婦產科腹腔鏡系列手術之成本分析－－以臺北市某區域醫院為例

The Cost Analysis on the Gynecological Laparoscopy Inpatients a Study for a Regional Hospital

自民國八十四年三月起實施全民健康保險，在短短的九年中醫療費用快 速成長，健係局為了因應高額醫療費用便開始實行論病例計酬（ Case Payment ）。此項制度從之前的二十八項擴展至今已有五十項之餘，預計民國九十五年 元月全面實行診斷關聯群DRG （Diagnosis Related Group） 之後，此項支付制 度包含的疾病項目將會增加。且此項支付制度是採前瞻性訂價方式，使整體 之醫療費用支出易於控制。但此制度造成現實上問題即是醫院的經營；因 此，要兼顧醫療品質提升和醫院營運唯有賴成本分析。本研究即以三項婦產 科腹腔鏡手術（分別為子宮切除、卵巢及輸卵管切除、子宮外孕）為例，精 算其成本並評估醫院實行效益。 本研究以北市某一區域醫院為例，病例還取期間自氏國九十三年一月一 日至六月三十日。將手術總成本細分為用人成本、藥品成本、衛材成本、器 械包盤、放射成本、設備折舊、病房費用及行政管理費用共九項單項成本。 經過成本分析後發現，婦產科腹腔鏡jh 列手術之用人成本（約佔總成本 50%）、衛材成本（約佔總成本20%~30%）、病房費用（約佔總成本10%），將 結果與其他成本分析相關研究比較可得知與此相去不遠。此三大費用項目為醫療院所實行腹腔鏡系列手術時庭、要注意的成本項目。若能有效控制此三項 成本費用，便可降低醫療成本，促進醫療機構營運。

Since the implementation of the National Health Insurance in March , 1995 in Taiwan, medical expenses have increased. In order to solve the problem of high medical expenses, the Bureau of National Health Insurance BNHI has pushed case payment system. And BNHI will push DRG Diagnosis Related Group system in January 2006. It will easy to control medical expenses increase under the payment system. The study focused on gynecological laparoscopy inpatients selected during January to June 2004. Total cost included salary, medicine cost, material cost, instruments cost, radiation fee, depreciation, ward cost, and administration cost. After cost analysis it found that salary in the proportion of total cost is 50%; material cost is 20%-30%, and ward cost is 10%. We compared the outcome with similar study that had no difference. Controlling these three large proportion cost will decrease gynecological laparoscopy operation cost and advance hospital performance.