医疗机构血液净化服务成本核算应用研究

发布时间：2018-05-05 03:27

本文选题：独立血液净化中心 + 成本　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:通过比较不同医疗机构血液净化服务的运行成本、收支结余及服务量等方面存在的差异,并对差异背后存在的原因进行分析。发现独立血液净化中心的机构运行优势,为完善独立血液净化机构准入及医保支付标准,鼓励社会力量积极举办独立设置血液净化机构提供客观的决策依据,指导优质医疗服务下沉至基层。探索适宜的成本核算路径,为今后类似医疗服务成本核算提供方法借鉴。方法:编制访谈提纲,对相关科室负责人进行访谈。了解综合医院与独立设置血液净化中心血液净化医疗资源配置情况、血液净化患者数量及变化趋势、血液净化服务开展种类及每类服务收费标准和医保报销等现况发现机构运行中存在的困难和问题;了解两类机构信息化建设、成本管理、日常工作数据记录等情况。通过自主设计的成本数据采集表,采集相关数据,计算两类机构血液净化科室直接成本,并确定行政后勤科室、相关医辅科室直接成本,按照《医院财务制度》规定的分项逐级分步结转的办法计算出血液净化科室全成本。以工作量和项目难度系数作为分摊系数求得不同种类的血液净化服务项目成本。采用比较分析法对两类机构血液净化资源配置情况、血液净化服务收入、成本构成及收支结余等情况进行比较,找出差异较大的部分,剖析产生差异的原因。结果:数据分析结果显示,一个季度运行期间,市医院血液净化科收支结余25.14万元,收支结余率15.96%,市级独立血液净化中心收支结余21.97万元,收支结余率15.71%;县医院血液净化科收支结余16.4万元,收支结余率13.84%,县级独立血液净化中心收支结余28.68万元,收支结余率24.03%。两家独立血液净化中心均可以实现良性运转。结论:调研点独立血液净化中心配有开展血液净化服务的医疗卫生资源,并与医保部门对接,维持稳定的血液净化患者流量。通过采取合理的血液净化服务收费价格,控制机构运行成本,均实现了较高比例的收支结余,其中县级独立血液净化中心收支结余率为23.04%,为四家机构中最高。两家独立血液净化中心的检查化验收入均比同区域的医院高,而综合医院血液净化科药品成本均比同区域的血液净化中心高,反映独立血液净化中心重视评估患者病情,及时将病情较为复杂的患者转至综合医院接受治疗,控制医疗风险的发生。独立血液净化中心主要为病情较为稳定的患者提供血液净化服务,可作为方便患者的血液净化服务分级诊疗机构,完善血液净化服务提供体系,缓解目前血液净化供需紧张局面。同时,综合医院可以发挥急救和治疗危重病症的功能,承担更多复杂病情患者的血液净化治疗。
[Abstract]:Objective: to compare the operating cost, balance of income and expenditure and service volume of blood purification service in different medical institutions, and analyze the reasons behind the differences. It is found that the operation advantage of the independent blood purification center can provide an objective decision basis for perfecting the admission of the independent blood purification institution and the payment standard of medical insurance, and encouraging the social forces to organize and set up the blood purification organization independently. To guide the quality of medical services to sink to the grass-roots level. To explore the appropriate path of cost accounting to provide reference for the cost accounting of similar medical services in the future. Methods: the outline of interview was compiled and the responsible persons of relevant departments were interviewed. To understand the allocation of medical resources for blood purification in general hospitals and independently set up blood purification centers, the number of patients with blood purification and the trend of changes, The types of blood purification services and the current situation such as charging standard for each type of service and medical insurance reimbursement etc. The difficulties and problems in the operation of the two organizations are found, and the information construction, cost management and daily work data record of the two types of institutions are understood. The direct cost of blood purification department of two kinds of institutions is calculated through the cost data acquisition table designed by oneself, and the direct cost of administrative logistics department and related medical assistant department is determined. The total cost of blood purification department was calculated according to the method of carrying forward step by step by step in accordance with the regulation of hospital financial system. The cost of different kinds of blood purification services was obtained by using workload and project difficulty coefficient as the sharing coefficient. This paper compares the distribution of blood purification resources, the income of blood purification service, the composition of cost and the balance of income and expenditure between the two kinds of institutions by means of comparative analysis, finds out the big difference and analyzes the reasons for the difference. Results: the results of data analysis showed that the balance of revenue and expenditure of blood purification department of municipal hospital was 251400 yuan, the balance rate of income and expenditure was 15.96 yuan, and the balance of income and expenditure of municipal independent blood purification center was 219700 yuan during a quarterly operation. The balance rate of income and expenditure was 15.71 yuan, the balance of income and expenditure of blood purification department of county hospital was 164000 yuan, the balance rate of income and expenditure was 13.84%, the balance of income and expenditure of county independent blood purification center was 286800 yuan, and the balance rate of income and expenditure was 24.03 yuan. Two independent blood purification centers can achieve benign operation. Conclusion: the independent blood purification center is equipped with the medical and health resources to carry out blood purification service and docking with the medical insurance department to maintain a stable blood purification patient flow. By adopting reasonable price of blood purification service and controlling the operating cost of the organization, a high proportion of the balance of income and expenditure was realized, and the balance rate of the independent blood purification center at the county level was 23.04, which was the highest among the four institutions. The examination income of the two independent blood purification centers was higher than that of the hospitals in the same region, and the cost of drugs in the blood purification departments of the general hospitals was higher than that of the blood purification centers in the same region, which reflected the importance attached by the independent blood purification centers to the evaluation of the patients' condition. Timely transfer the more complicated patients to the general hospital for treatment, to control the occurrence of medical risks. The independent blood purification center mainly provides blood purification services for patients with relatively stable condition. It can be used as a convenient blood purification service grading organization for diagnosis and treatment, and perfect the blood purification service providing system. Ease the current tension between supply and demand for blood purification. At the same time, the general hospital can play the role of first aid and treatment of critical disease, undertake more complex patients blood purification treatment.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.322

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