近年來，由於護理之家的迅速發展，加上醫療產業紛紛強調「責任中心制」，為提昇競爭力，護理之家的經營管理及成本控制也逐漸受到重視。 本研究主要依據作業基礎成本制度（Activity-Based Costing；ABC）的理念，以某醫院附設護理之家為例，建立護理之家之成本制度，其目的為「依據作業基礎成本制度的精神，建立一套護理之家的成本制度，並藉由合理的成本分攤，瞭解護理之家各級住民實際耗用之成本，做為未來收費定價之參考；未來希望透過此制度提供財務性及非財務性之資訊，做為護理之家經營管理上之參考。」 本研究的結果發現，經由作業基礎成本制所求得之各等級住民成本，明顯的隨著住民的等級不同而有所差異。作業基礎成本制度在管理上的應用主要包含成本、作業及績效三個方面。在成本面部分主要包含「各作業中心成本的監控」、「成本預算之參考」；在作業面主要包含「目標管理與作業流程改善之參考」、「找出附加價值之作業」；在績效面主要為「績效評估及異常管理」。 在建議部分，本研究建議實施作業基礎成本制度前須建立完整的資料登錄以蒐集完整的作業訊息；與相關人員的溝通與配合以深入瞭解各項作業；會計財務報表之修訂使成本費用能確實歸屬至各作業；成本效益之衡量以決定實施的範圍及深度。在未來發展上，為能更確實的了解各項作業成本，照護人員各項作業成本可根據住民等級及不同班別之差異再加以區分。; As the result of increasing aging people in the past two decades in Taiwan, the nursing homes have burgeoned dramatically. On the other hand, management skills are widespread utilized by hospitals gradually. Hospital-based nursing home are considered as one of the “Center of Cost Responsibility “ in hospital. Therefore, the efficiency of operation of hospital-based nursing home is much emphasized. This is a case study of hospital-based nursing homes. The objective of this study is to establish an Activity-Based Costing (ABC) cost accounting system for a nursing home. Through establishing the new cost accounting system, we can realize the cost drivers, which show why and how costs happen. The cost drivers provide not only financial but also non-financial information which can assist managers to improve the efficiency of operation as well as to evaluate performance. The results revealed that costs consumed by patients differ from each other based on their health status. This new cost accounting system has several implications for hospital-based nursing home. In terms of cost, this system enables the manager to monitor the costs of activity centers , to obtain the information of the budget cost and to set price for service. In terms of activities, this system assists the manager to set up the goal of management by objectives and it also provides the reference to improve the process of activities. In addition, managers can find the added-value activities by applying this system. In terms of performance, this system helps the manager to evaluate the performance of activities and to manage the extraordinary phenomenon. Because the implementation of ABC cost accounting system for hospital-based nursing home needs both significant monetary and human resources, future study should perform a cost-effectiveness analysis to determine the scope and depth of this system.
