建構一家精神專科教學醫院－－以線性規劃模式進行財務決策分析

Constructing a Psychiatric Teaching Hospital--A Financial Approach on Decision Making by Linear Programming

目的：由於全民健康保險及總額預算制度之施行，對醫院營運造成重大 影響，因此本研究期望能在符合醫療服務標準規定下，運用管理會計之規 劃、控制與決策觀念，為精神專科教學醫院作最佳病房及醫事人員組合方 案，以創造醫院或員工之最大利潤為目標。 方法：參考健係給付標準、精神專科醫院評鑑標準、專科醫師訓練醫院 認定標準等規定；以虛擬資料，假設欲建構之精神專科醫院室內面積、病房 種類、病床數、及各類醫事人員薪資等數據，在各種限制條件下，運用 EXCEL 規劃求解工具進行線性規劃運算，分析各種最佳盈餘之病房及醫事人 員組合方案。 結果：在不同限制條件考慮下，經電腦程式運算後，可以得到四種最佳 病房及醫事人員組合方案，而每一種方案各有其優缺點。 結論：在健係服務標準支付點數調高不易情況下，與其等待言周漲健係費 率，不如先做好醫院內部財務管理；而線性規劃工具的運用，可以預測最佳 醫療服務營運方案，提前作好適當人力資源使用計畫~ ，因此是一項值得未來 運用於醫院財務管理之工其。

Purpose: Due to the recent introduction of global budget in Taiwan National Health Insurance system, many major influences and changes are expected in hospital management practice. Under the requirement of hospital accreditation, using concepts for planning, control, and decision making in managerial accounting, this research tries to offer the best human resource utility program to achieve the most optimal profit distribution among the employee, and to benefit the management and continual growth for the hospital. Method: Using the references of Taiwanese National Health Insurance (NHI) payment, standard of accreditation for psychiatric teaching hospital, training capacity of residency program for psychiatric teaching hospital, we create a virtual psychiatric teaching hospital and assume its following data: floor area, number of ward, base pay of all medical staffs, and then we use Excel Solver to process a linear programming under above restriction, in order to obtain various combination of ward and human resource utility possibilities with the best profit. Result: Considering different situations, we derive four better combinations of ward and human resource utility. Each combination has its advantages and disadvantages. Conclusion: Since it s impractical to expect the continual increase in NHI payment, proper hospital financial management is essential. It s possible to predict the most optimal human resource utilization and the best hospital management program by linear programming, which shows great potential for hospital financial management in the future.