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博碩士論文 etd-0209107-170600 詳細資訊
Title page for etd-0209107-170600
論文名稱
Title
民間參與公立醫院正子造影中心財務可行性評估之研究 ---以高雄榮總正子造影中心為例
A Feasibility Study on the Private Participation in the P.E.T. Center of Public Hospital – The P.E.T. Center of Kaohsiung Veterans General Hospital as Example
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
115
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2007-01-30
繳交日期
Date of Submission
2007-02-09
關鍵字
Keywords
財務評估模式、正子造影、民間參與
positron emission tomography, Private participation, financial assessment model
統計
Statistics
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中文摘要
由於資訊科技進步、社會福利漸增,造成政府財政支出增加、財政困難,然而,國家重大公共建設為全民福利之所必需,豈能因政府財政問題而怯步,故政府於民國八十九年公布民間參與公共建設法,積極推動民間機構參與公共建設,期引進民間之資源、技術、效率以減輕政府沉重之財政負擔,並提供社會所需之公共建設,創造蓬勃的民間商業生機。

高科技健康檢查係醫療產業的延伸,是臨床醫學的前哨站,也是推動預防醫學的一種重要工具。它雖利用了大量的醫學理論與技術,但未涉及治療行為和用藥處方。然它與人類健康息息相關,因此,仍被定位在醫療範圍,必須受政府衛生主管機關的監管。目前健康檢查有兩種經營模式,一種是附屬於醫院之內,為醫院的部門之一;另一種是不屬於任何醫院,採獨立經營形式。本案屬於前者。

民間參與高雄榮總正子造影中心興建暨營運案係依據促參法第八條第一項第四款ROT之規定辦理,整建暨營運(10年)期間共為11年,行政院國軍退除役官兵輔導委員會辦理民間參與政府規劃之公共建設前,應由執行機關高雄榮總辦理可行性評估及先期規劃或聘請相關專業機構辦理,先期計畫書經核定後,高雄榮總即須依促參法第四十二條至四十五條及促參法施行細則第四十條至四十三條之規定,辦理後續之前置及招商作業。

依據市場分析發現,高高屏地區已有五家醫院設置正子斷層造影設備,將正子斷層造影應用於腫瘤、腦神經、心臟等方面之檢驗,目前市場供給量增加,潛在市場需求量尚待開發,且在健保總額給付點值的各項因素影響下,採ROT方式辦理設置正子斷層造影中心,對廠商投資意願勢必造成影響,另外,產業和市場環境的條件,如正子藥物FDG供應來源、市場開發程度、醫院團隊的醫療水準,均是本計畫成功與否的重要關鍵課題。

由財務評估發現,民間機構以ROT模式參與高雄榮總正子造影中心之營運,高雄榮總除獲取為數可觀之權利金收益外,提供民眾所需之健檢服務,經營效率和品質的提升對高榮聲譽正面加分,特許廠商亦能賺取其要求之合理報酬,高雄榮總權利金收益、特許廠商計畫淨現值和債權銀行融資保障都得到顯著的成長。因此,民間參與高雄榮總正子造影中心興建暨營運案的合約規定對於甲乙雙方誠屬合理的契約。







由敏感度分析發現,影響高雄榮總正子造影中心營運的重要因素依次為:營運收入、營運成本、營運費用、投資金額,融資利率之影響性則較小。而自費健檢收入對計畫的影響程度又較檢查人數高,健保收入對計畫的影響程度受到健保總額支付制度的規範,我們發現正子造影中心對健保支付點數的敏感度更甚於浮動點值,而且廠商必須花費更多的資源以開發自費市場。

高雄榮總正子造影中心ROT計畫為成功的個案,其成功的要點包括:第一,公立醫院以ROT模式引進民間廠商參與醫療服務之經營,確實可以突破公立機構之法規限制,各展所長,有效提升經營彈性及整體績效。第二,甲方在規劃階段及營運階段皆派任專職人員持續參與協調與管理,有助於ROT案的順利推行。第三,規劃較低的開發權利金門檻與較高的工程監督標準,有助於合約品質管理並創造三贏局面。最後,以營運參考資料做計畫之財務評估,有助於預先掌握經營風險及合約管理與補充。
Abstract
Because the information advance in technology, the social welfare gradually increase, creates the government expenditure to increase, the finance is difficult. In 2000, the government had announced private participation public construction law, positively impelling the private organization participation public construction, and used the resources, the technology, the efficiency to lighten the government serious financial burden, and created the vigorous folk commercial vitality.

