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  • 學位論文

醫療成本與訂價策略: 以A醫院的自費無痛大腸鏡為例

Healthcare Cost Analysis and Pricing Strategy: A Case Study of Painless Colonoscopy at Hospital A

指導教授 : 郭瑞祥

摘要


目前的健保制度最大的困難是收入的健保費無法應付快速成長的醫療需求。健保當局最大的責任就是「收支平衡」,但是在無法有效開源,只能從節流上著手,也就是抑制醫療費用的成長。 不論醫療機構的規模大小,所有的醫療費用訂價都要達到自給自足的角度出發規劃。在此情況下,適度的開放自費項目是解決的方式之一,但目前健保當局對於自費項目的限制仍多,如果能提出合理的成本估算公式,尤其是把直接參與該醫療行為的醫事人力成本計入,才能讓給付的費用更接近實際成本支出。 從實務執行面觀察,現行醫療費用的成本計算方式並不合理。目前成本計算的方式的主要缺點為現行方法未反映的成本以及現行方法無風險準備金的分攤。 本論文研究目的為: 導正目前部分不合理的醫療費用訂價 計算醫事人力成本,分項收費 合理訂價讓人力回流,產業板塊移回正軌 合理訂價導正民眾就醫觀念與行為 政府對弱勢及偏鄉醫療補助有計算基礎 本論文以無痛大腸鏡麻醉的單項醫療行為,以作業基礎成本制的成本分析,得到一個計算醫療行為所耗用的直接醫事人力成本公式。隨後,本論文再應用這個公式,推算剖腹生產的半身麻醉與插管全身麻醉,得出相應的直接醫事人力成本公式。 本論文的研究結果可以依推算出以作業基礎成本制的成本分析,有助於對醫療行為合理訂價,做為醫療機構永續經營以及健保制度分配資源的參考。

並列摘要


The major obstacle of National Health Insurance (NHI) is the aggregate insurance premium is not able to meet the rapid growth of medical demands in Taiwan. Without increasing the rate of NHI premium, NHI Bureau can only reduce the costs and expenses (i.e. control the growth rate of medical expenditure), and hence it is very challenge for NHI Bureau to breakeven. Taiwan's NHI is a single payer system. No matter whether the scales of medical institutes and hospitals are large or small, the pricing strategies of all medical services should aim to be self-sufficient in order to make medical institutes and hospitals sustainable. One of the possible solutions is for NHI Bureau to provide certain flexibilities for medical institutes and hospitals to offer medical services to be paid out of pockets of patients. At the moment, most expenses of the medical services are primarily covered by NHI and only minor percentage is paid by patients. Patients will be benefited from having choice(s) to pay extra for certain health services on-demand, which may not be covered by NHI. To date, there are still a lot of constraints regulated by NHI Bureau for the health services under self-expenditure of patients. It would be optimal for NHI Bureau, medical institutes and hospitals, and patients to have reasonable cost - pricing formulas. Among all, the direct cost of medical personnel of health services is the most important element, which is substantially under-estimated by the current cost - pricing formula utilized by NHI Bureau. Only when the cost of medical personnel is fairly reflected in the pricing formula, the correlation between the payment and the actual costs and expenses involved will make sense. The current cost – pricing formulas neither reflect the costs involved of the respective health services nor take into account the risk provisions. The purposes of the thesis are: To provide information for the NHI Bureau, medical institutes and hospitals to better price health services To break-down the cost of health personnel for various items of health services in order to better price the self-expenditure services on-demand To re-gain medical personnel by properly pricing health services and to move the healthcare industry into the right track To educate patients with proper attitude and concepts for taking medical treatments To provide the calculation basis for government to subsidize those people with low income and those remote villages without sufficient medical resources The thesis utilizes Activity Based Costing (ABC) to analyze the costs involved for Painless Colonoscopy in order to break down each item of medical services, especially the direct cost of medical personnel. Thereafter, the thesis modified the cost – pricing formula of Painless Colonoscopy and applied into the Spinal Anesthesia for Cesarean Section and Incubated General Anesthesia. The thesis concluded that Activity Based Costing analysis is helpful for properly pricing medical procedures and medical services. The result is a useful reference for NHI system to better allocate resources and for medical institutes and hospitals to operate with long term plans.

參考文獻


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