重庆市中医医疗服务项目收费及成本核算的调查研究

目的 :通过对重庆市中医医疗服务项目收费现状及成本进行调查,为医疗服务价格调整和方案制定提供决策依据。方法 :采用《中医医疗服务项目价格调查表》和《重庆市增补医疗服务项目成本测算表》对9所中医临床服务机构进行价格和成本调查,以SPSS软件进行数据处理和统计分析。结果 :重庆市中医医疗项目收费价格普遍偏低,中医类手术、治疗项目收费标准大部分低于50元;50%以上的项目成本核算价是目前收费价格的2倍以上。结论 :目前重庆市中医项目数量偏少,不能满足广大患者的需求;现行中医医疗服务项目价格偏低不能调动医务人员积极性,亟需调整价格、建立科学合理的中医服务价格体系。     

医疗机构补偿机制改革的思考

我国卫生事业的性质是“公益性福利事业”。这种属性要求医疗机构按“不含工资的医疗成本”收费，国家财政给予“差额补助”。笔者认为，现阶段对医疗机构的医疗补偿仍应采取市场补偿和财政补偿双轨并行的复合补偿模式。对于医疗补偿机制的改革，笔者提出以下几点设想：一、市场补偿医疗价格背离价值是一个不容忽视的问题。这个问题解决不好，医疗机构就赔本。笔者认为，准确计算医疗成本是制订医疗收费标准的基础，应进行一次医疗成本调查，以完全成本和微利作为特殊医疗服务项目的收费标准；以“不含差额补助的医疗成本”为基本医疗服务项…     

新疆医疗服务价格调整前后的医疗服务项目成本补偿变化

通过对新疆区、地、县18家医院的100个医疗服务项目的实际成本测算发现,大部分项目的实际成本高于原有和现行收费标准。价格调整实现了提高医务人员劳务价值和降低检查费的目的,但地、县级医院医疗服务项目成本补偿仍存在较大缺口。结果表明:政府履行社会公共职能,发挥财政补偿的调节作用是实现医疗服务价格调整政策改革目标的根本。     

中医针灸治疗项目成本核算与补偿标准研究

对中医针灸治疗服务项目的实际成本与标准成本测算,并与浙江省执行的收费标准进行比较,为浙江省不同级别中医院中医针灸治疗服务项目收费标准的调整提供参考依据。     

部分手术类项目标准成本分析

对6个手术类医疗服务项目进行了标准成本测算,分析了其成本构成,并与全国的实际成本平均水平进行了比较。建议政府以标准成本作为调整医疗服务价格的依据,同时,建议医院在加强手术室成本管理时应着重加强医用材料的管理。     

在新版医疗服务项目规范下医用耗材打包定价的策略研究

目的:在国家出台的新版医疗服务项目规范下,对医用耗材打包定价项目进行成本测算,借此客观反映公立医院医疗服务项目的成本,探讨科学定价策略。方法:利用《全国医疗服务价格项目规范(2012年版)工作手册》选择某三级综合医院2013年具有代表性的综合服务类17个项目对照新版规范进行成本测算和分析。结果和结论:通过对17项医疗收费项目的实际发生成本与现行收费标准的测算比对,得出现行收费标准全部低于实际发生成本,亏损达3 733万元;通过17项新版成本与现行收费标准的测算比对,提出了下一步进行医疗服务项目定价中涵盖打包耗材项目价格调整的合理区间,并建议根据物价指数的浮动变化来建立合理的价格动态调整机制。     

部分大型医疗设备成本与收费标准的对比分析

以本次调查所得标准成本结合现场回顾性调查所得之实际成本同上海卫生局公布的相应的大型医疗设备收费标准进行分析比较,并探讨收费标准与标准成本、实际成本之间的关系,提出制定合理收费标准的依据。本次研究结果表明,目前所实行的收费价格体系与标准成本相比存在一定的差异,现行价格体系中收费标准总体偏低,卫生技术人员劳务价值有待进一步提高。建议卫生行政部门在进一步调整价格体系时,可以通过一些有效的行政手段、医学审计等各种宏观控制及微观方法的引进加强管理,既能有效控制医疗费用的上涨,又能使医院获得正常的补偿。     

