醫療部門資源耗用分析與成本管理系統之建立 -以某醫學中心胸腔內科為例

Resources Utilization Analyses and Establishment of Cost Management System for a Medical Department An Example of Pulmonary Care Division in a Medical Center

周建銘(Chien-Ming Chou)

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(2004年)

https://doi.org/10.6342/NTU.2004.02232

摘要

全民健保實施至今已餘八年，由於醫療費用不斷上升，中央健保局除了在民國八十九年七月開始實施呼吸器依賴患者整合性照護前瞻性支付方式，並於民國九十一年七月實施總額預算制度。因此，醫療機構在收入成長受到限制下，醫院與胸腔內科部之管理者將焦點專注在成本控制與管理，期望能獲得合理之利潤。
胸腔內科部門不但具有高成本、作業型態多樣化、產品複雜性高之特性，其所提供的服務包含門診、弁鈶邠d室、住院及教學研究，若以傳統責任中心制度分析之，僅能計算至部門成本，而無法提供各項處置作業與產品之實際成本資訊，亦無法作為管理者做為決策之參考。在眾多成本管理系統中，作業基礎成本與管理制度(ABC/M)最能反映醫院胸腔內科部門實際耗用的成本，且此成本資訊對於管理者有莫大的助益，故本研究之目的依據ABC/M之原則，建構胸腔內科部之作業與產品分析模式，並利用ABC/M提供之財務與非財務資訊，協助胸腔內科部達到成本管理之目的。
本研究選擇某醫學中心的胸腔內科部門為分析單位，就該部門92年3月之成本進行分析。首先，確認門診、弁鈶邠d室、住院與教學研究四項作業中心；接著，利用資源動因將胸腔內科部成本歸屬至各作業中心內之作業；最後，利用作業動因將作業成本歸屬至最終的產品，並計算各項產品之成本。
經由ABC/M實際規劃與分析後，本研究得到下列之結果：胸腔內科部確認二十九項作業與十九項產品；全科之毛利率為5.9%；就資源耗用而言，以醫材耗材佔51.7%最高，人力成本佔38.6%次之，儀器設備成本與作業費用分別佔5.2%與4.4%；就作業中心資源耗用而言，以住院佔78.3%最高，門診佔17.6%次之，弁鈶邠d室與教學研究分別佔2.9%與1.2%；就損益平衡點而言，住院之呼吸治療實際人日皆超過損益平衡點，弁鈶邠d室實際人次則未超過損益平衡點。
本研究論證ABC/M可應用於醫院胸腔內科部，且透過該成本管理系統計算各作業中心之作業與產品成本，可提供每位病患精確之服務成本資訊，進而協助胸腔內科部達到成本管理之目的；相較於責任中心之資源控制， ABC/M提供之非財務性資訊，有助於胸腔內科部管理者從事產能利用管理與績效評估；ABC/M提升胸腔內科部資源的管理及決策管理之能力，並做為未來獎勵之基礎。

關鍵字

作業基礎成本與管理制 ； 成本管理系統 ； 資源耗用 ； 胸腔內科部門 ； 呼吸照護中心

並列摘要

The National Health Insurance had been implemented eight years to date.Because the health care expenditures had continuously increased, Bureau of National Health Insurance not only executed the Demonstration of Ventilator Dependents Managed Care in July 2000, but also introduced an overall global budget in July 2002. For this reason, with the constraints on the growth of hospitals’ revenues, hospitals and pulmonary care division managers, which expect to obtain adequate profits, focus on cost control and management.
Pulmonary care divisions in hospitals are of high cost, multiple activity patterns, and complex products. They provide services such as outpatient services, functional diagnoses, hospitalizations, and teaching and research.
Traditional responsibility center costing system can calculate the cost of the department level simply. Therefore, neither can it provides accurate cost
information of activities and products, nor a basis for hospitals’ managers to make a strategic decision. In the various cost management systems, ABC/M system is considered to provide accurate cost information of pulmonary care divisions, and the value of cost information to hospitals’ managers is substantially useful. The purpose of this study is to establish a costing and management model based on ABC/M principles for pulmonary care divisions, and to utilize financial and non-financial information obtained from ABC/M system in order to assist pulmonary care divisions to procure the goal of cost management.
The analysis unit of this study is a pulmonary care division in a medical center. The data were collected in March, 2003. First, four activity centers are defined, and they are the outpatient unit, the functional diagnosis room, the hospitalizations, and the teaching and research. Secondly, total pulmonary care costs are assigned to activity center and activities which belong to each
activity centers based on resource drivers. Last, the activity costs are assigned to the final products based on activity drivers, and the cost of each product is calculated.
After implementing and analyzing ABC/M system in the pulmonary care division, the results of this study are as follows. There are twenty-nine activities and nineteen products are distinguished. The overall gross profit rate is 5.9%. The resource analyses show that 51.7% of the total costs are supplies and drugs, followed by 38.6% of the total costs are labor costs. The equipments and overhead allocated are 5.2% and 4.4% respectively. The activity center analyses also show that the hospitalization is the greatest activity center and accounts for 78.3% of the total costs, and the outpatient unit accounts for 17.6% of the total costs secondly. The functional diagnosis room and the teaching and research are of 2.9% and 1.2% respectively. The break-even quantity analyses show that the services volumes of ventilator dependents in ICUs, RCC, and Medical and Surgical Wards are exceed the break-even quantities, however, the volume of the functional diagnosis rooms is under the break-even
point.
Through this study, the conclusions are as the followings. ABC/M system is applicable to the pulmonary care division. In addition, accurate cost information obtained form ABC/M system can provide service costs for each patient and then assist the pulmonary care division to achieve the goal of cost management. Moreover, in comparison with traditional responsibility center costing system, ABC/M system can provide non-financial information to help pulmonary care division managers to devote themselves to capacity management and performance evaluation. Finally, ABC/M system is used not only to improve resources management and the capabilities of managers’ decision-making, but also to be a basis for the reward system.

並列關鍵字

Activity-Based Costing and Management ； Cost Manage

參考文獻

錢慶文：作業基礎成本制度在醫院成本會計上之應用。醫院 1994；27(3)：1-7。

楊昭恂、陳玉枝：縮短呼吸器依賴患者平均住院日。醫務管理 2001；2(1)：56-75。

簡肇明：呼吸器依賴患者長期照護之成本效果分析-以某區域教學醫院為例。高雄醫學大學

Player S, Lacerda R. Arthur Andersen's Global Lessons in Activity-Based

Conrad K, Nagle C, Wunar R. Cost Accounting Helps Ensure Group Practice