This is my presentation in Chinese as to manage the department of Anesthesiology in Taiwan, the most efficient practice in the world.

2. Needs help?

3. Needs help?
Help what?

4. ...
...
! David Armano http://darmano.typepad.com

5. From Babel Tower
to Ether Dome

6. Ether Dome
( )

7. Ether Dome
( )

8. 1846
Ether Dome
( )

11. (data)
(information)

12. 2004

13. 2004
1%

18. 2004.Feb

19. -
2004.Feb 2004.Aug

20. Cost down?
or,
Quality/Safety down?

21. (Cost)
/
≠
≠

22. -
-( )
-( )

25. ∆ =0
∆ =∆ - (∆ ∆ ) =0
∆ ∆ ∆

26. ∆ =0
∆ =∆ - (∆ ∆ ) =0
∆ ∆ ∆
(marginal cost)

27. Methods
Cost analysis of anesthetic practice
Conventional method
National Health Insurance database
Activity-based costing

29. An Activity-based Analysis
of Anesthetic Cost in a
Medical Center

30. *

31. *

32. *

33. 2006-April

34. 2%
2006-April

36. 24%

37. 24% 24%

38. 2006-April

39. 11%
2006-April

40. 11% 4%
2006-April

41. Where are they?
21% off!

42. ๏ 120
๏ 0.25
0.5
1
๏ 50%

43. ๏
๏ 16%
๏

44. ABC
๏
๏ *
๏

45. ABC
ABC
200 191
150
120 120
100
60 60
51
50 38
30 30
0

46. ABC
200
71
150
120 120 120
100
50
0
ABC

47. ABC
200
71
150
120 120
100
50
0

48. ABC
2006-April

49. ABC

51. ABC

54. 8 …..

55. 8 …..
1 24 135%
2 3 60%
3 3 100%
4 / 2 ±50%
5 2 ±50%
6 6 60%
7 2 ±50%
8 4 30%

56. ABC
(%)
ABC
75
44 43 37
22
0
-15 -13
-21
-31 -29
-75
-102
-131
-150
-225
-255
-300

57. ABC
78%

58. 5,000
6,000
480
5,700
1,150
5,000
3,750
4,500
3,200
2,500
3,000
240
500
2,500
1,600
1,250
1,500
120
500
00 250
34

59. ABM I
(Package)
Simple Package
22% 75
45 43
10% 22
0
-15 -21
32
-75
-150
-225
-255
-300

60. Supply Chain Services

61. Supply Chain Services

62. Supply Chain Services
Acute Pain Service
= 7000

63. ABM II
2007
10.0
( )
7.5 8
5.0
4
2.5 3 3
0

64. ABC
(
)

65. ABC
(
)

66. 2006-April

67. 31%
2006-April

68. 31% 3%
2006-April

69. 2.5 /
Where have all the profit gone?
21% off!

70. (Non-value added cost)

71. ABC
ABM

72. ABC
ABM

74. ABC

75. ABC

76. ABC
ABM

77. ABC
cost
driver
ABM

78. =
S T
O
C WN
D O

79. =
S T
O
C WN
D O

80. =
/
S T
O
C WN
D O

81. =
/
S T
≠
O
C WN
D O

82. =
/
S T
≠
O
C WN
D O

83. =
/
S T
≠
O
C WN
D O

84. (Non-value added cost)

85. (Non-value added cost)

86. -

87. -
No one!

88. ! David Armano http://darmano.typepad.com

89. Synthesizer!
! David Armano http://darmano.typepad.com

94. -