手術器械委外方案探討－－以某區域教學醫院為例

The Study of Outsourcing Surgical Instruments: Take a Regional Teaching Hospital as an Example

醫院採用委外經營，越來越多樣化與成熟。目前國內實施手術器械供應委外作業模式並不多見，本研究透過個案醫院手術器械運作現況分析及供應商問卷調查，探討開刀房手術器械委外之可行性、器械供應商之合作意願及合作方式，作為雙方未來合作之實務應用參考，資料分析結果，歸納如下：1. 在台灣，廠商對委外合作方式相當陌生。手術器械委外方案之服務內容，供應商期望界定在部分器械提供，由此可見其選擇採行最為保守、服務範圍最小及成本最少的服務，而以成本過高、醫院使用者因素，造成器械耗損過高，為最主要的風險因素。選擇合作對象以開刀量及醫院財務面、信用為主。關鍵成功因素為醫院內部之整合、廠商之專業能力、合作模式及器械剩餘價值的估算。2. 實務合作方式，供應商選擇較為保守的部份承攬，廠商規模與選擇廠商進駐方案有相關，且每年合理利潤應維持在淨利10%~30%，承受耗損及維修的程度，應在承包器械價值的0.5~1.5%，與個案醫院之統計結果相符，不會因為選擇較高或較低的利潤，而願意承受較高或較低的耗損。3. 針對此外包方案，供應商認為具未來性及可做為與醫院關係建立的橋樑，超過五成願意參與承包，其承包意願與規模大小及是否接觸過此方案，無明顯相關。

The hospitals are getting more selective and proficient in outsourcing now. Yet, the outsourcing of surgical instruments is still very rare in Taiwan. The study evaluates the current operation of surgical instruments in the sample hospital, conducts the suppliers’ survey, analyzes problems to find out the possibility of surgical instruments outsourcing, intentions of suppliers and the mode of cooperation, and then integrates the proposal for practical applications to hospitals and suppliers. The main results of the research can be summarized as follows: 1. The outsourcing of surgical instruments is rare in Taiwan, so suppliers are unfamiliar with the mode of it. Therefore, suppliers would like to choose the most conservative service with minimum scope and cost as the contents of outsourcing. They consider high costs, users’ factors and high attrition rates as the main risks. Their concerns for the hospitals focus on the amount of surgical operations, financial situation and credit in the hospital. The key success factors of outsourcing are the internal integration of the hospital, the professional capability of the supplier, the cooperative mode, and the estimate of the surplus values of the instruments. 2. Suppliers will undertake more conservative tasks, and the suppliers’ scale has relation with the option of the suppliers for the outsourcing project. The annual net profit should be between 10%-30%. The attrition and maintenance cost should be limited to 0.5%-1.5% of the value of the instruments involved. These results are consistent with the statistics of the sample hospital. Whether the profit is higher or lower has no effect on suppliers’ willingness to afford the higher or lower attrition rates. 3. The suppliers are willing to join the proposal because of the future prospect and the relationships with the hospitals, and more than 50% of suppliers are willing to join the outsourcing proposal. There is no significant correlation between the intention of suppliers and their business scale and experiences with outsourcing.