基于标化工作量的社区医养结合服务项目成本测算研究

背景　社区卫生服务中心作为医养结合的支持平台，其对医养结合服务的持续输出，离不开对其所消耗成本的合理补偿，而现有研究尚缺乏对医养结合服务项目的全成本核算。目的　测算各项社区医养结合服务项目的成本，为社区医养结合服务的合理补偿提供依据。方法　于2019年6-8月，对上海市浦东新区东明社区卫生服务中心的259项医养结合服务项目进行成本测算。成本测算所需的各项指标，包括人力消耗与耗时、技术难度、风险程度、单位时间相对人力价值、初级全科医师人力支出、业务科室人力支出、非业务科室人力支出、非人力支出、非人力支出（可收费）、政府补贴，主要从东明社区卫生服务中心管理层、业务科室骨干、财务科和人事科获取。结果　经计算，社区医养结合服务各类成本为：直接人力成本取值为5~3 444元，中位数为31.7元；间接人力成本取值为1.4~970.7元，中位数为8.9元；非人力成本取值为0.4~309.8元，中位数为2.8元；总成本取值为6.9~4 724.5元，中位数为43.4元。与收费价格比较结果显示，118项收费项目中，仅在直接人力成本上，就有75项服务的成本超过收费价格；间接人力成本上，有19项服务的成本超过收费价格；非人力成本上，有3项大于收费价格；总成本上，有88项大于收费价格。结论　本研究所测算医养结合服务成本有一定的合理性，测算结果揭示了社区在满足老年人不同需求时的投入差异，以及现有补偿方式可能会引发“入不敷出”的问题。医养结合服务的持续开展，需要社区卫生服务中心、政府等相关部门或机构的共同保障和支持。

Cost Accounting of Community Integrated Health and Social Care Service Based on Standardized Workload

Background The community health service center,as a support platform for the integrated health and social care service,cannot provide continuous output of integrated service without reasonable compensation for the costs it consumes.However,the current research still lacks the full cost accounting of integrated health and social care service in China.Objective To calculate the total cost of community integrated health and social care service,in order to provide a basis for reasonable compensation for community integrated health and social care service.Methods The cost accounting were performed for 259 items of integrated health and social care service in Dongming Community Health Service Center of Pudong New Area in Shanghai from June to August in 2019.Various indicators required for cost accounting,including manpower consumption and time consumption,technical difficulty,degree of risk,relative manpower value per unit time,manpower expenditure of junior general practitioners,manpower expenditure of business segment,manpower expenditure of non-business segment,nonmanpower expenditure,non-manpower expenditure(chargeable)and government subsidy,were mainly obtained from the management staff,backbone staff of the business segment,finance section and the personnel section of Dongming Community Health Service Center.Results According to cost accounting,the various costs of community integrated health and social care service were direct labor cost of 5-3444 yuan with a median of 31.7 yuan,indirect labor cost of 1.4-970.7 yuan with a median of 8.9 yuan,the non-manpower cost of 0.4-309.8 yuan with a median of 2.8 yuan,and the total cost of 6.9-4724.5 yuan with a median of 43.4 yuan.The comparison with the price tag showed that among 118 items,75 items costed more in terms of the direct labor cost,and 19 items costed more in terms of the indirect labor cost.There were three items costing more than the price tag in terms of non-manpower cost.In terms of total cost,88 items costed more than the price tag.Conclusion The cost accounting of the integrated health and social care service is reasonable in this study.The calculation results reveal the difference in the community input when meeting the various needs of the elderly,and it shows that the existing compensation methods may cause problems of living beyond their means.The continuous development of integrated health and social care service requires the joint support of community health service centers,governments and other relevant departments and institutions.