公立医院临床服务类科室交叉成本的分摊方式探索

随着医疗业务内容的不断发展和变化,公立医院已设置的四大类核算单元和三级医疗成本分摊体系,但仍无法解决临床服务类科室交叉成本分摊的问题,因此造成了临床科室收支不配比的情况。通过分析公立医院临床服务类科室交叉成本的特点及其产生原因,进而采用按收入占比的方法进行临床服务类科室交叉成本分摊。其中,核算单元的准确划分、提高成本核算数据的准确性,对完善医院全成本核算体系、加强医院成本费用分析、开展医疗项目成本核算和医院未来发展具有重要意义。     

药品零差率下药剂科成本分摊探析——基于医疗服务项目成本核算视角

以样本医院为例,采用两种不同的医疗服务项目成本分摊方式,比较分析药剂科成本分摊对医疗服务项目成本核算结果的影响,提出在药品零差率下医疗服务项目成本核算中药剂科成本分摊的建议:优化医疗技术类核算单元设置,调整医疗服务项目成本核算方法,设置临床用药类医疗服务项目.     

对医院成本核算若干问题的思考

一、存在的问题１．政府对医疗收费的统一定价造成医疗成本的不可比基于历史原因 ,医疗收费由政府统一定价。目前 ,政府对医疗收费的定价相对偏低 ,有的医疗服务定价甚至低于成本。一方面是由于价格政策对医疗服务定价的约束 ;另一方面 ,是因为医院的医疗成本核算基础薄弱 ,影响了医疗服务的按成本定价 ,造成医疗项目收入和成本的不可比 ,价格并没有体现医疗服务的真正价值。２．间接的管理成本合理分摊存在困难医院要实行全成本核算并准确分摊各种间接成本 ,首先要在各供应保障部门及行政管理部门实行内部成本核算。但是由于历史原因和政府…     

医院成本核算与管理初探

1 医院实行成本核算的对象参照企业成本核算的做法,医院实行成本核算的对象应是医疗服务和药品经营。其中:医疗服务中的成本项目包括:医疗人员的经费、医用耗材、应分摊计入管理的费用及固定资产折旧等;药品经管中的成本项目包括:药剂人员的经费、药品费、应分摊计入的管理费用及固定资产折旧等。同时,在成本核算中要注意医疗服务成本具有不确定性,每一项医学技术和服务的提供都会因患者对医疗服务的需求时间、选择方式、应用程度不同,而使医疗服务成本有所差异,同时要从控制成本费用的角度细化成本对象。     

从人力成本看成本核算方法一致性问题

由于医院成本项目较多且医疗服务具有特殊性,在实际工作中成本分摊成为医院成本核算的难点和重点,成本分摊参数的选择影响成本核算数据的准确性和可靠性,参数一旦选定,在以后的成本期间就保持一致性,随意变更分摊参数将会严重影响成本核算数据的可比性.     

成本核算在医院管理中的应用

成本核算和成本管理的关系极为密切，成本核算是成本管理的一个组成部分，为成本管理提供必要的核算资料，是医院经济管理的基础工作。成本管理包含成本核算，二者相辅相成、互相促进，其根本任务是共同为降低医疗服务成本服务。成本核算工作的深度和层次直接影响医院成本管理的成效，而开展成本管理和核算应以财务会计成本核算为主。只有严格按照财会制度归集、分摊成本，才能保证医院财务成本的真实性、合法性和可比性。强化科室成本核算与管理亦是医院经济管理的基础。在此，本文针对我国医院医疗成本核算的方法、医疗成本核算的重点及医院成本核算存在的问题做些相关的探讨。     

现行成本核算方法的比较研究

为规范医疗服务成本测算,上海申康医院发展中心于2009年2月下发了“市级医院成本核算办法（试行）”,对医院成本核算的组织机构和相关部门职责、成本范围和成本项目、成本核算对象与单位、成本归集和分摊、成本核算和成本分析、成本控制等相关工作做了比较具体的部署。同时,卫生部规划财务司为掌握全国医疗服务成本变动情况,采用卫生部卫生经济研究所研制的“医院医疗服务成本测算办法”,在全国选取了12个省96所省、市、县级医院作为全国医疗机构成本监测点,     

