醫(yī)院病例的成本計(jì)算

醫(yī)院病例的成本計(jì)算Agenda內(nèi)容Guidingprinciplesofpricing定價(jià)的指導(dǎo)原則Costingofin-patienthealthcare住院治療的費(fèi)用計(jì)算Allocationofcoststoanindividualcase

單個(gè)病例成本的分配Conclusion結(jié)論2Guidingprinciplesofpricing

定價(jià)的指導(dǎo)原則3Startingpointforpricinginstatutoryhealthinsurance

強(qiáng)制醫(yī)療保險(xiǎn)中定價(jià)的起點(diǎn)actualcostsofhealthcare醫(yī)療服務(wù)中的實(shí)際成本versus與availablefundsofapurchaser醫(yī)療服務(wù)購買者的可用資金Solvingofadiscrepancy彌補(bǔ)差額的解決方法bydecreasingcosts(salaries)通過減少成本（工資）byreducingrangeofcoveredservices通過減少覆蓋（包含）的服務(wù)范圍byreducingavailability(capacityofproviders)通過減少可用性（醫(yī)院的能力）4Calculationoftariffs/pricesforremuneration

報(bào)銷費(fèi)用/付費(fèi)的價(jià)格Thebasicruleforreimbursementcanbeexpressedasfollows:

報(bào)銷的基本規(guī)則可用以下形式：

Reimbursement+Costsharing+Incentives

=

Costs+Profit報(bào)銷費(fèi)用+費(fèi)用分擔(dān)+獎(jiǎng)勵(lì)=成本+收益5Costingofin-patienthealthcare

住院治療的費(fèi)用6Whycosting成本計(jì)算的原因Needtodeterminepricefor需要為下列內(nèi)容定價(jià)perservice每項(xiàng)服務(wù)perday每天perdischarge每項(xiàng)出院percase每項(xiàng)病例Approachestocosting

成本計(jì)算的方法costingstudiesbasedonactualcosts成本計(jì)算學(xué)是以精算為基礎(chǔ)的normativeapproachbasedonstandards

規(guī)范的方法是以標(biāo)準(zhǔn)為基礎(chǔ)的physicians,nursesperonebed每床使用的醫(yī)師、護(hù)士standardsalaries標(biāo)準(zhǔn)的工資combinationofboth綜合兩者8Costingofin-patientcare

住院治療的成本計(jì)算rathercomplicatedorganizationalstructureofhospitals醫(yī)院或復(fù)雜的組織結(jié)構(gòu)costingstudiesdoneonlyforasampleofhospitals(referentialhospitals)成本計(jì)算學(xué)僅僅只在一組抽樣醫(yī)院開展(參照醫(yī)院）10-25%hospitalsinthesampleusuallysufficient將10-25%的醫(yī)院作為抽樣一般地就足夠了Costs成本directcosts-attributabletoindividualhospitalcases直接成本—直接歸于醫(yī)院病例example-moreexpensivematerial,implanters例如—昂貴的材料，移植物overheadcosts–allocatedtoindividualhospitalcasesbysomedistributionmechanism管理成本—通過一些分配機(jī)制分?jǐn)偟矫總€(gè)的醫(yī)院病例上example-administrativecost,heating,maintenance例如—管理成本，取暖，維護(hù)和保養(yǎng)Costcentres成本點(diǎn)thelowestleveloforganizationalunitfromthepointofviewofaccounting從會(huì)計(jì)的角度看，最低層次的組織單位productioncostcentres(direct)-healthcareisactuallydeliveredinthem生產(chǎn)成本點(diǎn)（直接）--醫(yī)療服務(wù)事實(shí)上送達(dá)的對(duì)象indirectcostcentres–supportofproductioncostcentres間接成本點(diǎn)—支持生產(chǎn)成本點(diǎn)Productioncostcentres生產(chǎn)成本點(diǎn)Standardward標(biāo)準(zhǔn)病房Intensivecare重癥護(hù)理Dialysis透析Operationaltheatre手術(shù)室Anesthesia麻醉Deliveryrooms接生室Cardiologicdiagnosticsandtherapy心外科診斷和治療Endoscopicdiagnosticsandtherapy內(nèi)鏡診斷和治療Radiology放射Laboratories化驗(yàn)Otherdiagnostics(EKG,EEG,sonographoetc.)其他診療（心電圖，腦電圖，超聲波等等）Indirectcostcentres間接成本點(diǎn)overheadcostscentres管理成本點(diǎn)Management行政管理Kitchen伙食laundryetc.衣物清洗等等costcentresofmedicalinfrastructure醫(yī)療基礎(chǔ)設(shè)施的成本點(diǎn)pharmacy藥房centralsterilization集中消毒internaltransportofpatients病人內(nèi)部轉(zhuǎn)送orthopaedicwork-shopetc.骨科工作室Costsofcostcentres成本點(diǎn)的費(fèi)用owncosts自產(chǎn)成本personnelcostsofphysicians醫(yī)師的人事成本personnelcostsofnurses護(hù)士的人事成本personnelcostofmedical-technicalservices醫(yī)療技術(shù)服務(wù)的人事成本drugcosts藥品成本costsofimplantsandprostheses移植和材料成本costsofothermedicalmaterial其他醫(yī)療材料成本re-allocatedcosts(fromindirectcostcentres)再分配成本（從間接成本核心中）Processofcosting費(fèi)用計(jì)算的過程Determinationofowncostsforallcostcentres對(duì)所有成本點(diǎn)的自產(chǎn)成本計(jì)算Determinationofreallocationkeys再分配原則的決定Reallocationofcostsofindirectcostcentres間接成本點(diǎn)費(fèi)用的再分配Allocationoftotalcostsofdirectcostscentrestoremunerationunits將直接成本點(diǎn)的總費(fèi)用加到支付機(jī)構(gòu)上Reallocationkeys–overheadcostcentres再分配原則—管理成本點(diǎn)Costcentre成本點(diǎn)Reallocationkey再分配原則Propertyadministration財(cái)產(chǎn)管理m2ofusefularea可用面積Administrationandmanagement行政和管理numberofemployees人員數(shù)量IT信息技術(shù)numberofemployees人員數(shù)量Kitchen伙食numberofmeals就餐次數(shù)Laundry衣物清洗kgofwashing清洗重量Cleaning清潔m2ofcleanedarea清潔面積Energysupply電力供應(yīng)m2ofusefularea可用面積In-housetransport院內(nèi)搬運(yùn)numberoftransports搬運(yùn)數(shù)量Centralstore集中存儲(chǔ)numberofstoreditems存儲(chǔ)數(shù)量Reallocationkeys-costscentresofmedicalinfrastructure