医疗服务价格扭曲的测量及其分析

医疗服务价格扭曲有两种基本表现形式，既价格政策引致的价格扭曲和供方行为导致的价格扭曲。本利用医疗服务收费标准、成本信息和医院实际收费调查资料对两种价格扭曲的程度进行了测量和分析。结果表明，两种价格扭曲在目前医疗服务价格体系中同时存在，并且扭曲的程度较高。改变现行定价和调价机制，加强对医疗服务机构收费行为的监管，是降低医疗服务价格扭曲的政策选择。     

作业成本法在医疗服务项目成本管理中的应用

立足精细化管理,加强医疗服务项目成本管理是当前医院经营治理的必然要求.本文首先介绍了医院成本核算的方法与体系,然后以某大型医院超声科为例,运用作业成本法核算了2011年某季度4个主要医疗服务项目的成本,与传统成本法及收费标准进行了对比分析,提出了改进医疗服务价格成本测算方法、开展医疗服务项目作业成本管理的思路与建议.     

浅析技术劳务价值在医疗服务项目价格中的体现

医疗服务项目价格的测算、申报、评审、核定，大都采用传统的成本核算和定价方法，对构成医疗服务项目的直接人工费、直接材料费、间接费用进行归集、分配与核算，并在此基础上拟订、核准收费标准。在实际工作中，我们对直接材料按实际消耗数和购入价格计入成本，对间接费用按照一定的方法和比率摊入成本，这都无可厚非；     

Physician knowledge and attitudes about health insurance after the introduction of capitated health care plans

A two-part closed-end survey similar to a survey done in 1980 was given to 25 family physicians at an academic family medical center to assess physician knowledge about five insurance programs covering most of the patients seeking care in the center, and to assess physician attitudes about the capitated insurance plan with which the clinic was affiliated. Results did not differ significantly from those obtained in a similar survey four years earlier at the same center. Physicians correctly identified benefits offered by insurance programs only about one half of the time and many did not ascertain patient insurance coverage at all. Physicians considered the most important advantages of capitated health care to be the patient protection from fees for services obtained, the coverage for health care maintenance, and the potential for controlling health care costs. Physician-perceived disadvantages included difficulties controlling costs generated by other specialists, dealing with after-the-fact authorization requests, controlling access to services, and obtaining information about costs within the capitated system.     

Improving the implementation of cost recovery for health: lessons from Zimbabwe

In the current debate over health financing policy in developing countries, governments are increasingly focusing on cost recovery--having patients pay part or all of their health care costs--as a way to mobilize more resources for health, improve equity by selectively charging the wealthy, and increase efficiency by encouraging reinvestment of fee revenues into cost-effective primary care. Zimbabwe offers an important example of a country with a tradition of levying fees in government health facilities, but where enforcement became lax in the 1980s. In 1991, policymakers resolved to resuscitate and strengthen cost recovery, as part of a broader economic reform program. This paper discusses the strengths and weaknesses of Zimbabwe's cost recovery system, its potential for improvement, and the obstacles to change in revising the fee structure and billing and collection procedures. It argues that cost recovery can help to achieve Zimbabwe's health objectives, but only in conjunction with other measures to redirect public spending to essential public health and clinic care and improve the efficiency of government services. The paper finds that during the 1980s, the fee schedule became badly misaligned with actual medical care costs and created distortions in patient referral patterns. Billing and collection were also weak, because of deficiencies in personnel and information systems and lack of incentives for revenue generation. The paper concludes that if key steps were taken to raise the collections-to-billings ratio, recover fees from privately-insured patients, and adjust fees in line with medical cost inflation, recoveries could increase fourfold, from 5% to 20% of government spending for clinical care. At the same time, access to government health services for the poor could be maintained by improving exemption procedures.     