基于时间驱动作业成本法的超声室医疗服务项目成本核算

目的:探索基于时间驱动作业成本法(TDABC)医疗服务项目成本核算方法,并与传统作业成本法的计算结果进行比较,为国内医院项目成本核算的方法选择提供参考依据。方法:采用TDABC对样本医院超声科9项医疗服务项目进行成本核算,采用Wilcoxon配对符号秩和检验对TDABC与传统作业成本法结果进行分析,比较不同方法核算出的医疗服务项目成本结果之间是否具有差异性。结果:TDABC方法可以通过时间动因将科室成本分摊至项目成本,其核算过程简便,符合医院的实际成本•与传统作业成本法相比核算结果无统计学差异。结论:TDABC方法是一种便捷准确的项目成本核算方法,依据其核算过程的特点,建立医院成本管理及核算制度方案,加强监督管理并合理分配各职能岗位,确保医疗项目成本核算的各个环节均有章可循。     

医院成本核算与成本控制的应用与分析

论述了医院成本核算的必要性和现实性,阐明了医疗成本的经济实质和实现内容。重点分析了医院成本核算的种类和定位、医院成本核算方法的选择、医院成本核算流程及分摊方法。     

我国三甲医院内部成本核算问题研究

在目前政府对卫生经费投入严重不足、医疗收费由国家统一定价的情况下，国内医院大多处在计划经济模式和市场经济模式的夹缝中生存，医院成本分摊的核算方法很难兼顾公平和可操作性。本文对我国三甲医院成本核算存在的高层次的医院成本会计制度和医疗服务成本核算体系尚未建立、医院成本核算的有关内容还未科学制订、医院实物管理不够规范以及医院成本核算过程中存在一些消极现象等问题进行了研究，同时提出了合理引导三甲医院成本核算与管理的发展方向。     

作业成本法的基本原理及其在医疗服务成本测算中的应用前景

国外已有较多医院采用作业成本法方法进行成本控制和成本管理，收到了良好的效果。与传统的成本核算方法相比，作业成本法能够提高服务成本核算的准确性和合理性。本文对作业成本法的产生背景，基本概念，基本原理及医疗服务成本测算中的应用前景作一介绍。     

医改背景下项目成本核算问题研究

作业成本法由于在分配间接费用方面的优势而被引入项目成本核算中.通过实证分析,进一步揭示了作业成本法下的项目成本核算在解决医院成本控制、医改财政补偿、医疗服务定价改革中将发挥的积极作用及重大现实意义.     

Applying activity-based costing to the nuclear medicine unit.

Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.     

以时间驱动作业成本法核算病人护理成本方法探索

以科室内核算任意病人的护理成本为例,讨论传统作业成本法与时间驱动作业成本法的区别,介绍时间驱动作业成本法在医疗领域的应用。重点提出了辅助作业的计算和分摊方法,同时提出了病人的主要作业护理成本数据可代表消耗的护理服务水平并用于比较,以及医疗护理服务不适宜使用资源能力实际使用量这一概念的观点。     

关于对医疗服务病种成本测算方法的探讨

目的:根据国内外医疗服务成本测算的原理、方法和项目成本前期研究成果,探讨医院病种成本测算方法.方法:在测算全部医疗医疗服务项目和病种分类的基础上,采取3种方法测算病种成本.一是利用已测算的项目成本结果结合医院每日清单所有服务项目和服务量累加总和,得出平均病种成本;二是从临床路径入手,结合项目成本计算出标准病种成本;三是将医院床日成本和病种平均费用结合计算平均病种成本.结果:比较实际可行的方法是方法一.建议:医院在进行全部项目成本的基础上进行代表性病种成本测算.     

作业成本模式的运用——以中国台湾某医学中心手术室为例

随着作业成本法（Activity-based costing，简称ABC）在企业的普及，ABC被引入作为医院财务管理．这种制度能更加精确地计算医院成本。以中国台湾某医学中心手术室为例，实证作业成本法对医院财务管理的帮助。结果显示作业成本法除可由作业活动的归纳计算出更精彩的成本之外，还可为许多管理决策提供帮助。     

脊柱外科创建优质护理服务单元的体会

目的提高专科护理服务质量及患者的医疗满意度。方法通过改善住院环境,实施优质护理服务单元,全程无缝隙护理操作,加强人文关怀,丰富护理服务内涵,改进护理质量控制等措施提升脊柱专科护理服务质量。结果创建优质护理单元后住院患者满意度、护士对工作的满意度和后勤科室的保障支持满意度显著提高(P<0.05)。结论创建优质护理服务单元能有效地提高护理质量,提高患者满意度,提升护理人员自我成就感。     

Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider

This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.     

Physician outcome measurement: review and proposed model.

As health care moves from a free-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective, quality care for the health care consumer.     

Evaluation of activity-based costing versus resource-based relative value costing

Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided.