全成本核算与绩效考核在口腔专科医院的实践

【摘要】 本文介绍了全成本核算工作和以成本核算为基础所开展的绩效考核工作在中国医科大学附属口腔医院实施两年多时间所取得的效果,目的是探讨如何建立适合口腔专科医院特点的全成本核算体系、绩效考核体系,使口腔医院适应社会和经济发展要求,实现医院的可持续发展。     

新冠来袭 口腔专科医院有多“受伤”

正受新冠肺炎疫情影响,原有的行业间经济平横被打破,各行各业都受到了不同程度的影响,对公立医院的影响同样显而易见。口腔专科医院经济运营以门诊收入为主、住院收入为辅;药品支出少,卫生材料消耗多;医生工作强度大、人员经费占比高为主要特点。与综合医院相比,在这次疫情阻击战中,口腔专科医院不具备冲锋陷阵的技术优势,但疫情对口腔专科医院经济运行的影响却     

成本核算在公立专科医院的应用

成本核算是当前公立医院加强经营管理、适应医疗市场竞争、规范医疗管理的需要。公立专科医院在成本核算方面有其特殊性，正确处理之，是解决专科医院成本核算能否顺利进行，分配制度能否顺利实现的关键。     

口腔专科医院高质量发展SWOT分析——以北京口腔医院为例

目的 结合高质量发展要求,分析口腔专科医院内部资源、外部环境,高质量发展资源优势和劣势,明确机会和挑战,确定医院高质量发展途径和策略,助力口腔医院高质量发展。方法 从认识论层面对高质量发展内涵进行阐述,以SWOT方法剖析北京口腔医院发展现状。结果 通过打造国家级高水平口腔专科医院、构建区域口腔分级诊疗服务体系、健全市级口腔公共卫生服务体系,逐步构建医院高质量发展新体系,建设与人民群众健康需求相匹配的、优质高效的口腔专科医院。结论 口腔专科医院可综合运用SWOT分析方法,充分认识内部条件,了解外部环境,设计高质量发展最优管理框架和发展路径。     

复合型口腔医学人才公开招聘工作的问题及建议

为满足群众日益增长的口腔卫生服务需求,做好复合型口腔医学人才的引进与储备,提升口腔专科医院发展整体实力,本文通过总结某三甲口腔专科医院口腔医学专业公开招聘工作的问题及经验,提出研究设计招聘复合型口腔医学人才的人员测评方案,建立招聘工作标准流程.     

病种成本核算方法对比及实施路径研究

目前我国尚缺乏科学规范的病种成本核算体系,各医院对病种成本核算方法及核算流程尚未达成共识,探索科学合理的病种成本核算方法并研究其实施路径迫在眉睫。通过将收入分配法、当量系数分配法及项目叠加法等进行对比,分析各病种成本核算方法的优缺点。厘清了病种实际成本与病种标准成本的关系与核算路径,选定了项目叠加法作为病种成本的核算方法,并进一步提出以资源为基础的相对价值法作为项目成本的核算方法,设计了病种成本核算的运作方案。     

口腔专科医院医务人员手卫生依从性干预效果

目的提高口腔专科医院医务人员的手卫生依从性,有效降低医院感染率。方法依照世界卫生组织推荐的《手卫生指南》及《手卫生实施方案》,制订系统、循序渐进的口腔专科医院手卫生促进方案,分5个步骤进行:全院戒备、基线调查、实施改进、跟踪调查和回顾分析。对比手卫生促进活动前后医务人员的手卫生依从性。结果通过手卫生促进活动,医务人员手卫生知识问卷调查平均得分由之前的58.33分提高至77.40分,提升了32.69%;平均手卫生依从率由24.28%(59/243)上升至49.81%(133/267),差异有统计学意义(χ2=35.331,P=0.000);5个手卫生时刻的手卫生状况也有较大改善。结论手卫生促进活动对口腔专科医院医务人员的手卫生依从性有显著影响。     

成本核算与绩效评价相结合的医院奖金分配模式探讨

根据目前医院奖金分配方案存在的问题,提出建立成本核算与绩效评价相结合的奖金
分配机制。本文通过介绍成本核算的具体操作和构建绩效评价体系的理论方法,并应用于医院奖
金分配和分析其客观效果,为我国医院分配制度改革提供了科学参考。     

口腔医院青年人才创新培养实践探讨

人才梯队建设是提升医院综合实力的重要影响因素,关系到医院发展的兴衰成败.其中青年人才培养是人才梯队建设的关键.首都医科大学附属北京口腔医院(以下简称北京口腔医院)是一所集医疗、教学、科研和预防保健为一体的三级甲等口腔专科医院,目前已形成以口腔内科学、口腔颌面外科学、口腔修复学和口腔正畸学为支柱的特色口腔临床医学学科群....     

