公立医院单病种成本核算方法及应用研究

发布时间：2018-04-20 22:22

本文选题：单病种 + 成本核算　；参考：《长沙理工大学》2014年硕士论文

【摘要】：随着医疗卫生体制改革的深入和医疗保险制度改革的推进,医院如何在保持其公益性定位的前提下,增收节支、控制医疗卫生成本、提高医疗服务质量,从而实现可持续发展是医院亟待解决的难题。本文从医院的成本核算入手,特别是通过对单病种成本核算的研究,对解决这一难题具有一定理论和实践指导意义。本文从公立医院医疗改革现状出发,回顾了按病种付费方式和单病种成本核算的相关文献。以病种分型、医院成本管理理论等理论为基础,对单病种和单病种成本核算的相关概念进行界定,用充分的理论支持,分析了单病种成本核算的必要性和现有核算方法的利弊,然后结合我国公立医院的现状,并以此为依据,构建公立医院单病种成本核算模型。本文选取湖南省某三级甲等医院急性心肌梗死单病种为案例进行研究,以2011-2013年间该病种患者的住院费用和患者情况等相关数据作为研究样本进行案例分析。首先,将构建的单病种成本核算模型运用于案例病种,核算353例患者的成本,然后对病种成本的构成、成本与患者社会特征、成本与患者临床特征的关系进行描述性统计分析,最后采用多元线性回归方法分析单病种成本的影响因素,并验证单病种成本与患者情况的相关性,并在此基础上生成该病种成本的测算模型。案例分析的结果表明：在我国现有的医院会计制度下,单纯从医院的角度研究单病种成本的核算模型,不能满足医疗改革的需要。从医院和患者双方面入手,研究单病种成本核算模型,医务人员可以将就诊患者的各项情况转化成对应参数代入成本测算模型中,测算出不同情况的患者选择不同治疗方案时产生的成本。该模型用于辅助医生根据患者病情预测治疗过程将会耗用的医院成本,指导医生在保证有效的治疗措施的前提下,尽量控制医疗费用,帮助患者家属选择治疗最适合的治疗方案。同时也可以为医保部门定价提供科学的参考依据。单病种成本测算模型的构建无疑将是造福社会、医院和病患家庭的“多赢”之措。
[Abstract]:With the deepening of the reform of the medical and health system and the promotion of the reform of the medical insurance system, how to increase the income and reduce the expenditure, control the cost of medical and health care, and improve the quality of medical service under the premise of maintaining its public welfare orientation, Therefore, the realization of sustainable development is a difficult problem to be solved urgently in hospitals. This paper starts with the cost accounting of the hospital, especially through the study of the cost accounting of the single disease, which has a certain theoretical and practical significance to solve this difficult problem. Starting from the current situation of medical reform in public hospitals, this paper reviews the related literature on the way of paying for each disease and the cost accounting of single disease. Based on the theory of disease classification and hospital cost management, this paper defines the related concepts of single disease and single disease cost accounting, and analyzes the necessity of single disease cost accounting and the advantages and disadvantages of existing accounting methods with sufficient theoretical support. Then, based on the current situation of public hospitals in China, the cost accounting model of single disease in public hospitals is constructed. This paper selects the single disease of acute myocardial infarction in a hospital of Grade 3A in Hunan Province as a case study, taking the hospitalization cost and patient condition of patients with this disease from 2011 to 2013 as the case study samples. Firstly, the single disease cost accounting model is used to calculate 353 patients' cost, and then the relationship between the cost and the social characteristics, the relationship between the cost and the clinical characteristics is analyzed. Finally, the multivariate linear regression method was used to analyze the factors affecting the cost of single disease, and to verify the correlation between the cost of single disease and the patient's condition. The results of the case study show that under the present hospital accounting system, the study on the cost accounting model of single disease from the hospital perspective can not meet the needs of medical reform. Starting from both hospital and patient, the cost accounting model of single disease is studied. The medical staff can convert each condition of the patient to the corresponding parameter into the cost calculation model. The cost of choosing different treatment options for patients with different conditions was estimated. The model is used to assist doctors to predict the hospital cost that will be consumed by the treatment process according to the patient's condition, and to guide doctors to control the medical cost as far as possible while ensuring effective treatment measures. Help the patient's family to choose the most suitable treatment. At the same time, it can also provide a scientific reference for the health care sector pricing. The construction of single disease cost calculation model will benefit the society, hospital and patient family.
【学位授予单位】：长沙理工大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.322

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