醫療機構以懷著「病人優先」及「救人第一」的醫者情懷和熱誠作為理想，不以營利為首要目的。但不重視成本管理，無法以有限的資源，達到有效的運用。且全民健保自民國八十四年開始實施至今，中央健保局為平衡龐大的醫療支出壓力，近年來，陸續實施「論病例計酬」與「總額預算」等給付制度，來取代傳統之「論量計酬制」。因此，醫療機構在收入成長大幅受到限制下，必須加強對成本的控制與管理，成本管理已成為目前醫院管理者最重要的課題之一。 目前國內各醫院已普遍採用傳統成本會計制度，由於缺乏因果關係之分攤基礎，無法合理的、正確的呈現各項醫療服務成本，易導致管理者作出不當的決策。而作業基礎成本制度，係以因果關係為基礎，故能較合理、較正確的計算各項醫療服務成本，其分析可協助醫院釐清作業、資源及最終各項醫療服務的關係，此系統所產生的資訊更可以支援管理者決策所需。 本文藉由作業基礎成本制度之原理，以某地區性精神專科醫院為例，以個案研究方式進行實地探討，建立精神專科醫院之作業基礎成本模式。透過成本的計算與分析，對個案醫院管理所需資訊提供建議，以協助達成營運之目標。 本研究的結果發現，經由作業基礎成本制所求得之各項醫療服務成本，明顯的隨著資源耗用程度不同而有所差異，而以傳統成本分攤求得之成本則未因耗用資源量不同而有明顯的差異。耗用資源程度高之各項醫療照護成本，以作業基礎成本制分攤之成本，如初診病患成本、急診病患成本、Ｔ病房病患成本及Ｒ病房病患成本等，明顯高於以傳統分攤法分攤之成本；耗用資源較低者，如複診病患成本、Ａ病房病患成本及遊民收容成本等，則以傳統成本法分攤之成本較高。 本研究對後續研究者之建議：結合臨床路徑及作業基礎成本制度之相關國內討論文獻，國內相關研究甚少，遑論有關精神科文獻，更是付之闕如。本研究個案醫院因未實施臨床路徑，故無法從臨床路徑切入作業基礎成本制度，深感可惜。故對後續研究者應可結合臨床路徑，以為架構探討，應可改善作業基礎成本制度最令人詬病的兩項主要缺點－作業活動劃分不易及成本動因不易確認。 The traditional cost accounting system had been widely used by domestic hospitals nowadays. Due to lake of cause-effect relationships, it does not reasonably and correctly reflect the actual cost of medical services. So, it may lead to incorrect decision-making. Activity-based costing is on the basis of cause-effect relationships. All costs could be more reasonably and correctly calculated from the actual cost of medical services, the relationships among products, activities, and resources. Therefore, information followed by this system becomes the essential references to support the supervisors in making correct decisions. This study intends to establish an activity-based costing system for a psychiatric local community hospital. Investigation was first conducted to analyze business processes and products in the hospital. The costs of activities and procedures were thus calculated. Management information was further explored in order to assist operating objectives. The results revealed the costs of medical services based on activity-based costing differ from the resources consumed by patients. The more resources consumed by patients based on activity-based costing, the more the costs of medical services, such as “First-Time Appointment” patients, “Emergency Appointment” patients, T-Ward inpatients and R-Ward inpatients. The lower resources consumed by patients based on activity- based costing, the lower the costs of medical services, such as “Return-Appointment” patient and A-Ward inpatient.
