医院成本核算系统中成本的分摊及配比计算方法

研究了全成本核算中成本的合理分摊问题,叙述了具体的分摊策略。根据医院的具体情况,应用四级分摊方式将不同成本项目依据不同分摊原则进行分摊。通过对成本项目的合理分摊,分摊后医院的成本数据真实反映了全院和科室的深层收支情况。     

通过全成本核算增强医院在医疗市场中的竞争力

随着医院规模越来越大,医院间的竞争越来越激烈,医疗行业逐渐引见全成本核算,运用全成本核算能降低医院的运营成本,提高医院的经济效益。为了规范该院成本管理工作,通过加强成本核算与控制,降低医院的各项运营成本,提高医院医疗服务质量和效益,结合昆山中医医院财务管理实际情况,该院引进了全成本核算。     

新医改背景下公立医院实施成本核算的探讨

医院成本核算是医院经济管理的重要内容,药品实行零差价、医保支付方式改变,要求医院在全成本核算基础上实行医院成本三级分摊,积极开展项目成本核算、单病种成本核算,实施成本控制、降低成本费用,减轻病人负担。     

医院成本核算中手术室成本分摊模式的探讨

手术室成本核算是医院成本核算的重要组成部分,其成本分摊的准确与否直接关系到临床服务科室的效益情况。文章结合我院成本核算的实践,对手术室成本分摊模式进行探讨。     

医院全成本核算四级分摊法模型的应用与体会

阐述全成本核算必要性,依据医院发展状况和医疗活动实际,编制全成本核算流程,步骤遵循"谁受益谁承担"原则,按四级分摊步骤,把非临床科室的成本归集分摊到临床科室,兼顾公平,加强管理。全成本核算的实施推进了医院管理先进模式形成。     

医院科室全成本核算改进实例:以Z医院为例

科室成本核算是医院成本核算体系的基础,医院在开展医疗服务项目、病种和DRG成本的同时应回顾其科室成本核算的科学性。在三级分摊体系下,科室成本核算的关键点在于:确定成本额、划分成本责任中心和确定成本分摊系数。本文结合Z医院的实践经验,提出实现科室成本核算规范化、精准化的思路:夯实数据基础;明确成本中心;严格按照成本动因分摊。     

新《医院财务制度》和《医院会计制度》下的全成本核算研究

依据新《医院财务制度》和《医院会计制度》对公立医院加强成本核算的要求.以探讨公立医院开展全成本核算为切入点,提出如下建议:建立全成本核算组织机构,开发医院全成本信息系统和配套模块,进行科室成本的三级分摊,提供不同层面、不同角度的成本会计报表.     

间接费用的分摊

医院成本核算中,是否进行间接成本分摊是区别全成本核算和半成本核算的主要标准.但间接成本分摊又是一项困难的工作,主要原因一是由于管理者对医院成本核算的重要性与必要性认识不足,仅仅将其看作是奖金核算的一个工具;二是由于间接成本分摊程序复杂,工作量大,从而导致大多数医院的成本核算工作处于半完全成本核算阶段.笔者通过总结自身工作的经验,提出解决间接成本分摊难题的措施,请同行指正.     

医疗服务间接成本中行政管理费用分摊的实证研究

目的分析医院行政管理费用现状,并对医院行政管理费用初步分摊。方法首先对医院行政管理费用概念作了理论界定,进而采用职工人数平均法、收入比重法、成本比重法等相结合的综合方法对军队某三级甲等医院2007、2008年行政管理费用进行了分摊。结果建立了新型医院成本核算方法。结论必须将医院行政后勤管理费用列入各科室的成本中,才能实现真正意义上的全成本核算。     

医院成本核算中员工角色管理与人力资源成本分摊模式探讨

人力资源是医院的战略资源,是医院竞争取胜的关键.在医院全成本构成中,三级医院的人力成本占总成本之比为30％左右,二级及以下医院则更高,是医院成本的重要组成部分,也是成本核算的重点和难点.建立科学合理的人力成本分摊模型是医院成本核算研究的重要内容之一.     

Equivalence of two healthcare costing methods: bottom‐up and top‐down

This paper compares two quite different approaches to estimating costs: a ‘bottom‐up’ approach, represented by the US Department of Veterans Affairs' (VA) Decision Support System that uses local costs of specific inputs; and a ‘top‐down’ approach, represented by the costing system created by the VA Health Economics Resource Center, which assigns the VA national healthcare budget to specific products using various weighting systems. Total annual costs per patient plus the cost for specific services (e.g. clinic visit, radiograph, laboratory, inpatient admission) were compared using scatterplots, correlations, mean difference, and standard deviation of individual differences. Analysis are based upon 2001 costs for 14 915 patients at 72 facilities. Correlations ranged from 0.24 for the cost of outpatient encounters to 0.77 for the cost of inpatient admissions, and 0.85 for total annual cost. The mean difference between costing methods was $707 ($4168 versus $3461) for total annual cost. The standard deviation of the individual differences was $5934. Overall, the agreement between the two costing systems varied by the specific cost being measured and increased with aggregation. Administrators and researchers conducting cost analyses need to carefully consider the purpose, methods, characteristics, strengths, and weaknesses when selecting a method for assessing cost. Copyright © 2008 John Wiley & Sons, Ltd.     

