我國醫療機構投資體外震波碎石機之研究

Abstract

本研究主要針對台灣地區醫院在目前健保對體外震波碎石術 (ESWL)定額給付制度下，對投資體外震波碎石機依不同的營運方式如委外合作經營(類似商業租賃)及買斷自營，進行成本與績效的分析及投資的評估。以二家北部及一家中部區域公立醫院為例做深度的分析研究，委外合作經營是指不須自行購買機器設備及編列維修費用，醫院只要提供場地及醫師。買斷自營是指醫院向廠商購買機器設備及訂立維修合約，醫護和技術人員則由醫院負責。其中A醫院是採買斷自營，B及C醫院採委外合作， 三家區域公立醫院規模相當。收入的部份；買斷自營者全部歸為醫院所有，而委外合作經營則是醫院與廠商按比例分配。 本研究為一回溯性研究，採立意取樣的方式，首先至醫院收集相關財務資料及醫療記錄，以獲得疾病治療的直接成本資料及績效資料，資料的分析包括描述性及分析性統計。 一、結石治療成本:體外震波碎石術治療的成本主要來自於材料設備成 本以及人事成本。 二、績效評估: 分析三家醫院的績效並作比較。 三、投資評估: 本研究從需求面及供給面以及敏感性分析進行評估，並依研究結果，分別對未來研究者、醫療機構管理者、及衛生主管機關提出在投資體外震波碎石機時的建議，供有關單位參考。 玆將重要結果摘要如下： 一、 從結石治療的成本來看，買斷自營的成本當然大於委外合作經營。 二、 委外合作經營醫院一開始不需要投入太多的資金就能擁有機器來治療病人，廠商也會積極投入，所以就績效而言在北部地區B醫院的績效就會比A醫院好很多。 三、以敏感性分析，目前仍建議可以考慮投資體外震波碎石機。

The purpose of this research is to evaluate the investment alternatives of the Extracorporeal shock wave lithotripsy (ESWL) machine in Taiwan by analyzing the costs and performances under different ways of management, including outsourcing cooperation and self-management. The definition of outsourcing cooperation is that the hospital just provides medical staff and place for operation without actually buying the machine for ESWL. On the other hand, self-management means that the hospital has to buy a machine for ESWL by itself and enact a contract of maintenance with the importing firm. Under the current system of health insurance for all the people in Taiwan, the payment for ESWL treatment is fixed. The payment belongs to the hospital using self-management. But the hospital using outsourcing cooperation has to share the payment with the importing firm at a percentage (about 30-40%) which is negotiated at the beginning of the contract. In this study, we use the related financial data and medical records collected from the Bureau of General Health, as well as three public hospitals for a retrospective-research type evaluation. The hospitals include two in the northern area and one in the central area of Taiwan. The scale of the three hospitals is similar. In particular, the followings are analyzed: 1. Costs of ESWL: the cost of equipment, consumed materials and medical staff. 2. Performance evaluation: the performances of the three hospitals are distinctly evaluated. 3. Investment evaluation: the investment alternatives from the viewpoints of supply and need are evaluated. Some sensitive analysis is conducted. We hope the results of this research can provide some guidance for medical managers and the managers of general health insurance concerning the investment decision of ESWL machine. In conclusion, the important results are as follows: 1. The cost of self-management is higher than that of outsourcing cooperation. 2. The performance of B hospital is better than that of A hospital. 3. By sensitivity analysis, the investment of EWSL machine is still recommended at present.