楊銘欽臺灣大學：醫療機構管理研究所林威仲Lin, Wei-ChungWei-ChungLin2007-11-282018-06-292007-11-282018-06-292004http://ntur.lib.ntu.edu.tw//handle/246246/60130自從全民健康保險開辦以來因醫療費用持續攀升，故健保局以一連串的政策措施來抑制醫療費用成長，醫療院所在開源不易的情形下，更加地重視成本的管控。在醫院的成本結構當中，以人事成本比重最高，其次為資材成本，醫院若欲從此處獲得節流效果，可從幾個方面來思考：採購、倉儲、配送、存貨等，因此漸有藥品醫材物流委外事業的出現。 本研究之目的以醫院及第三方專業物流商之觀點，評估雙方在物流委外合作案中各自的成本效益，並且期望建立一套醫院物流委外之成本效益分析模式，作為未來評估工具。本研究以國內某公立醫學中心採用第三方專業物流之模式為研究個案，在流程要素及成本要素之雙構面交叉分析的架構下，進行合作雙方之成本效益分析研究。重要研究結果如下： 一、 物流商觀點 全年共需支出4,205,576元來執行此委外業務，效益面則由於無償承攬而無法自醫院收取物流委外費用，原本期望自供應商獲得之合理報償也因認知上的差距而無法獲得，故對物流商而言，並無有形之效益，等於是在虧損的狀態下認賠承攬，在成本大於效益的情形下，不值得投入，但無形效益（如承攬業績、商譽等）則有待探討。 二、 個案醫院觀點 因物流商無償承攬而無需支付委託費用下，全年共獲得3,796,634元的效益，乍看之下節流效果似乎甚為顯著，但若相較於該院藥品醫材全年約40億元的支出，雖說效益大於成本，值得推動，但實際上帶來的效益可說是微乎其微，故建議該院設法提升效益以發揮委外優勢。 以整體觀點來看兩方面的研究結果，由於雙方無法互蒙其利，僅醫院一方得利且效益極其有限，物流商則概括承受運作成本而徒增損失，故此物流委外模式推行至此不甚成功，最主要的因素是由於供應商有權益受損之虞而配合意願不高，使得推動過程中諸多不順，要使此模式有繼續推行的價值，需將眾供應商的立場納入考量，以合理的方案求得共識，排除其抵制的可能性；再者應當擴大委外品項規模，以收規模經濟之效；然物流商的效益應當大於成本，亦即改變其對醫院或供應商的無償關係，使其擁有至少足以損益平衡的收入來源。如此一來，以完整的配套維護三方共同的利益，醫院物流委外模式方可在互利共生的合作關係上，樹立典範，永續經營。Background Because of the continued growth of medical expenditure after the initiation of the National Health Insurance program, the Bureau of National Health Insurance has been making a series of policies to depress the growth of medical expenditure. In view of limited revenue sources, hospitals emphasize more on cost control. In the cost structure of a hospital, personnel cost is in the first place and the next is material cost. A hospital can lower its material cost from several ways like purchasing, warehousing, deliverying, stock management etc. This ushers the business of hospital logistics outsourcing for drugs and medical materials. Objectives The purposes of this research were to evaluate the cost and benefit of the case of logistics outsourcing for drugs and medical materials from the viewpoints of both a medical center and a third party logistics (3PL) company. Also, we hope to build up a new model of cost benefit analysis for hospital logistics outsourcing as the evaluating instrument in the future. Methods We used cost-benefit analysis to evaluate the adoption of the third party logistics in a public medical center. Results From the viewpoint of the logistics company, the operation of the logistics outsourcing business cost NT$4,205,576 in the year 2002, and the revenue taken from the hospital was zero because of undertaking the logistics outsourcing business free of charge. The logistics company did not achieve the expected effect from drug and medical material suppliers, either. Thus the logistics company did not have any physical benefit at all, which means it practiced the contract in the state of loss. Under the circumstances of cost larger than benefit, it was not worthwhile to devote to the business, but the intangible benefits need