民國八十四年三月一日台灣開始實施健保，這個制度可能算是台灣醫療史上一個重要的分水嶺，健保的開辦使得人民的就醫更方便，惟近年來健保費用調漲不易，迫使健保局必須變更支付制度，致使醫療院所財務吃緊。醫療院所為求生存，除積極發展自費巿場進行開源，更重要的是醫院管理階層要如何進行成本之管控。過去學者認為作業基礎成本制適用於醫療產業，惟因作業基礎成本制所需之成本過高，且無法即時的進行更新，致使醫療產業界使用較其他產業界來得低。 Kaplan and Anderson 於2007提出時間導向作業基礎成本制度大幅降低作業基成本制度之運算，且亦能夠隨時進行調整，對於在現今醫療產業的成本控制注入了一股新的契機。本研究以某醫學中心之睡眠檢查中心為研究對象，個案醫院對於睡眠檢查之相關成本並不了解，本研究應用個案研究法探討時間動因之作業基礎成本制是否適用於醫療院所。 本研究發現醫療產業中每項處置或作業所需支援部門多，若使用TDABC可減少計算步驟，因此能夠即時的更新成本資訊，另外，亦可減少傳統ABC上動因分類因主觀所造成成本資訊錯誤。依據TDABC計算個案醫院自費睡眠檢查之成本高於健保局支付標準，若個案醫院以現行健保支付點數進行檢查時，恐造成虧損之情況。 Health insurance was started at March 1 1995 in Taiwan. This system is probably regarded as an important watershed in Taiwan medical t history. This system makes people of cure more convenient. In recent year the medical expense increases strongly. Because it is not easy to increase the health insurance expenses, national health insurance change payment system. This change would make the medical institution finance become critical. In this situation it is important understand how to control of cost. The scholar thinks the Activity Based Cost (ABC) theory was accepted for medical industry, however implement this system is not easy and not cheap. This is why the medical industry used this theory lower than other industry. Kaplan and Anderson in 2007 publish Time Driven Activity Based Cost (TDABC). This theory not only significantly reduce calculation step of ABC, but also could adjust at any time. This research takes the center of the sleep check of certain medical center as a research object, because this hospital would like to understand the related cost of the sleep check. This research purpose would like to understand whether TDABC is applicable to a medical institution or not. Because each treatment in the medical industry need a lot of department support, if using TDABC could reduce calculation step. Using TDABC could not only immediately update the cost information. The research finds sleep checks cost is higher than national health insurance standard payment. If individual case hospital using national health insurance standard payment to make price policy, it could be get loss.
