鑑於目前台灣的護理之家大都未建立起完整的會計以及成本分析制度,其收費制度缺乏特定標準,且未考慮依住民照護資源的耗用程度或其失能狀況引發之照護需求,因此常使得照護費用之合理性受到質疑。本研究乃以某署立醫院附設護理之家為個案研究對象,利用作業基礎成本制度,根據住民所需的照護項目資源耗用情形及其失能狀況與健康狀況,來計算其對照護成本之影響。 首先,本研究利用個案研究法之實地觀察與訪談,設計出「主要專業護理活動項目表」以及「照護員主要照護活動項目表」,並由研究者實地紀錄53項照護作業之時數,再經由作業基礎成本制度之架構,求得不同狀況住民之照護成本,進而分析護理之家之照護成本及其病例組合。 研究結果顯示,透過作業基礎成本制度所計算得到的照護時數與照護成本,會隨著住民功能狀況或插管數的不同而有差異,住民對於照護時數耗用越高者,所產生之成本越高。而本研究所建構的病例組合模式一,為較佳之分組模式,其使用身體功能狀況與插管數進行分組,組群數為4 組,對總照護成本的解釋力為70.2﹪,所使用的分組變項容易評估,且在護理之家病歷中皆可取得,符合病例組合分組之各項原則。 根據研究結果,本研究建議護理之家可利用作業基礎成本制度來計算其照護成本,亦可透過此制度來進行照護人力之安排。另外,透過病例組合的模式可根據住民的功能、插管情形或照護需求的不同,作為估計經營上所需之成本之參考。
The standard of cost in nursing often is an issue being debated since the current nursing home in Taiwan haven’t developed a complete accounting and cost analysis system. This is a case study of hospital-based nursing home. Using Activity-Based Cost approach, based on the nursing utilization, disability, and health condition, of the patients, to calculate the effect it has in the cost of nursing. The research calculates care hour and cost by the Activity-Based Cost approach. Taking the framework of Activity-Based Cost approach to derive the difference in care cost, that reflects different degree of nursing needs. Furthermore, to analysis the care cost of the nursing home and then develop the case-mix system. It differs by the resident’s functional status and tube numbers. Resident who needs more care hours required more care cost. The case-mix model 1, which the research established, is the optimal grouping model. It is grouping by the physical status and tub numbers, and has 4 groups. The case-mix model 1 could explain 70.2﹪variation of care cost, the reference variables of grouping are easy to assess, and also easy to derive from medical record. The result of this research concludes that nursing home is recommended to use Activity-Based Cost system to calculate the care cost and manage the human resource. Also, based on combination of the resident’s functional Status, tube numbers, or different care needs to develop the cost standards as well as the estimate the hospital operating cost.