to be studied further. From the viewpoint of the medical center, it obtained a benefit of NT$3,796,634 in 2002 because of free charge. It seems that the effect of reducing expenditure was significant, but it became seems trivial compared with four billion expenditure on drugs and medical materials. In this regard, we advise that the medical center try to increase the benefit in order to enhance advantages of outsourcing. Conclusion Looking at the results from a holistic point of view, the case is not mutually beneficial for both sides. Only the medical center got tiny benefits, and the logistics company took the whole operating costs and bore the loss. Therefore, the practice of the logistics outsourcing model is not completely successful. The most important reason is that the suppliers worried about the loss of their rights and interests and had low intention to join the case. If the logistics company and the medical center want to make the model reach worthy to be continuously practiced, they have to think about the suppliers to a consensus with reasonable schemes to exclude the possibility of the boycott. They should expand the scale of outsourced items to get the benefits of economics of scale. However, the benefits of the logistics company should be greater than the costs; in other words, it should change the cost-free relationships either with the medical center or the suppliers to acquire the revenue source for break-even. Thus, by maintaining common benefits for three sides with integrated programs, the hospital logistics outsourcing model would be established as the paradigm and operate permanently on the foundation of mutually beneficial partnership.中文摘要 IV Abstract VI 第一章 緒論 1 第一節 研究背景 1 第二節 研究動機 3 第三節 研究目的 4 第四節 預期貢獻 4 第二章 文獻探討 5 第一節 物流基本概念 5 第二節 醫院物流委外 16 第三節 國內醫院物流委外實施現況與相關研究 25 第四節 經濟評估 29 第五節 綜合討論 33 第三章 研究方法與材料 34 第一節 研究方法 34 第二節 研究流程與架構 36 第三節 研究對象 38 第四節 資料收集與分析 47 第四章 個案分析與結果 55 第一節 物流商觀點之成本效益分析 55 第二節 醫院觀點之成本效益分析 64 第五章 討論 82 第一節 物流商成本效益分析重要結果討論 82 第二節 個案醫院成本效益分析重要結果討論 86 第三節 綜合討論 90 第四節 相關研究比較 94 第五節 研究限制 97 第六章 結論與建議 99 第一節 結論 99 第二節 建議 100 參考文獻 104 附錄 108 附錄一 委外醫材佔全院醫材庫備品比例試算庫房建築成本 108 表目錄 表2-1、各學者提出的物流機能整理 15 表2-2、各學者提出的物流委外動機與理由 23 表2-3、雙構面成本交叉分配表 32 表3-1、不同研究方法適用條件 35 表3-2、雙構面成本交叉分配表 50 表4-1、物流商設備折舊費用統計表 57 表4-2、物流商全年成本投入交叉分配表 62 表4-3、醫材倉庫委外品項直接耗用資源統計表 68 表4-4、個案醫院物流委外前之30天存貨價值 70 表4-5、醫材物流作業流程與委外前後全年成本差異交叉分配表 81 表5-1、醫院物流委外相關研究列表 96 圖目錄 圖2-1、物流範疇示意圖(一) 11 圖2-2、物流範疇示意圖(二) 11 圖2-3、物流主要迴路 13 圖3-1、個案研究設計類型 35 圖3-3、概念性研究架構 37 圖3-2、研究流程 37 圖3-4、寄倉型物流作業模式示意圖 42 圖3-5、通過型物流作業模式示意圖 43 圖3-6、物流商運作流程 45 圖3-7、醫院運作流程 46280953 bytesapplication/pdfen-US醫院物流委外第三方物流經濟評估成本效益分析third party logistics (3PL)cost-benefit analysishospital logistics outsourcingeconomic evaluationthesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/60130/1/ntu-93-R90843017-1.pdf