医院医疗辅助科室成本分摊方法新探

在测算医疗服务单元成本时，要将医院医疗辅助科室成本分摊到临床科室和医技科室，这样测算出的成本才是全成本。分摊医疗辅助科室成本应该按照受益的原则来分摊，即按照辅助科室为其他科室提供服务量的多少进行分摊，这种分摊在实际操作中很难实现，因为决大多数医院不保...     

新医院财会制度实施中的难点及建议

1999年1月1日开始在医院实施新的《医院财务制度》和《医院会计制度》(以下简称新制度),实践证明新制度与旧制度相比确有优势。但在执行中还存在以下一些需要研究和解决的难点问题。1 关于间接费用的分摊问题 《医院财务制度》第十九条规定,间接费用按医疗和药品部门的人员比例逐项进行分摊。这就是说科室人员越多分摊的间接费用就越多。这样一来,各科室都会争着精减人员,这虽然符合“减员增效”的提法,但又出现了新的富余     

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。     

浅谈医院全成本核算中间接费用的分摊方法

目的:了解和总结医院全成本核算中间接费用的分摊方法,为进一步科学、合理地分摊间接费用提供依据。方法:结合某院2004年经济发展的实际,调查研究了有关科室的人员、收入、费用及利润等情况,并对调查数据进行统计分析和对比;运用统计学原理及数学原理对分摊方法进行科学运算和验证。结果:医院在实行全成本核算时,对间接费用的分摊方法加以选择和有效运用;发展和完善了医疗事业单位的成本费用核算方法。结论:运用科学、合理的方法分摊间接费用,尤其是基本方法及补充方法的有效配合,有利于提高医院的社会及经济效益,使医院健康可持续地发展。     

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。     

浅议医院成本核算与会计核算--兼与韩晔同志商榷

医院的科室成本核算应简单明晰,对于费用的分配归集,应按科学的分配方法进行合理分摊。     

我院核准科室用房面积的实践与体会

目前,医院实行成本核算是适应市场经济的必然选择.只有通过降低成本、提高效率,才能促进医院的可持续发展[1].在医院的运行成本中,房屋维修基金和水电暖气等费用占有相当的比重,而医院分摊这些总费用与科室用房面积密不可分.因此,准确核定科室用房面积是医院实施成本核算的重要前提.     

构建科学的医疗服务价格体系的思考

1 按服务项目收费与现行成本测算方法的弊病。按服务项目收费的制度，产生于计划经济年代。作为社会公益性的福利事业，医疗服务供不应求。随着经济体制改革的深入，医院逐渐成为独立核算的经济实体，看病难向看病贵转化。受经济利益的驱动，一方面医院乱收费(超标准收费)、分解项目收费等；另一方面由于信息不对称，患者在“交易”中处于劣势，不知道应该接受哪些服务项目。。而医院又有意提供过度的服务，如滥用抗生素、不合理用药，做不必要的检查(尤其是CT、MRI等高新技术医疗设备检查)。医疗设备少的医院，形成以药养医的局面。这样，同样的病在不同的医院治疗，费用差距很大。如2002年上海市44家二甲以上综合性医院阑尾切除术住院费用，三级医院最大值为3875元，最小值为2215元，平均值为3104元。此外，传统的医疗服务项目成本的测算，采用的是成本分摊方法。全院的成本、费用分摊到各科室，形成各科室医疗成本；各科室医疗成本分摊到所提供的服务项目上，就成为服务项目的成本；服务项目的成本根据不同病种进行分摊，最终形成病种成本。以此为基础制定医疗服务项目收费标准，医院管理不善、人浮于事、效率低下形成的损失浪费，患者是终极承担者。     

优化医院科室成本核算的实践探讨△

目的：以某大型三甲医院为例，分析科室成本核算存在的现实问题，探讨科室成本核算的优化方法，使科室成本数据真实反映医院经营状况，帮助医院找到成本控制点。方法：梳理该医院5年科室成本的数据，梳理存在的问题，分析背后的原因。结果：在成本归集方面临床科室直接成本数据质量不高，在分摊计算方面核算方法复杂且不合理。结论：提高科室成本核算水平的关键是高质量的基础数据和因地制宜的分摊设置。     

浅谈医院成本管理及核算

1成本核算的做法(1)以科室为单位进行成本核算。制定科室材料、物资消耗定额并实行超额自负,节余提奖的核算方法。对各种直接费用全部进入科室成本。对医院公共支出按比例分摊进入科室成本,实行以收抵支,节余提成的核算办法控制成本,降低消耗。但对科室发生的不可控费用的单位成本,如临床、医技科室的水、电、汽、洗涤、消毒等费用科室只能力求在用量上节约,若单价虚高就会影响科室利益,同时也失去了成本核算的严肃性。因此,医院在实际操作中对上述费用要求以实定价,最高不得超过市场价,这样迫使物资保障部门也想方设法降低成本。(2)降低药…     

How many beds should a hospital department serve?

Departmental cost functions are constructed for selected hospital departments, using total number of beds in the hospital served as a proxy output measure. Calculation of maxima or minima for the resulting cost functions reveals that, on average, different departments have extremes in their cost functions of different levels of output. A relative cost index is constructed, using parameters of the departmental cost functions, and departmental costs are compared across regions. The significance of departmental differences in optimum output is discussed with regard to sharing of services and modified system design.     

