基于成本测算的医疗费用影响因素及控制研究

发布时间：2019-01-01 22:00

【摘要】：研究背景近年来我国医疗改革在医疗保障、药物制度、公共卫生服务等重点领域取得明显进展,但医疗费用依旧过高,为减轻百姓医疗负担的任务任重道远。外因是变化的条件,内因是变化的依据,如何从医院的角度出发,研究其成本的变化对医疗费用的影响,并采取相应的管理措施,才能使公立医院在不断变化的外部环境中,真正实现其公益性,控制医疗费用的增长。研究目的本研究通过对两家样本医院的总成本与病种成本的测算,将成本与费用进行比较分析,探讨目前医院发展存在的问题以及成本的变化对医疗费用的影响,为医院管理发展和医疗费用控制提供理论与数据的支持。研究方法选取宁夏回族自治区A县、B县2家县级公立医院作为样本医院,通过文献复习、现场调查、经济学原理及方法、统计方法等对样本医院成本、病种成本进行测算与比较分析,同时分析两家医院医疗费用的构成与影响因素,采用多元线性逐步回归的方法研究医院的主要成本要素对医疗费用的影响。研究结果1.医院总成本构成与测量情况:两家医院均是劳务成本与其他成本为医院的主要成本,A县人民医院劳务成本占比36.57%、其他成本占比26.55%。B县人民医院劳务成本占比31.78%、其他成本占比15.84%。2.病种成本测量情况:分别采用项目成本法、临床路径法、床日成本法对两家医院主要病种进行测量,测量结果显示,项目成本法与床日成本法测算的病种成本普遍高于病种的例均费用,采用临床路径法测算的病种成本最低。3.医疗费用的构成与影响因素分析:两家样本医院的医疗费用主要由床位费、诊察费、药品费、化验费、护理费、手术费、检查费及其他费用构成,药品费与其他费用为医疗费用的主要组成部分。因子分析结果显示,药品费用、其他费用、检查费用为医疗费用的主要影响因素。4.医院总成本对医疗费用的影响情况:通过多元线性逐步回归建立的方程显示A县医院医务人员数量回归系数为0.625,平均住院天数回归系数为0.157,诊疗项目数量回归系数为0.133,设备价值回归系数为0.055。B县医院医务人员数量回归系数为0.699,平均住院天数回归系数为0.245,诊疗项目数量回归系数为0.201,设备价值回归系数为0.102。说明医院劳务人员数、设备价值、平均住院天数、诊疗项目数量等成本因素为医疗费用的主要影响因素。建议1.加强县级医院医疗信息的管理与建设2.提高县级医院财务管理水平,推行全成本核算3.控制劳务成本与行政管理成本,提高医院资源利用效率4.提升医院人力资源管理水平,加强人才队伍建设5.转变传统管理理念与方式,促进临床路径管理的实施6.调整药品价格,降低住院医疗费用,提高医院的运行效率7.改革医院薪酬制度,引导回归公益性
[Abstract]:Background in recent years, China's medical reform has made significant progress in the key areas of medical security, drug system, public health services, but the medical costs are still too high, in order to reduce the burden of medical care for the people, the task is a long way away. External cause is the condition of change, and internal factor is the basis of change. How to study the influence of the change of cost on medical cost from the point of view of hospital, and take corresponding management measures, in order to make the public hospital in the constantly changing external environment, The real realization of its public welfare, control of the growth of medical costs. Objective the purpose of this study is to compare and analyze the total cost and the disease cost of the two hospitals, and to discuss the problems existing in the development of the hospital and the influence of the change of the cost on the medical cost. To provide theoretical and data support for hospital management development and medical cost control. Methods A county and B county hospitals in Ningxia Hui Autonomous region were selected as sample hospitals. Through literature review, field investigation, economic principles and methods, and statistical methods, the cost of the sample hospitals was analyzed. At the same time, the composition and influencing factors of medical expenses in two hospitals were analyzed, and the influence of main cost factors on medical expenses was studied by the method of multiple linear stepwise regression. Results 1. The composition and measurement of total hospital cost: the labor cost and other cost are the main cost of the hospital, and the labor cost of the people's Hospital in A County is 36.57%. Other costs account for 26.55.B county people's hospital labor costs account for 31.78meters, other costs account for 15.84.2. Cost measurement of disease species: project cost method, clinical path method and bed day cost method were used to measure the main diseases in two hospitals, and the results showed that, The cost calculated by item cost method and bed day cost method is generally higher than the average cost of disease cases, and the cost calculated by clinical pathway method is the lowest. Analysis of the composition and influencing factors of medical expenses: the medical expenses of the two sample hospitals are mainly composed of bed fee, medical examination fee, drug fee, laboratory fee, nursing fee, operating fee, examination fee and other expenses. Drug and other expenses are the main components of medical expenses. Factor analysis showed that the cost of drugs, other costs, and the cost of testing were the main factors affecting medical expenses. 4. The effect of total hospital cost on medical cost: the regression coefficient of hospital medical staff was 0.625 and the regression coefficient of average hospitalization days was 0.157, according to the equation established by multivariate linear stepwise regression. The regression coefficient of number of diagnosis and treatment items was 0.133, the regression coefficient of equipment value was 0.055.B, the regression coefficient of medical staff was 0.699, the regression coefficient of average days in hospital was 0.245, the regression coefficient of quantity of diagnosis and treatment items was 0.201. The regression coefficient of equipment value is 0.102. The cost factors such as the number of service personnel, the value of equipment, the average length of stay in hospital, the number of diagnosis and treatment items are the main influencing factors of medical expenses. Recommendation 1. Strengthening the management and construction of medical information in county-level hospitals. We will improve the financial management level of county-level hospitals and implement full cost accounting. Control labor cost and administrative cost, improve hospital resource utilization efficiency 4. 5. Improve the level of human resources management in hospitals, strengthen the construction of talent team 5. 5. To change the traditional management concepts and methods, promote the implementation of clinical pathway management 6. 5. Adjust drug price, reduce hospitalization medical expenses, improve the efficiency of hospital operation. Reform the hospital salary system and guide the return to public welfare
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.322

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