| Summary: | 碩士 === 國立臺灣大學 === 商學組 === 104 === The major obstacle of National Health Insurance （NHI） is the aggregate insurance premium is not able to meet the rapid growth of medical demands in Taiwan. Without increasing the rate of NHI premium, NHI Bureau can only reduce the costs and expenses （i.e. control the growth rate of medical expenditure）, and hence it is very challenge for NHI Bureau to breakeven.
Taiwan''s NHI is a single payer system. No matter whether the scales of medical institutes and hospitals are large or small, the pricing strategies of all medical services should aim to be self-sufficient in order to make medical institutes and hospitals sustainable.
One of the possible solutions is for NHI Bureau to provide certain flexibilities for medical institutes and hospitals to offer medical services to be paid out of pockets of patients. At the moment, most expenses of the medical services are primarily covered by NHI and only minor percentage is paid by patients. Patients will be benefited from having choice（s） to pay extra for certain health services on-demand, which may not be covered by NHI.
To date, there are still a lot of constraints regulated by NHI Bureau for the health services under self-expenditure of patients. It would be optimal for NHI Bureau, medical institutes and hospitals, and patients to have reasonable cost - pricing formulas. Among all, the direct cost of medical personnel of health services is the most important element, which is substantially under-estimated by the current cost - pricing formula utilized by NHI Bureau. Only when the cost of medical personnel is fairly reflected in the pricing formula, the correlation between the payment and the actual costs and expenses involved will make sense.
The current cost – pricing formulas neither reflect the costs involved of the respective health services nor take into account the risk provisions.
The purposes of the thesis are:
To provide information for the NHI Bureau, medical institutes and hospitals to better price health services
To break-down the cost of health personnel for various items of health services in order to better price the self-expenditure services on-demand
To re-gain medical personnel by properly pricing health services and to move the healthcare industry into the right track
To educate patients with proper attitude and concepts for taking medical treatments
To provide the calculation basis for government to subsidize those people with low income and those remote villages without sufficient medical resources
The thesis utilizes Activity Based Costing （ABC） to analyze the costs involved for Painless Colonoscopy in order to break down each item of medical services, especially the direct cost of medical personnel. Thereafter, the thesis modified the cost – pricing formula of Painless Colonoscopy and applied into the Spinal Anesthesia for Cesarean Section and Incubated General Anesthesia.
The thesis concluded that Activity Based Costing analysis is helpful for properly pricing medical procedures and medical services. The result is a useful reference for NHI system to better allocate resources and for medical institutes and hospitals to operate with long term plans.
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