癌症醫院財務分析—以主要病症為例

Abstract

自1982年起，癌症已蟬聯十大死因之首27年，隨著人口結構老化、現代人飲食及生活環境改變，癌症篩檢、預防、診斷、治療機會增加，癌症照護市場急遽擴大。又癌症和傳統醫療有別，重視科部間整合的醫療服務，以器官為分科標準，加上癌症人口劇增，所以癌症專科醫院已在國際間蔚為風潮。永齡基金會於2007年9月與台灣大學簽訂「捐贈暨合作規畫備忘錄」，捐贈具500床規模的台大癌症醫院，與先進的質子治療機，並與台大合作生醫工程相關研究。 台大癌症醫院硬體設備與早期營運經費靠捐贈而來，而本研究目的在模擬未來五到十年後，台大癌症醫院財務狀況，可否藉由國人主要癌症別病患得到足夠資金，以發展長久的營運。 本研究分成兩部分，產品邊際計算與未來情境模擬。以台大醫院2004年到2007年的癌症病人登記資料為母體，分年取三種癌症病人就診醫令為收入，對應執行部門直接成本支出，相減得每項醫令獲利。取同一癌症、期別、年度所有病人的產品邊際平均值，回溯五年資料，可得該癌症該期別五年的產品邊際期望值。再以上述計算的五年產品邊際期望值來推算未來的財務狀況模擬。分成兩種情境：(1)和台大醫院現有病人結構相同(2)醫療技術進步，早期發現的人口增加。計算台大癌症醫院2012年到2020年此三種重大癌症對醫院的現金流量貢獻。 結果觀察到，癌症病人第一年對醫院的平均邊際貢獻度最高，第二年會有顯著下降，第三到五年呈現低而穩定的狀態；在未來的財務預測方面，2012年到2020年和現行台大醫院規模相同下，產品貢獻加總不同癌症的貢獻度不同．當醫療技術進步，早期人口增加，對不同癌症有不同程度的影響．

Cancer has been the top one of the ten most important diseases of Taiwanese for 27 years. Due to aging of population, change of the diet and environment, and chances of cancer being screening, preventing, diagnosing, and curing, the market of cancer healthcare system is increasing dramatically. Not only cancer treatment demands the integrated healthcare, which is different from traditional healthcare- divided the hospital department by organs instead of medical or surgical, increasing number of cancer patients cause the trend of founding cancer hospital. The foundation of Yonglin donates NT$15 billion to NTU to build a 500 bed NTU cancer hospital with proton beam radiation therapy and develop the most advanced cancer research. In the early years the hardware and operation fund of NTU Cancer Hospital mainly comes from donation. The study purpose is to simulate the financial status of NTU Cancer Hospital five to ten years from inception by distinguishing the types of cancer. By knowing the types of cancer will allow the hospital to design a long-run financial strategy. The study is divided into two parts. One was calculating of specific cancers product contribution margin, and another one was future financial scenarios’simulation. The first part was based on the patient data of National Taiwan University Hospital from 2004 to 2007. Took different cancer patients’data as the revenue base, and corresponded to the costs of caring department including medical and surgical to get the profit of different treatment of different cancers and cancer stages. Accumulated the total treatments of the patients for the year we can derive the profit margin of the specific cancer stage. Because of lack of track of the patient data after one year, the study collected data retrospectively to get the five year average contribution margin of different cancer and different stage. The second part was calculation the cash flow of NTU Cancer Hospital for 2012-2020 by two different scenarios. The two scenarios are (1) NTU Cancer Hospital patient stage percentage was the same as NTU Hospital historical patient data (2)the early stage patient percentage went up due to the progress of the medical treatment technique. The major findings of this paper are: (1) the first year average contribution margin are the highest regardless of cancer type. The second year patients’contribution margins go down dramatically; and third to fifth year contribution margin is low and stable. The future financial status of NTU Cancer Hospital from 2012 to 2020, different cancers have different contribution margins over the years. As the progress of the medical treatment techniques and as the percentage of early stage patients goes up, all have different impact to the cancer hospital financial situation.