醫療成本與訂價策略：
以A醫院的自費無痛大腸鏡為例

儲寧瑋

doi:10.6342/NTU201602544

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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

儲寧瑋 , Masters　　Advisor：郭瑞祥　　

繁體中文 DOI： 10.6342/NTU201602544

作業基礎成本制；醫療費用定價策略；健保制度；自費； Activity Based Costing （ABC）； National Health Insurance ； Healthcare Pricing Strategy ； Self Expenditure ； Cost – Pricing Formula（s）

Abstract │ Reference (34) │ Altmetrics

Abstract 〈TOP〉

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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.

Reference ( 34 ) 〈TOP〉

2. Akira Horiuchi, Yoshiko Nakayama, et al. 2012. Safety and effectiveness of propofol sedation during and after outpatient colonoscopy. World J Gastroenterol. 2012 Jul 14; 18（26）: 3420–3425
連結：
4. John K Triantafillidis, Emmanuel Merikas, 2013. Sedation in gastrointestinal endoscopy: Current issues. World J Gastroenterol. 2013 Jan 28; 19（4）: 463–481
連結：
5. Karen J. Wernli, Alison T. Brenner, et al. 2015. Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology. 2016 Apr; 150（4）: 888–894
連結：
6. Peter Porostocky, Naoki Chiba, et al. 2011. A survey of sedation practices for colonoscopy in Canada. Can J Gastroenterol. 2011 May; 25（5）: 255–260
連結：
7. Ronald W. Hilton，Managerial Accounting, Creating value in a Dynamic Business Environment, 6e
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