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研究生:周建銘
研究生(外文):CHIEN-MING CHOU
論文名稱: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
論文名稱(外文):Resources Utilization Analyses and Establishment of Cost Management System for a Medical Department An Example of Pulmonary Care Division in a Medical Center
指導教授:張睿詒張睿詒引用關係
指導教授(外文):Ray-E Chang
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:醫療機構管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:146
中文關鍵詞: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
外文關鍵詞:Activity-Based Costing and ManagementCost Management SystemResources UtilizationPulmonary Care DivisionRespiratory Care Center
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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、功能檢查室、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、功能檢查室、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,功能檢查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,功能檢查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。
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.
目錄……………………………………………………………………Ⅰ
圖目錄…………………………………………………………………Ⅲ
表目錄…………………………………………………………………Ⅴ
第一章 緒論………………………………………………………1
第一節 研究緣起…………………………………………1
第二節 研究目的…………………………………………4
第二章 文獻探討…………………………………………………5
第一節 成本管理系統之演進……………………………5
第二節 作業基礎成本與管理之架構與內涵……………15
第三節 作業基礎成本與管理制度之應用………………26
第四節 醫院的成本管理系統……………………………37
第五節 胸腔內科部之成本管理系統……………………46
第三章 研究方法與設計…………………………………………56
第一節 研究流程…………………………………………56
第二節 研究對象…………………………………………57
第三節 研究方法與設計…………………………………59
第四節 資料收集與來源…………………………………64
第五節 研究限制…………………………………………67
第四章 研究實例…………………………………………………69
第一節 確認產品………………………………………69
第二節 作業分析………………………………………72
第三節 資源成本之歸屬………………………………83
第四節 計算成本標的之單位成本……………………95
第五節 成本資料的分析………………………………104
第六節 呼吸照護中心之分析…………………………117
第五章 討論與結論………………………………………………121
第一節 ABC/M資訊之管理應用與討論……………….121
第二節 結論……………………………………………132
參考文獻………………………………………………………………138
中文部分………………………………………………………………138
英文部分………………………………………………………………140
圖 目 錄
圖 2-1 整合性作業基礎成本與管理系統………………………..11
圖 2-2 作業基礎成本制度之架構圖……………………………..16
圖 2-3 作業基礎成本制度架構之演進…………………………..17
圖 2-4 作業基礎管理制度之內涵………………………………..19
圖 2-5 作業基礎管理制度資訊結合策略及績效測量…………..23
圖 2-6 ABC/M將數據轉化成資訊示意圖………………………...26
圖 2-7 策略決策中的ABC/M………………………………….....27
圖 2-8 ABC/M於策略決策雙構面之應用………………………...29
圖 2-9 產能利用策略……………………………………………..31
圖 2-10 ABC/M結合限制理論對決策者之過去、現在與未來…...33
圖 2-11 價值分析的重點…………………………………………..35
圖 3-1 本研究流程………………………………………………..56
圖 3-2 個案醫院胸腔內科部組織架構圖………………………..58
圖 3-3 個案醫院胸腔內科部之ABC制設計步驟…………….....61
圖 4-1 胸腔內科部病患照護流程圖……………………………..73
圖 4-2 支氣管鏡室流程圖………………………………………..75
圖 4-3 胸腔超音波檢查室流程圖………………………………..75
圖 4-4 肺功能檢查室流程圖……………………………………..76
圖 4-5 病房睡眠檢查流程圖……………………………………..76
圖 4-6 個案醫院胸腔內科部資源歸屬流程圖…………………..85
圖 4-7 個案醫院呼吸照護中心資源歸屬流程圖……………….118
表 目 錄
表 2-1 成本管理系統之新需求之比較表…………………………9
表 2-2 營運控制系統與作業基礎成本制度之比較表…………..10
表 2-3 成本管理系統演進與決策支援關連表…………………..13
表 2-4 成本管理系統與決策支援著眼點之比較表……………..13
表 2-5 作業屬性之分類表………………………………………..20
表 2-6 作業基礎管理制度之優勢與功能………………………..25
表 2-7 國內外醫院RCC成本效益分析之彙總表………………….53
表 2-8 國外胸腔內科部實施ABC/M研究之彙總表……………….55
表 3-1 不同研究策略的相關比較表……………………………..59
表 3-2 資料收集來源彙總表……………………………………..65
表 3-3 研究變項定義表…………………………………………..66
表 4-1 胸腔內科部之產品項目表………………………………..71
表 4-2 胸腔內科部作業中心之作業及作業動因表……………..79
表 4-3 功能檢查室產品之作業耗用表…………………………..81
表 4-4 胸腔超音波檢查室各項作業之標準資源耗用量……....82
表 4-5 胸腔內科部92年3月成本動因耗用表…………………….84
表 4-6 胸腔內科部92年3月作業中心之成本歸屬表…………….86
表 4-7 門診作業歸屬表………………………………………....88
表 4-8 功能檢查室作業歸屬表………………………………....92
表 4-9 住院作業歸屬表………………………………………....93
表 4-10 教學研究與行政管理之作業歸屬表…………………....94
表 4-11 門診之單位作業成本表………………………………....95
表 4-12 功能檢查室之單位作業成本表………………………….100
表 4-13 住院之單位作業成本表………………………………….100
表 4-14 行政管理之單位作業成本表…………………………...101
表 4-15 作業中心內成本標的之作業成本彙總表……………...102
表 4-16 胸腔內科部92年3月成本與收入統計表…………………105
表 4-17 胸腔內科部各作業中心之資源耗用分析表…………….111
表 4-18 胸腔內科部各作業中心之作業耗用分析表…………….112
表 4-19 胸腔內科部各作業中心之收入與成本統計表………….114
表 4-20 胸腔內科部醫師別門診成本與收入統計表…………….108
表 4-21 功能檢查室實際耗用成本與健保支付比較表………….115
表 4-22 功能檢查室損益平衡分析表…………………………….115
表 4-23 住院呼吸治療實際耗用成本與健保支付比較表……….116
表 4-24 住院呼吸治療損益平衡分析表………………………….116
表 4-25 胸腔內科病患於呼吸照護中心單位作業成本表……….120
表 4-26 胸腔內科病患於呼吸照護中心實際耗用成本與健保支 付比較表………………………………………………….120
表 5-1 功能檢查室機器設備利用率分析表…………………….128
表 5-2 功能檢查室技術員利用率分析表……………………….128
表 5-3 住院呼吸機可使用產能統計表………………………….129
表 5-4 住院呼吸機利用率分析表……………………………...129
表 5-5 住院呼吸治療師利用率分析表………………………….130
表 5-6 住院佐理員利用率分析表……………………………….130
表 5-7 住院呼吸治療師工作時間統計表……………………….130
表 5-8 個案醫院胸腔內科部92年3月份責任中心成本統計表..131
表 5-9 個案醫院胸腔內科部92年3月份作業中心成本統計表..131
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