再分配原則—醫(yī)療基礎(chǔ)設(shè)施成本點(diǎn)Costcentre成本點(diǎn)Reallocationkey再分配原則Archive檔案文件numberofdocuments文件數(shù)量Filmlaboratory膠片沖洗室numberofdocuments文件數(shù)量Orthopaedicwork-shop骨科工作室numberofhours時(shí)間Medicallibrary醫(yī)學(xué)圖書numberofphysicians醫(yī)師數(shù)量Transportofpatients病人轉(zhuǎn)移numberoftransports轉(zhuǎn)移數(shù)量Pharmacy藥房numberoforders處方數(shù)量Centralsterilization集中消毒numbersterilizedunits消毒單位數(shù)量Medicalstore醫(yī)療倉庫numberofstoreditems存儲(chǔ)數(shù)量Supplyofmedicalgasses醫(yī)療氣體供應(yīng)consumedvolume消耗體積Reallocationcostsofindirectcostcentres(1)間接成本點(diǎn)的費(fèi)用再分配

mutualreallocationofcosts成本的相互再分配

whereVNiareowncostsofi-thcostcentreVNi是i-th成本點(diǎn)的自產(chǎn)成本

Ci

arecostsofi-thcostcentreaftertheredistributionofcosts

Ci

是費(fèi)用再分配后，i-th成本點(diǎn)的費(fèi)用

pijisshareofconsumptionofthei-thcentreonproductionofj-thcostcentrepij表征的是第i個(gè)消費(fèi)中心所消耗的占第j個(gè)成本中心所生產(chǎn)出的比例Reallocationcostsofindirectcostcentres(2)間接成本點(diǎn)的費(fèi)用再分配steppedreallocationofcosts費(fèi)用再分配的步驟reallocationisdoneinsequenceofindirectcostscentres(indescendantorderaccordingtotheirowncosts)對(duì)間接成本按次序再分配（依據(jù)其自產(chǎn)成本的產(chǎn)出順序）directreallocationofcostsofindirectcostscentrestoproductioncostcentres直接把間接費(fèi)用分?jǐn)偟匠杀军c(diǎn)上allcostinteractionsamongindirectcentresareneglected間接成本點(diǎn)的相互作用的費(fèi)用不予以考慮Determinationofowncostsofcostcentres*

自產(chǎn)成本費(fèi)用點(diǎn)的計(jì)算Overheadcostcentres雜項(xiàng)費(fèi)用點(diǎn)Personnelcosts人事成本Materialcosts材料成本Othercosts其他成本Totalowncosts總計(jì)次產(chǎn)成本Administration行政管理5600010001200069000Cleaning清潔180007000500030000Laundry清洗衣物900060001200027000Personnelcost(RMB)MaterialcostsProductioncostscentres生產(chǎn)成本點(diǎn)Doctors醫(yī)生Nurses護(hù)士Drugs(general)藥品（一般）Drugs(assigned)藥品（指定）Othermaterial其他材料Surgicalward外科手術(shù)區(qū)200000350000300000200001500Intensivecare重癥護(hù)理20000600002000015000600Operatingtheatre手術(shù)室30000400003000

2000*everythinginthousandsofRMB所有以千元人民幣計(jì)算

Determinationofreallocationkeys

再分配原則的確定Costcentres費(fèi)用點(diǎn)Administration行政Cleaning清潔Laundry衣物No.employees員工數(shù)量M2