The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches

Background: Published guidelines on the conduct of economic evaluations provide little guidance regarding the use and potential bias of the different costing methods. Objectives: Using microcosting and two gross‐costing methods, we (1) compared the cost estimates within and across subjects, and (2) determined the impact on the results of an economic evaluation. Methods: Microcosting estimates were obtained from the local health region and gross‐costing estimates were obtained from two government bodies (one provincial and one national). Total inpatient costs were described for each method. Using an economic evaluation of sirolimus‐eluting stents, we compared the incremental cost–utility ratios that resulted from applying each method. Results: Microcosting, Case‐Mix‐Grouper (CMG) gross‐costing, and Refined‐Diagnosis‐Related grouper (rDRG) gross‐costing resulted in 4‐year mean cost estimates of $16 684, $16 232, and $10 474, respectively. Using Monte Carlo simulation, the cost per QALY gained was $41 764 (95% CI: $41 182–$42 346), $42 538 (95% CI: $42 167–$42 907), and $36 566 (95% CI: $36 172–$36 960) for microcosting, rDRG‐derived and CMG‐derived estimates, respectively (P<0.001). Conclusions: Within subject, the three costing methods produced markedly different cost estimates. The difference in cost–utility values produced by each method is modest but of a magnitude that could influence a decision to fund a new intervention. Copyright © 2008 John Wiley & Sons, Ltd.     

阑尾切除手术配合的护理成本核算方法研究

目的探讨阑尾切除手术配合的护理成本核算方法,找出与目前医疗服务价格的差距.方法根据项目综合评估核算方法,核算阑尾切除手术配合的护理成本.结果阑尾切除手术配合的护理成本为256.46元.结论全面客观地核算了阑尾切除手术的护理成本,为制定相应合理的护理服务价格,体现护理服务的价值提供了准确的依据,也为单病种服务收费提供了依据.     

作业成本法在医院医疗服务项目成本核算中的应用

针对医院间接成本大、流程复杂的特点,提出在医院医疗项目核算中运用作业成本法的可行性,详细列示运用作业成本法核算医疗服务项目单位成本的步骤,核算重点是间接成本费用的分配,充分体现了"作业消耗资源、产品消耗作业"的基本指导思想,在精细化核算的基础上,提供更有针对性的管理建议和措施。     

Are Unit Costs the Same? A Case Study Comparing Different Valuation Methods for Unit Cost Calculation of General Practitioner Consultations

ObjectivesTo inform allocation decisions in any healthcare system, robust cost data are indispensable. Nevertheless, recommendations on the most appropriate valuation approaches vary or are nonexistent, and no internationally accepted gold standard exists. This costing analysis exercise aims to assess the impact and implications of different calculation methods and sources based on the unit cost of general practitioner (GP) consultations in Austria.MethodsSix costing methods for unit cost calculation were explored, following 3 Austrian methodological approaches (AT-1, AT-2, AT-3) and 3 approaches applied in 3 other European countries (Germany, The Netherlands, United Kingdom). Drawing on Austrian data, mean unit costs per GP consultation were calculated in euros for 2015.ResultsMean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach (DE) and the Austrian Physicians’ Chamber’s price recommendations (AT-3), respectively. The mean unit cost was estimated at €18.9 based on Austrian economic evaluations (AT-1) and €17.9 based on health insurance payment tariffs (AT-2). The Dutch top-down (NL) and the UK bottom-up approaches (UK) yielded higher estimates (NL: €25.3, UK: €29.8). Overall variation reached 173%.ConclusionsOur study is the first to systematically investigate the impact of differing calculation methods on unit cost estimates. It shows large variations with potential impact on the conclusions in an economic evaluation. Although different methodological choices may be justified by the adopted study perspective, different costing approaches introduce variation in cross-study/cross-country cost estimates, leading to decreased confidence in data quality in economic evaluations.     

Breast cancer treatment pathway improvement using time‐driven activity‐based costing

Time‐driven activity‐based costing (TDABC) is increasingly used to establish more accurate and time‐dependent costs for complex health care pathways. We propose to extend this approach to detect the specific improvements (eg, lean methods) that can be introduced into a care process. We analyzed a care trajectory in radiation oncology for breast cancer patients at major Canadian urban hospital. This approach allowed us to identify the activities and resource groups related to the execution of each activity, and to estimate the execution time for each. Based on the model, we were able to extract financial data with which we could evaluate process costs. The total cost of the care trajectory was $2383.82 for 2015 to 2016. Out of a total of 1389 trajectories, only 268 were completed. The implementation of TDABC gives users a clearer idea of costs and encourages managers to understand how they break down over the course of a care trajectory. Once these costs are understood, decisions can be made regarding resource allocation and waste elimination, enabling lean methods to be implemented. The result is better reorganization of work by allocating resources differently, optimizing the care trajectory, and thereby reducing its costs.     

医院成本核算的现状及作业成本法的适用性分析

简要介绍了医院成本核算的现状及作业成本法这一先进的成本管理方法,并进一步探讨了作业成本法在医院的适用性及实际运用中应注意的问题.     

作业成本法在医院成本管理中的应用研究

目的探索先进、有效的医院成本管理方法，提高医院经济管理效益。方法现场研究、专家咨询、作业成本管理、作业流程重组、满意度调查结合统计学、计算机网络技术等。结果建立作业成本法实施方法学体系，并在降低医疗服务成本、优化业务工作流程、提高人员成本意识、辅助发展决策等方面取得了比较显著的效果。结论作业成本法是一种先进的成本管理方法，对于我国医院降低运行成本、优化工作流程、提高管理效益有着重要的意义。     

加强医院经营管理的措施-医疗设备成本核算

医院经营管理中存在的问题和解决措施，组织实施医疗设备成本核算是一件非常有意义的事。     

应用作业成本法管理医院成本的实践

目的:将作业成本法应用于医院成本管理实践.方法:以某医院血液透析中心为研究对象,结合医院及医疗服务流程特点,划分医院作业及血液透析中心作业,确定作业成本动因.结果:根据作业成本法原理,测算科室及医疗服务项目成本.结论:应用作业成本法于医院内部管理是一个新的发展方向.