기준병상수와 상급병상수의 적정규모에 관한 연구 : 한 종합병원을 중심으로

Abstract

[한글]

이 연구는 서울시내 위치한 1,100병상의 종합병원을 대상으로 고객의 요구도를 반영한 병상등급별 최대이익을 창출하는 병상의 최적규모를 알아보고자 하였다.연구방법으로는 고객의 병상 요구도와 의사 및 간호사의 병상등급별 서비스량을 설문조사한 후 모의실험 방법을 이용하여 분석하였으며 다음과 같은 결과를 얻었다.

첫째,병실등급별 요구도를 조사한 결과 입원을 희망하는 환자의 93.8%가 의료보험이 적용되는 기준병상을 선호하였고 1인실은 4.3%,2인실은 1.7%,3인실은 0.1%였다.

둘째,병실등급별 인건비 배부기준을 설정하기 위하여 병동의 의사 및 간호사를 대상으로 병실등급별 서비스량을 설문조사한 결과,기준병상인 5-6인실을 기준으로 할때 1인실의 내과계는 1.7배,외과계는 1.9배,2인실의 내과계는 1.4배,외과계는 1.7배,3인실의 내.외관계는 모두 1.2배의 차이가 있었다.

셋째,병상당 이익과 환자1인당 이익은 1인실이 가장 높았으나,병실등급별 단위면적을 기준으로 분석한 결과,2인실의 내.외과계 병실이 기타병실등급보다 높았다.

넷째,병실등급별 원가자료를 기초로 하여 병원 전체이익이 최대가 되는 적정병상규모를 모의실험으로 분석한 결과,1인실의 내과계 16병상,외과계 23병상,2인실의 내과계 202병상,외과계 198병상,3인실의 내.외과계 각3병상,6인실의 내과계 198병상,외과계 252병상 이었다.

이상의 연구결과를 근거로 할 때 단위면적당 이익을 기준으로하여 등급별 병상수 규모를재조정한다면 기존 병상 중 일부를 평당 이익이 가장 많은 2인실로 전환하는 것이 경영수지상 바람직할 것으로 판단된다.

향후 좀더 의사 및 간호사의 인건비 배분기준을 과학화하고,원가의 3대요소인 재료비,인건비,괸리비가 변할 때 이익이 극대화되는 최적병상 규모를 규명하는 후속 연구가 수행되길 기대한다.

[영문]

The purpose of this study was the acquisition of the optimum scale of the apportionment of standard & high-class bed for the maximum profit representative of the desire of customers in a General Hospital with 1,100 beds located in Seoul.This investigation was proceeded by the analysis of the result of the simulation with the survey of both the patient's needs for bed and the degree of the medical service by the grade of the ward.And finally the consequence was obtained as follows:

a. The result of the investigation of the inpatients' preference for the grade of ward classes shows that a private ward reflected 4.3 percent,a semi-private ward 1.7 percent,a three-bed ward 0.1 percent,and a ward with six beds 93.9 percent each other.

b.A questionnaire poll was paralleled of service terms of a medical doctor and a nurse by ward class,the data were used for the standard of the allotment of labor cost by the ward class.The poll shows that the service term of a medical doctor and a nurse based on a ward with six beds by ward class showed 1.7 times in internal medicine and 1.9 times in surgery at a private ward;1.4 times in internal medicine and 1.7 times in surgery at a semi-private room;and 1.2 times both in internal medicine and in surgery at a three-bed ward.

c.The resultant findings revealed the most profit per bed and per patient in a private ward.However, an analysis of profit with a standard of unit area by ward class represented a higher profit in both the internal medicine and the surgery semi-private ward than other ward calsses.

d.The result of the analysis through simulation based on the data of the prime cost per the ward class proved the optimum scale of the distribution of beds by class as follws:sixteen beds of the internal medicine and twenty three beds of the surgery in the private ward;two hundreds and two of the internal medicine and one hundred and ninety eight of the surgery in the semi-private room;three of both the internal medicine and the surgery each other in the three-bed ward;one hundred and ninety eight of the internal medicine and two hundred and fifty two of the surgery in the ward with six beds.

The result of this research exhibits that the income and expenditure of the hospital could be improved by changing parts of wards into private ones(containing the maximum profit per a unit of width) in case the scale of the number of beds inreset with the consideration of the profit per the unit width.

In the near future it's strongly expected that the research for the more scientificstandard of the allotment of labour cost by ward class and for definition of the optimum scale of the number of beds that actualize the maximum profit with the change of the three elements of the prime cost:cost of materials;labor costs:

management expenses.