ABC/M system, we found the non-value-added process and help make decisions to eliminate it. Last, with the information produced by work process analysis of this system, the microbiology laboratory management can be continuously improved including reducing the failure cost, increasing the operation efficiency, adjusting laboratory testing utilization.

並列關鍵字

ABC/M

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