| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 91 === Abstract
With the implementation of National Health Insurance in 1995, the health care expenditures have continuously escalated. In order for Bureau of National Health Insurance to control the expenditures, many policies to contain the supply and demand of health care have been in effect, and the reimbursement system was directed into an overall global budget mechanism in July 2002. Moreover, the reform regarding the fee schedule is also based on RBRVs. Therefore, with the intense constraint on the growth of hospitals’ revenues, cost management has become one of the most important issues facing hospital managers in Taiwan.
The traditional cost accounting system, widely used by domestic hospitals, is based on responsibility centers and can only calculate the cost of the department level. Due to lake of cause-effect relationships, it does not reasonably reflect the actual cost and cause cross subsidization among departments. It may thus end up leading to wrong decisions for the management. With ABC/M’s cause-effect basis, all costs and the relationships among products, activities, and resources could be clearly developed; therefore, such information could serve as valuable reference in making decisions.
Clinical pathology departments provide physicians with important pathologic information. The accuracy, speed, and quality of such information have considerable impact on healthcare services and cost of a hospital. Therefore, to construct a suitable cost management system for clinical pathology department is inevitable. However, due to the variety and variability consuming human resource, reagents, and equipment, either the traditional accounting system or the standard costing system could not reflect the actual costs of services provided by a pathology department and is thus of limited assistances to hospital managers.
Based on the ABC/M principles, the objective of this research is to establish a costing and management model for a clinical pathology department in a medical center. The data were collected for the June, 2002. Results can be summarized as followed:
1. Three activity centers, administration, preparation, and execution activity centers and 7 sub-activity centers are defined. 47 activities and 27 cost objects are defined in administration, preparation, point-of-care, outpatients and emergency, and biochemistry sub-activity centers.
2. The results show that 44.2% of costs are reagents, 34.3% of costs are labor expense, 13.8% of costs are equipment related, and 7.6% of costs are overhead allocated.
3. The largest activity center is the execution activity center (84%), followed by the administration activity center (5.8%) and preparation activity center (4.7%).
4. The largest execution sub-activity center is the outpatient and emergency sub-activity center (27.3%), followed by the biochemistry sub-activity center (21%) and point-of-care sub-activity center (3.1%).
5. These three sub-activity centers’ actual quantities are over the break-even point quantity.
6. Equipments utilization is low.
7. The quality strategy could be evaluated through the ABC/M system.
8. The potential benefits of process improvement can be quantified through the ABC/M system.
The conclusions of this study are the following:
1. ABC/M can be implemented in clinical pathology departments.
2. ABC/M can provide more precise cost information for clinical pathology services.
3. An ABC/M system can improve a clinical pathology department’s resource management, as well as cost control.
4. For other aspects in clinical pathology departments, such as quality management, process reengineering, capacity management and performance evaluation, ABC/M could provide valuable information for managers for their decision-making reference.
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