社区卫生服务成本核算特点、发展历程及适宜方法研究

我国社区卫生服务机构尚无统一、规范的成本核算方法。与公立医院成本核算相比,社区卫生服务成本核算存在服务功能定位范围更广泛、服务量较难统计、新增服务成本测算需求大、信息基础相对薄弱等特点,因此需要探索区别于公立医院的适宜方法。文章基于文献梳理了社区卫生服务成本核算发展历程,系统分析、对比了4种常见方法（比例系数法、作业成本法、当量法、标化工作量法）及其在社区成本核算工作中的适用性。发现当量法和标化工作量法因具有采用“时间”为核算的主要参数、方法较简单、能够快速测算新增服务项目成本等优势,在实际工作中应用更为广泛;同时,两类方法均提供了统一“标尺”,能够为社区卫生服务机构的绩效管理、财政补偿和人员补充等提供依据。因此,当量法和标化工作量法可以为“公益一类财政保障、公益二类绩效管理”提供绩效和成本基础,是目前阶段社区卫生服务机构较为适宜的成本核算方法。建议形成社区卫生服务成本核算和管理的标准及规范,提升机构的自身管理能力,助推社区卫生服务整体高质量发展。

Cost Accounting in Community Healthcare Institutions: Characteristics,Development and Appropriate Methods

There is no consistent, standardized cost accounting method for community healthcare institutions. The cost accounting in community healthcare institutions differ from that in public hospitals in that these institutions have a wider scope of function orientation, more difficulties in counting volume of services, higher demand for calculating the cost of new services, and relatively weaker informatization foundation, so it is necessary to explore a cost accounting method that is different from that used in public hospitals, and specially applicable to community healthcare institutions. We reviewed relevant literature, then summarized the development of cost accounting in community healthcare institutions, and systematically analyzed four common methods (proportionality coefficient, operating method, equivalent method, standardized workload method) and compared the similarities, differences and applicability of them. We found that the equivalent method and the standardized workload method are more widely used in practice because both of them are simple with "time" as the main accounting parameter, and can quickly calculate the cost of new services. Moreover, the two methods provide a unified "yardstick", which can provide a basis for performance management, financial compensation and personnel supplement for community healthcare institutions. So these two methods can be used for calculating performance and cost basis for community healthcare institutions obtaining the financial security (the first class public welfare institutions), and for those using a performance management system (the second class public welfare institutions), and are more applicable to community healthcare institutions at present. Standards and norms for cost accounting and management in community healthcare institutions should be formed to improve the self-management ability of these institutions and promote the overall high-quality development of community health services.