| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 91 === The payment system of the National Health Insurance has undergone a radical transformation in recent years. As a result of the recent introduction of the global budget on July 1, 2002, hospital administrators as well as managers of the operating rooms (OR) are paying more attention to cost analysis and cost containment than they used to be. With the new challenge, OR managers attempt to reward good resource utilization and cost containment during the entire surgical process in order to obtain adequate profits. Thus, the purpose of this research is to provide a framework for analyzing actual costs of surgical services by using a multiple-stage activity-based costing/management (ABC/M) model to improve OR efficiency.
Surgical services, in fact, are provided through an integrated process of multiple stages, which is a series of interconneted steps that consume common resources such as anesthesia services, operation rooms, and post-anesthesia care. With the recognition that there are multiple stages in the OR to serve as cost drivers, the diversity of the resources consumed can be better segmented to truly reflect the variety and operational complexity of surgical services.
The data of costs and charges for 31,358 patients received surgery at a certain 2000-bed medical center from January to December in 2001 are analyzed in this study. The study follows a four-step process to identify and define the activities in the OR and its associated costs. First, three activity centers are defined. They are the anesthesia department, the OR department, and the post-anesthesia care unit. Secondly, the total OR costs are assigned to these activities centers based on first-stage cost drivers. Thirdly, the OR department cost is assigned to the activities of customized pack preparation and instrument sterilization through the use of appropriate intermediate cost drivers. The activity costs progressively accumulated are then subsequently reassigned to surgery-specific supporting and surgical activities Finally, costs are flowed and reassigned to the appropriate surgical procedures in the cost centers associated with all appropriate activities by the final-stage cost drivers.
The findings of this research are as follows. There are nineteen activities and 902 cost objects are identified. Our result shows that seventy-eight percent (78%) of operating costs are fix costs. Twenty-two percent (22%) of total costs are variable. The largest surgical activity center is the OR department (52.2%), followed by the anesthesia activity center (43.8%) and the post-anesthesia care activity center (3.9%). The result also shows that the surgical cost per patient ranges from NT$10,996 to NT$70,294 across the entire surgical services of the medical center and the mean is approximately NT$13,966. The profit analyses suggest that the net profit rate is29.2% for the entire surgical services. On the other hand, the break-even quantity is 14,282 patients per year for the operating rooms.
Through this study, it can be concluded that the multiple-stage ABC/M system is applicable in the operating rooms. In addition, this new costing system not only provides cost information on activities and surgical procedures but also assists resource management and cost control. Moreover, the new system can provide financial and non-financial information to help OR managers in the analysis of the OR activities/business and, thus, enhance their decision-making. Finally, this system can also help hospitals to set up a private physician’s fee (PPF) system based on the degree of resources consumed.
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