The high tech health center is medical industry extending, and is one kind of important tool to impel the preventive medicine. Although it has used the massive medicine theory and the technology, it has not involved the treatment behavior and the medicine prescription. However, it still located in the medical scope, must controlled by the government health organization. At present, the health center has two kinds of managements, one is attached in the hospital, and the other picks the independent form. This case belongs to former.

The rehabilitation, operation and transfer on the positron emission tomography center of Kaohsiung Veterans General Hospital bases on the law of private participation public construction. The rehabilitation and operation periods amounts to 11 years. Kaohsiung Veterans General Hospital should suggest that specialized organization or by itself to handle the feasibility and earlier scheme before R.O.T. proposals. If the earlier scheme checks to pass, Veterans General Hospital has to proceed following system of preposition and commercial attraction.

Bases on the market analysis, we find that five hospitals have been established positron emission tomography equipment in the area of Kaohsiung and Pingtung. At present, the market supplies increase much, and potential market demands develop slowly. Under these factors disturbance about global budget payment system or hospital excellent project, it inevitably will have the influence on the investment will of industry. Moreover, the condition of industrial and marketable environment, like the supply source of positron medicine FDG, the degree of market development, the medical standard of teams, will be the essential topics.


From financial assessment, we find that the private organization participates in the business of the positron emission tomography center of Kaohsiung Veterans General Hospital by the R.O.T. form, Kaohsiung Veterans General Hospital could gain considerable premium, the management efficiency, the higher reputation, and provide the precise health examines. The franchised corporation also could gain required return. The bank financing gets safety. Therefore, the contract about the private participation in the positron emission tomography center of Kaohsiung Veterans General Hospital resembles reasonable.

By the sensitivity analysis, we find that the key factors in turn as follows: Revenue, operating cost, operating expenses, initial investment, and financing interest rate. Revenue at their own expense affects this case much higher than customers. Health insurance revenue is regulated by the global budget payment system, we find that pay point is more sensitive than pay value per point, and the franchised corporation must spend more resources to develop the market about non-insurance revenue.

The R.O.T. on the positron emission tomography center of Kaohsiung Veterans General Hospital belongs to successful case, its main points including: First, we can use R.O.T. business model to break these constraint of laws and regulations, effectively promote the management elasticity and the overall achievements. Second, the party of the public in the plan and operating stage assigns professionals and continues to participate in the coordination and the management, which is helpful to the project implemented. Third, with the lower premium threshold and the higher surveillance standard, this is helpful to the quality control. Finally, by financial assessment, we can control risk management in advance.
目次 Table of Contents
第壹章 緒論
第一節 研究背景與動機……………………………………………………..1-1
第二節 研究目的與貢獻……………………………………………………..1-4
第三節 研究方法……………………………………………………………..1-5
第四節 研究架構……………………………………………………………..1-6

第貳章 文獻回顧與高雄榮總正子中心ROT之規劃
第一節 民間機構參與公共建設之法律規範………………………………..2-1
第二節 醫療服務公辦民營模式……………………………………………..2-5
第三節 醫療服務公辦民營之財務評估…………………………………….2-10
第四節 健保總額支付制度對醫療服務營收風險之探討………………….2-12
第五節 高雄榮總正子斷層造影中心ROT的規劃構想……………………2-18

第參章 正子斷層造影產業及市場分析
第一節 正子斷層造影簡介…………………………………………………..3-1
第二節 全球正子斷層造影技術的發展……………………………………..3-3
第三節 健檢產業概況與高屏地區正子造影產業競爭分析………………..3-4
第四節 高屏地區正子斷層造影之市場分析……………………………….3-11

第肆章 民間參與公立醫院健檢業務之財務評估模式
第一節 成本項目分析………………………………………………………..4-1
第二節 收益項目分析………………………………………………………..4-4
第三節 財務評估模式的建立………………………………………………..4-6

第伍章 民間參與公立醫院健檢業務之財務評估分析
─以高雄榮總正子造影中心ROT案為例
第一節 財務評估基本參數之假設…………………………………………..5-1
第二節 ROT方案之財務評估...…………………………………………….5-10
第三節 敏感度分析………………………………………………………….5-22
第四節 小結………………………………………………………………….5-34

第陸章 結論與建議
第一節 民間參與公立醫院醫療服務之財務可行性………………………..6-1
第二節 未來營運與合約管理之建議………………………………………..6-3
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