醫療服務項目之成本分析——以血液透析為例

The Cost Analysis of Medical Service Item-A Case Study for Hemodialysis

在2002年重大傷病花費達769億，占健保總醫療費用的比率達22.64%，其中又以血液透析（俗稱「洗腎」）排名第一位，佔總醫療費用的6.83%，且年年以12～14%速度持續增加中。到了2006年，洗腎的醫療費用支出高達287億；目前中央健保局已將洗腎納為定額支付制。為了瞭解透析成本之合理性，進行血液透析單項成本分析研究，以南部某地區醫院92年度相關單位提供的數據資料，分別計算血液透析之單項成本，將成本分為用人成本（變動與固定人力）、藥品及衛材成本、設備費用折舊、管理費用等四大項並計算其總成本。研究結果顯示每次透析成本為＄3,375元，比較健保單次給付4,100點（點值在0.8至1之間浮動），則此院淨利為18%，邊際貢獻率達50.4%，安全率為35%，營運槓桿比為2.85，本研究分析之結果顯示：目前的支付還是合理的。

In 2002, the Bureau of National Health Insurance spent 769 hundred million on the medical care for the serious diseases and this amount was about 22.64% of the total medical expenses. The medical expense of Hemodialysis (Also known as ”renal dialysis”) was 6.83% of the total and became the number one. Moreover, the expense of Hemodialysis is increasing at the rate of 12~14% per year. expenses spent on Hemodialysis was 287 hundred million in 2006. Currently, the Bureau of National Health Insurance agrees to include Hemodialysis in the case payment category. Since reasonable reimbursement is possible only when actual cost data are fully incorporated. Thus, a distric hospitals in southern Taiwan was conducted to investigate the cost. All possible costs related to the dialysis procedures were included and the item span for the year 2003. Costs were divided into four categories: (1) personal cost (variable personal and fixed personal), (2) material cost, (3) equipment depreciation and (4) overhead expenses. The result of the study showed that the cost for each dialysis was NT$3,375; contribution margin rate was 50.4%; safety margin rate was 35% and the degree of leverage was 2.85. Compare to 4,100 points (point value varies between NT$1 and NT$0.8) paid by the NHI for each dialysis visit, current reimbursement was reasonable.