應用作業基礎成本法評估自然產與剖腹產手術成本

Application of Activity Based Costing Method to Evaluate the Cost of Virginal Delivery and Cesarean Section

本研究以一婦產科診所為樣本，探討有關剖腹生產及自然生產的成本。本研究採用作業基礎成本法（Activity-based costing, ABC），依據成本動因（costdriver），成本池（cost pool）來分配（allocate）間接費用，將作業成本追溯至作業活動，使得成本的分配更為公平且符合實際狀況。將手術成本分成下列四個步驟：1. 病患掛號、2. 產前檢查、3. 手術與術前準備、4. 手術後的追蹤。研究結果：在未包含醫師費時，診所在每個產婦自然生產之平均成本為9,417 元，剖腹生產之平均成本為15,675.6 元。討論：其他成本占剖腹產成本比例最高，剖腹產手術與手術前準備之成本比例次之，自然生產手術以其他成本比例最高，人事成本次之。兩種手術之「其他成本」占了很重的比例，分析其原因為診所的每月醫療事故保險費 90,000 元，使之成為重要的成本項目，占其他成本的72.7%，比率為最高，若去除此一顯著因子，將會降低其他成本的比率。在本研究中，人事成本採用美國慣用之方式，將醫師費另外列之，若將醫師費列入人事成本計算，剖腹產手術及自然產手術之人事成本所占比例將提升至28%及40%。本研究依照作業流程分析之成本，可作為醫療機構從事成本規劃及績效管理之依據。

Introduction: an OBS/GYN clinic was chosen as the sample to analysis thecost of Cesarean section and virginal delivery. This research used Activity-based costingmethod to allocate the cost of the surgeries. This method categorized the surgeries intofour steps: 1. patients registration, 2. physical check before delivery, 3. preparationbefore operation, 4. physical check after operation. The research of results: excludingthe physician fee, the average cost of virginal delivery in the clinic was 9,417 NTdollars and the average cost of Cesarean section was 15,675.6 NT dollars. In theCesarean section, there was a high proportion in the cost of the other cost; and also thesame high for virginal delivery. We found that the reason was due to the medicalaccident insurance cost, which was 90,000 NT dollars, and composed 72.7% of “theother cost.＂ In this research, if we enlist the physician fee, the percentage ofC-section/ nature childbirth will raised to 28% and 40%. This research assayed the costby its activity, and it can be helpful for hospitals and clinics to manage and control thecost.