90年代我国若干卫生经济指标的动态分析

目的 了解我国90年代宏观卫生经济运行特点。方法 采用回顾性分析法,比较了1990－2000年我国卫生总费用、医疗费用、医疗服务费用及药品费用的增长态势。结果 我国卫生总费用呈持续增长,年平均增长率为13．33％;医疗费用自1993年也呈加速增长态势,年平均增长率为10．83％;医疗服务费用和药品费用的年平均增长率为14．14％和11．07％;自1994年,上述指标的增长速度明显高于GDP的增长速度。结论 “总量控制、结构调整”虽取得一些成效,但与发达国家相比,我国卫生经济状况有待继续改善。     

政府够买社区卫生服务的现状、问题与推进策略：以深圳市为例

分级诊疗制度的建立将有利于调节病人流向、降低医疗总费用以及解决大医院“看病难,挂号难”等问题。本文以贵州省数据为例,对住院人次、住院费用及报销费用进行分析,对比实际发生费用与理论发生费用进行对比,为分级诊疗政策的实施提供建议。     

试论新形势下医院医改与医保的关系

通过对镇江市15年来探索实施和完善医疗保障制度改革运行情况的分析,从医保在医院运行中的地位、作用与影响,存在的主要矛盾、问题及对策与建议等方面阐述了公立医院、医改与医保三方的发展关系.提出医院与医保之间要在医改的大前提下协调发展;建立医院与医保之间平等协商的谈判机制;建立与医保能力相适应的受益标准;建立科学可行的费用结算和付费方式;医院必须深化改革、加强管理,承担为群众提供优质医疗服务和合理控制医疗费用的双重责任.     

试论新形势下医院医改与医保的关系

通过对镇江市15年来探索实施和完善医疗保障制度改革运行情况的分析,从医保在医院运行中的地位、作用与影响,存在的主要矛盾、问题及对策与建议等方面阐述了公立医院、医改与医保三方的发展关系.提出医院与医保之间要在医改的大前提下协调发展;建立医院与医保之间平等协商的谈判机制;建立与医保能力相适应的受益标准;建立科学可行的费用结算和付费方式;医院必须深化改革、加强管理,承担为群众提供优质医疗服务和合理控制医疗费用的双重责任.     

中国居民高血压造成冠心病和脑卒中的经济负担研究

目的评价中国居民高血压造成冠心病和脯卒中的直接经济负担，分析高血压知晓率和治疗率的相关关系，为制订人群高血压防治策略提供科学依据，确定知晓率作为社区高血压防治效果的评价指标。方法利用2002年中国居民营养与健康状况调查、2003年第二次国家卫生服务调查等相关资料，分别计算高血压、冠心病和脑卒中的直接疾病负担；根据人群归因危险度百分比计算高血压造成的冠心病和脑卒中的直接经济负担。利用2002年调查数据分析高血压知晓率和治疗率的关系。结果2003年中国35～74岁人群高血压、冠心病和脑卒中的直接经济负担分别为201．5、157．1和242．9亿元人民币，其中由高血压导致的冠心病和脑卒中的直接经济负扭达190．8亿元人民币，占这两种疾病直接疾病负担的47.7％。高血压知晓率与治疗率呈高度相天（r=0．9777，P〈0．0001），知晓率是影响治疗率的关键。结论中国居民高血压所造成冠心病和脑卒中的直接经济负担，已占该两种疾病直接疾病负担的近50％。以知晓率作为社区高血压防治效果的评价指标具有实用价值。     

Recovery of recurrent health service costs through provincial health funds in Cameroon

This article describes the Provincial Health Funds pioneered in two Provinces of Cameroon. These funds are non-profit associations and financed by the community through drug fees and—to a lesser extent—through fees for services. The financial objective of the Funds is the full coverage of both the costs of the drug supply and the recurrent non-salary costs of the entire public health services in the province. In addition the funds are channels for community participation in the management and improvement of health services. Following a discussion of the institutional and legal framework, the paper examines the cost recovery targets and the mark-up necessary to achieve them. Comparison is made with mark-up and prices of private for-profit pharmacies. In its third year of operation, the Fund currently covers 62% of recurrent health service costs, up from 22% in the first year. With increasing number of health centers joining the fund full coverage of recurrent costs is projected to occur at the earlies in year four of operations. The authors argue that the appropriate role of donor assistance is not only to finance investment but also to subsidize recurrent costs, until the fund has reached its optimal anticipated size, thus realizing economies of scale. While the final word on sustainability can only be said years after the funds have reached their final size, the consistent trend towards full cost recovery is encouraging.