地區醫院腹腔鏡之成本效益分析

Cost-Benefit Analysis of Laparoscope in a Local Hospital

本研究細針對某一地區醫院購入之腹腔鏡儀器進行成本效益分析，樣本醫院使用腹腔鏡儀器進行之手術分為五種，計有剖腹探查、結紮、子宮切除、子宮外孕及卵巢切除等項手術，以90年度會計室提供的數據資料，分別計算其單項成本。並與健保支付標準或樣本醫院自行收費標準相較，了解各項手術損益情形，並運用淨現值法及回收期間折現等資本投資決策方法評估儀器投資效益。研究結果顯示：以單項手術成本言，子宮切除手術成本29287元最高，卵巢切除手術24808元次之，子宮外孕手術22627元居三，剖腹探查手術18192元第四，結紮手術12782元最低。就獲利能力分析，子宮切除手術利潤最高30353元（純益率50.9%），其次為子宮外孕，淨利為27423（54.8%），卵巢切除手術獲利居三，淨利為23929元（純益率48.4%），結紮手術居四，淨利為2218元（14.8%）；而剖腹探查手術則為虧損8192元（純益率高達81.9%）。就投資效益分析，淨現值為正值1772336元，回收年限約在4.02年，小於使用年限8年，回收期間可謂快速，為一適當之投資。本文建議未來健保局如將剖腹探查項目列為論病例計酬或論人計酬項目時，宜考量不同層級醫院資源耗用及生產規模，進行合理的費用調整，以利醫療資源合理的配置及醫院生存發展。兒結紮手術因屬自費範圍，院方可考慮供需情形，合理的調整收費標準，以使醫院更具競爭力。另建議院方積極開發新產品，擴展自費病患，適時檢視收費標準，在不浪費醫療資源及維持高度醫療品質前提下，提高儀器的使用率增加獲利機會。 The cost benefit of the laparoscope was discussed by capital investment decision methods (net present value method and discounted payback period method) to offer the administrators making the financial strategy in future. The results showed that the cost per operation was different. The costs were LAVH: NT$29,287, oophorectomy: NT$24,808, ectopic pregnancy: NT$22,627, laparoscopy: NT$18,192 and laparoscopic sterilization: NT$12,782. The net income and net income rates before taxes were LAVH NT$30,353 (50.9%), ectopic pregnancy: NT$27,423 (54.8%), oophorectomy: NT$23,292 (48.4%), laparoscopic sterilization: NT$2,218 (14.8%) and laparoscopy: NT$-8,192 (-81.9%). Using net present value method and discounted payback period method, the net present value was positive NT$1,772,336, and the payback period was 4.02 year lower away from service life. To sum up, the capital investment was asserted an adequate financial decision for the hospital. Finally, the study suggests the Bureau of National Health Insurance could consider if the reimbursement was reasonable and made adjustment to the laparoscopy. The administrators of the hospital could effort toward the directions under non-wasting medical source and maintained high medical quality. Exploring new medical care service of the laparoscope, extending new patients at their own expense, inspecting operation related fee standard to promote the using rate of the laparoscope.

The cost benefit of the laparoscope was discussed by capital investment decision methods (net present value method and discounted payback period method) to offer the administrators making the financial strategy in future. The results showed that the cost per operation was different. The costs were LAVH: NT$29,287, oophorectomy: NT$24,808, ectopic pregnancy: NT$22,627, laparoscopy: NT$18,192 and laparoscopic sterilization: NT$12,782. The net income and net income rates before taxes were LAVH NT$30,353 (50.9%), ectopic pregnancy: NT$27,423 (54.8%), oophorectomy: NT$23,292 (48.4%), laparoscopic sterilization: NT$2,218 (14.8%) and laparoscopy: NT$-8,192 (-81.9%). Using net present value method and discounted payback period method, the net present value was positive NT$1,772,336, and the payback period was 4.02 year lower away from service life. To sum up, the capital investment was asserted an adequate financial decision for the hospital. Finally, the study suggests the Bureau of National Health Insurance could consider if the reimbursement was reasonable and made adjustment to the laparoscopy. The administrators of the hospital could effort toward the directions under non-wasting medical source and maintained high medical quality. Exploring new medical care service of the laparoscope, extending new patients at their own expense, inspecting operation related fee standard to promote the using rate of the laparoscope.