海氏评分法在医院机关及保障科室岗位评价中的应用研究

目的应用海氏评分法评价医院机关及保障科室各个岗位的价值,为改进医院绩效管理提供依据。方法采用海氏评分法,对机关及保障科室的岗位进行评价,确定机关及保障科室岗位相对价值得分和价值等级序列,据此确定机关及保障科室岗位的薪资等级和岗位配置标准。结果机关及保障科室294人,共计109个岗位,岗位被划分为8级,其中:1级岗位11人,2级岗位16人,3级岗位40人,4级岗位31人,5级岗位41人,6级岗位80人,7级岗位40人,8级岗位35人。结论海氏评分法能科学、客观、公正地评估岗位价值,依此建立的机关及保障科室岗位价值评估体系,为医院机关及保障科室的岗位配置、绩效管理等提供依据。     

Global budgeting of hospitals in Hong Kong.

Policy-makers in industrialized countries face the dilemma of having to contain soaring hospital costs while resisting any reduction in the quality and quantity of hospital services. Among the many hospital financing systems, centralized control via global budgeting is advocated by some to be the most effective in containing hospital costs. Containing hospital costs, however, is but one aspect of the trade-off between cost containment and quality of care. The hospital financing system of Hong Kong provides some insights into the extent to which cost control can be achieved through global budgeting; and its impact on the accessibility of hospital care. The case of Hong Kong highlights three necessary conditions for effective cost control: (1) the payer must have a clear policy stance on overall public spending; (2) the payer must have a clear policy stance on the importance of hospital care relative to other goods and services; and (3) the payer must also have the will and ability to limit hospital spending within finalized global budgets. However, successful cost containment in Hong Kong affects the accessibility of hospital care. In a time of population growth and economic prosperity, new community needs seem to have preceded government plans and actions to build hospital facilities.     

利用指数因素分析法评价住院收入影响因素

目的通过指数因素分析法分析某科室住院收入的变动情况,评价不同因素在住院收入中的作用。方法以2007年为基期,2008年为报告期,分析某科室出院人次、平均住院日和人日均费用对住院收入的影响及其交互作用。结果该科室2008年住院收入的变化主要取决于人日均费用的变化,其次是出院人次。结论因素分配分析法适用于评价科室住院收入的影响因素,有助于评价科室的运行效率。     

医技人员技术水平等级考核初探

医技人员技术水平的客观评价与考核管理是医院管理的难点和重点。针对医技科室性质、特点及技术管理中存在的实际问题，结合实践经验，对医技人员实行技术水平等级考核。将医技科室分为两类，指标分为３个层次和９个等级，内容包括技术能力、技术扩展能力、诊断水平、工作效率和仪器运行等５方面的技术水平量化指标，采用纵横双向评价和双盲诊断的考核办法，对技术水平作出客观的、公平的科学评价，其结果作为晋升、聘任、奖惩及学习培训的依据，从而增强了竞争意识，技术水平和业务整体素质明显提高     

Medicaid policy and the substitution of hospital outpatient care for physician care.

This article explores the effects of reimbursement and utilization control policies on utilization patterns and spending for physician and hospital outpatient services under state Medicaid programs. The empirical work shows a negative relationship between the level of Medicaid physician fees relative to Medicare and private fees, and the numbers of outpatient care recipients, suggesting that outpatient care substitutes for physician care in states with low fee levels. In addition, it shows a positive relationship between Medicaid physician fees and outpatient spending per recipient, suggesting that in low-fee states outpatient departments are providing some types of care that could be provided in a physician's office. Finally, the analysis demonstrates that reimbursement and utilization control policies have significant effects in the expected directions on aggregate Medicaid spending for physician and outpatient services.     

What effect does physician "profiling" have on inpatient physician satisfaction and hospital length of stay?

Background  

2002 marked the first time that the rate of hospital spending in the United States outpaced the overall health care spending rate of growth since 1991. As hospital spending continues to grow and as reimbursement for hospital expenses has moved towards the prospective payment system, there is still increasing pressure to reduce costs. Hospitals have a major incentive to decrease resource utilization, including hospital length of stay. We evaluated whether physician profiling affects physician satisfaction and hospital length of stay, and assessed physicians' views concerning hospital cost containment and the quality of care they provide.     

Trends in Dutch hospital spending by age and disease 1994–2010

Understanding the age pattern of medical spending and changes therein – the purpose of this paper – is essential in an ageing society. We started by combining several data sources to create a comprehensive time-based data series of hospital spending by age group, gender and disease category for The Netherlands in the period 1994–2010. Subsequently, this time series enabled us to disentangle changes in the age pattern of hospital spending to various disease categories. Finally, we investigated to what extent trends in hospital spending by age and disease differed under the different hospital payment schemes – first global and fee-for-service budgeting and then patient-based budgeting – that were in place in The Netherlands between 1994 and 2010. Our results show that while hospital spending increased for all age groups, it grew most for the non-elderly aged. The greatest hospital spending growth for this age group related to the treatment of cardiovascular diseases and cancer. Furthermore, compared to global budget in 1990s, overall hospital spending grew considerably under fee-for-service and patient-based payment schemes, although this effect appears to be disease-specific.