作業基礎成本制在診所的應用――以一皮膚科診所為例

Abstract

健保自民國84年開辦以來，基層醫療診所的競爭加劇，而健保給付卻不斷萎縮，診所的經營面臨空前的挑戰。診所為強化其競爭力，除積極地開發一些自費醫療項目等開源手段以外，節流的方法如診所醫療服務產品的成本分析與控制也相對重要。 作業基礎成本制（ABC）是近年來管理會計的一項重要工具，藉由ABC的導入可以建立產品與成本之間的攸關性。國內已有多位研究者對大型醫院進行ABC制度規劃與實施的相關研究，但對於將ABC應用於診所的部份則相對較為缺乏，本研究即藉由對ABC相關文獻的回顧之後，為一皮膚科診所建構ABC制度，並希望達成下列的研究目的： 一、 以實例為一診所架構ABC制度，計算其個別醫療服務產品成本，並將ABC制度之精神介紹給診所管理者。 二、 利用ABC所獲得之成本資訊，作為成本管理與分析的基礎。 三、 利用研究之成果，對擬採用ABC之診所提出建言。 本研究主要係採取個案研究法的方式進行研究，獲得下列結論： 一、 ABC可適用於皮膚科診所，且能提供皮膚科診所合理正確的成本資訊。 二、 ABC有助於皮膚科診所資源的管理，並能協助皮膚科診所達到控制成本的目的。 三、 ABC可提供皮膚科診所決策參考的資訊，且有助於皮膚科診所績效測量與改善。

Since the implementation of National Health Insurance in 1995, the elementary medical clinics face a fierce challenge due to more competition and less medical payment than before. In order to become more competitive, the clinics should introduce some self-payment medical services to increase their incomes, as well as understand the cost structure and cost control of their medical services to decrease the costs. Activity-based costing（ABC）is an important cost management tool that has become popular in recent years. A clearer relationship between services and costs can be established through the implementation of an ABC system. In Taiwan, there have been many studies investigating the implementation of ABC in large hospitals, but there are no similiar researches for elementary clinics. This study applied ABC system to a dermatological clinic in order to achieve the following purposes: （1） To design an ABC model to calculate the costs of various medical service lines in a clinic and introduce knowledge of ABC to the managers of the elementary clinics. （2） To use the information obtained from the ABC system as a basis for cost management and control. （3） To use the research results to provide guidances for the clinics that will implement an ABC system. This study employed case study method and reached the following conclusion: （1） The ABC system can be implemented in the dermatological clinics and can provide more precise cost information for them. （2） The ABC system can improve resource management and cost control for the dermatological clinics. （3） The ABC system can also provide decision relevant information for managers and is helpful for dermatological clinics’ performance evaluation and improvement.