面積Kg公斤Administration行政

Cleaning清潔40

Laundry清洗衣物30600

Surgicalward外科室90015000750000Intensivecare重癥護(hù)理150150050000Operatingtheatre手術(shù)室5040020000Totally合計(jì)117017500820000Costcentres費(fèi)用點(diǎn)ReallocationkeysAdministration行政Cleaning清潔Laundry衣物Administration行政

Cleaning清潔3,4%

Laundry清洗衣物2,6%3,4%

Surgicalward外科室76,9%85,7%91,5%Intensivecare重癥護(hù)理12,8%8,6%6,1%Operatingtheatre手術(shù)室4,3%2,3%2,4%91.5%=750000/820000Reallocationofcostsofindirectcostcentres*

間接成本點(diǎn)的費(fèi)用再分配Costcentres成本點(diǎn)Owncosts自產(chǎn)成本Administration1ststep行政第一步Cleaning2ndstep清潔第二步Laundry3rdstep衣物第三步Administration行政69000

Cleaning清潔3000032359

Laundry衣物清洗270002876929879

Surgicalward外科區(qū)

5307780813108141Intensivecare重癥護(hù)理

88461162013442Operatingtheatre手術(shù)室

294936884417Totally合計(jì)12600012600012600012600032359=30000+69000*3.4%29879=28769+32359*3.4%108141=80813+29879*91.5%(1)(2)(3)*everythinginthousandsofRMB所有以千元人民幣計(jì)算

Recapitulationofcostsofdirectcostcentres*

直接成本點(diǎn)的費(fèi)用再分配Personnelcost人事成本Materialcosts材料成本Overheadcosts雜項(xiàng)Totalcosts合計(jì)Productioncostcentres生產(chǎn)成本點(diǎn)Doctors醫(yī)生Nurses護(hù)士Drugs(general)藥品（一般）

Drugs(assigned)藥品（指定)Othermaterial其他材料Surgicalward外科區(qū)2000003500003000002000015000108141993141Intensivecare重癥護(hù)理20000600002000015000600013442134442Operatingtheatre手術(shù)室30000400003000

2000441779417*everythinginthousandsofRMB

所有以千元人民幣計(jì)算Allocationofcoststoanindividualcase

單獨(dú)病例成本的分配24Allocationofcostsofdirectcostcentrestoanindividualhospitalcase對(duì)個(gè)別醫(yī)院的直接成本點(diǎn)的費(fèi)用分配Determinationofcostsofdirectcostcentres直接成本點(diǎn)的費(fèi)用確定Determinationofallocationkeysandtheirunitcosts分配原則和其單位成本的確定Determinationofcostsofthecaseinunitsoftheallocationkeys根據(jù)分配原則單位決定病例費(fèi)用Allocationofcostsforthecasebasedontheunitsofallocationkeys根據(jù)分配原則單位分配病例費(fèi)用AllocationkeysforcostsofindividualhospitalcasesProductioncostcentre生產(chǎn)成本點(diǎn)PersonnelcostsMaterialcostsPhysicians醫(yī)師Nurses護(hù)士Technicians技師Drugs藥品medicalmaterial醫(yī)療材料Standardward標(biāo)準(zhǔn)病房lengthofstay住院時(shí)長(zhǎng)normativenursingtime標(biāo)準(zhǔn)護(hù)理時(shí)間lengthofstay住院天數(shù)normativenursingtime標(biāo)準(zhǔn)護(hù)理時(shí)長(zhǎng)Intensivecare重癥護(hù)理weightednumberofhoursofintensivecare重癥護(hù)理時(shí)間的加權(quán)Dialysis透析weightednumberofdialysis透析數(shù)的加權(quán)Operationtheatres手術(shù)室durationofanoperationinhours手術(shù)時(shí)間的持續(xù)時(shí)長(zhǎng)Anaesthesia麻醉durationofanaesthesiaincludingpreparatorytime包括準(zhǔn)備時(shí)間的麻醉時(shí)長(zhǎng)Deliveryrooms產(chǎn)房durationofastayintheroominhours在病房的時(shí)長(zhǎng)Costsperunitsofallocationkeys每單位成本的分配原則Personnelcost人事成本Materialcosts材料成本Overheadcosts雜項(xiàng)成本Productioncostcentres生產(chǎn)成本點(diǎn)Doctors醫(yī)生Nurses護(hù)士Drugs(general)藥（一般）Drugs(assigned)藥（指定）Othermaterial其他材料Surgicalward外科病房2000003500003000002000015000108141Intensivecare重癥護(hù)理20000600002000015000600013442Operatingtheatre手術(shù)室30000400003000

20004417Personnelcosts人事成本Materialcosts材料成本Overheadcosts雜項(xiàng)成本Totally總計(jì)Productioncostcentres生產(chǎn)成本點(diǎn)

Doctors醫(yī)生Nurses護(hù)士Drugs(general)藥品（一般）Othermaterial其他材料Surgicalward(perdayofstay)外科病房（每日）500875750382702433Intensivecare(perhour)重癥護(hù)理（每小時(shí)）200600200601341194Operatingtheatre(perhour)手術(shù)室（每小時(shí)）150020001501002213971Totalcosts總成本(thousandRMB)Costsperunit每單位成本(RMB)/400000/100000Determinationofc