某醫院日間照護室的成本分析

Cost Analysis of an Adult Day Care Center

以醫院為基礎之日間照護是快速成長中的長期醫療照護重要的一環，其成本分析對日間照護的經營相當重要。因此，本研究旨在以成本分析方法，估算某醫院日間照護室營運四年之成本。其研究結果為：（1）就固定成本而言，以人事費與運輸費最多；就變動成本而言，以運輸費與伙食費最多；整體而言，依83年物價指數調整後之每個案日平均總成本為817元，其中人事費與運輸費佔總成本81％；(2)整體而言，依個案使用交通車接送服務之調整前或調整後每個案每月之服務成本皆高於平均月照護費，目前處於虧損狀態中；(3)有盈餘之每個案之營運淨收入比率，在第二年、第三年分別為0.053、0.079，這對獨立性之日間照護中心而言，因每個案之營運淨收入比率偏低，將阻礙日間照護中心的設立與發展，除本身需加強績效管理外，欲推展長期醫療照護之角色功能，迫切地需要主管單位對日間照護開辦初期之補助，或保險機構將日間照護服務納入給付中；(4)每月至少需要服務病患人次為25人，或每月至少需要受托人次為25人，或每月至少需要受託人日數為555人日，才能達到損益平衡點；(5)日間照護服務之收費，應根據預估服務量及其成本修訂之。雖然本研究顯示日間照護的純益較低，但是強調持續性、完整性、高品質的以醫院為基礎之日間照護仍然是值得推廣的。

Hospital-based adult care is one of a number of rapidly growing long－berm care options. It is very important for managers who run an adult day care center to analyze its cost. Therefore, the purpose of this study was to evaluate the cost of an dult day care center after four years of operation with the method of cost analysis. The results were shown below: (1) Most fixed costs were for expenses of personnel and transportation; most variable costs were for expenses of transportation and meals. As a whole, the mean total cost which was adjusted for 1994’s price index was NT$817 per participant day, of which the expenses for personnel and transportation accounted for eighty-one percent of total cost. (2) Based on using transportation service, either unadjusted or adjusted service cost per participant month was more than the average monthly income. This showed that the profit of this adult day care center was in the red. (3) The net operating margin ratio per participant was 0.053 and 0.079 in the second and third year respectively. The low net operating margin ratio will obstruct the establishment and development of an independent adult day care center. Besides enforcing internal administration effectively, it is urgently necessary to have either operating subsidies provided by authorities concerned at the initial stage of the foundation of an adult day care center or payments for these services enrolled in health insurance policy. (4) In four years, we should have served at least 25 participants or 555 participant-days every month to reach the break-even point in the financial statement. (5) The charges for adult day care program should be revised according to the estimated service volumes and total cost analysis. Although it showed that the net profit of adult day care program was low in this study, we would like to emphasize that continuous, comprehensive and high-quality services provided by hospital-based day care is worthy of establishment and development.