医院成本核算工作存在的问题及思考

一、成本核算存在的主要问题 1．并未做到真正的全成本核算。目前，经济效益作为科室奖金分配的一项重要考核内容，一般占有30％～50％的权重，即按当月科室收支结余额乘以一定的系数作为科室的绩效奖金。这里的科室成本实际具有很大的弹性，因为在奖金分配方案的制定中，各科室的奖金水平是根据前几年科室平均奖金水平适当调控后确定的，再根据大部分科室的奖金水平确定奖金分配系数和收支结余水平。这意味着科室成本实际上是根据奖金分配的需要来调控的，如管理费用可以作为调控的一种重要手段，其分摊比例和数额可根据实际需要确定，造成科室成本项目可能不全或小于实际数额。所以，成本核算中反映的科室成本并不是科室的完全成本，医院管理者不能真正掌握科室的实际经济运行水平。     

What risk managers should know about air medical patient transport: From the association of air medical services

The use of air medical services (AMS) has become an essential component of the healthcare system. Appropriately used air medical critical care transport can save lives and reduce the cost of healthcare. It does so by minimizing the time the critically ill and injured spend out of a hospital, by bringing more medical capabilities to the patient than are normally provided by ground emergency medical services, and by helping get the patient to the appropriate specialty care quickly. Risk managers should be aware of the everyday decisions made in critical care transport to ensure the most appropriate utilization of resources to benefi t the patient.     

A longitudinal study of the effects of graduate medical education on hospital operating costs

OBJECTIVE: To examine the effect of graduate medical education sponsorship on hospital operating costs over a seven-year period, to test for a longitudinal association between teaching intensity and cost, and to determine whether the indirect medical education (IME) payment adjustments made under Medicare's Prospective Payment System are appropriate. DATA SOURCES: Medicare cost and payment data from the Hospital Cost Report Information System and other related HCFA files, from FFY 1989 through 1995. The study population consists of all short-stay hospitals (approximately 5,000) participating in Medicare and receiving case payments by diagnosis-related groups. STUDY DESIGN: The original cost functions used to develop indirect medical education payment adjustments under PPS are re-estimated with panel data. Specification changes are included based on findings from critiques of the original hospital cost model. Additional variations on the model are explored to test for differences by hospital status, to control for the effect of additional disproportionate share and outlier payments, and to isolate the effects of improved case-mix measurement on model results. PRINCIPAL FINDINGS: Fixed effects regression produces no evidence of a significant within-hospital association between increased sponsorship of medical residents and increased cost per case. In models designed to capture a cross-sectional association, operating costs are positively related to teaching activity, but the association shows a decline in strength over time. In all years, the strength of the association is significantly greater among hospitals eligible for disproportionate share adjustments and among major teaching hospitals. Controlling for secular trends of increased teaching intensity results in a pattern of declining cross-sectional teaching coefficients that supports a theory that observed teaching effects are the result of unmeasured case severity. CONCLUSIONS: A significant but declining cost differential is observed between teaching and nonteaching hospitals. The association appears to be related to hospital and patient characteristics that cannot be controlled using currently available case-mix and wage indices. Longitudinal models do not provide evidence to support a payment adjustment formula that allows individual hospitals to recompute their IME adjustment rates as their teaching ratios rise or fall from year to year. Cross-sectional findings suggest that re-estimations of the teaching effect may be appropriate when significant improvements occur in Medicare case-mix measurement.     

当前医院档案管理工作分析

当前医院档案管理仍有不尽人意之处,要搞好医院档案管理工作,在提高管理人员素质和全员档案意识的同时,要健全档案管理制度,建立档案管理的新模式,最重要的是改变重管轻用的现状,多途径地开发利用档案信息资源。此外,要强调管理现代化,不仅是设备配置现代化,还包括管理标准的规范化管理技术及管理思想的现代化。     

The effects of cardiac specialty hospitals on the cost and quality of medical care

The recent rise of specialty hospitals--typically for-profit firms that are at least partially owned by physicians--has led to substantial debate about their effects on the cost and quality of care. Advocates of specialty hospitals claim they improve quality and lower cost; critics contend they concentrate on providing profitable procedures and attracting relatively healthy patients, leaving (predominantly nonprofit) general hospitals with a less-remunerative, sicker patient population. We find support for both sides of this debate. Markets experiencing entry by a cardiac specialty hospital have lower spending for cardiac care without significantly worse clinical outcomes. In markets with a specialty hospital, however, specialty hospitals tend to attract healthier patients and provide higher levels of intensive procedures than general hospitals.     

医院开展全成本核算工作的难点与对策

目的,我院注重经济管理,实施成本核算,在实践中遇到的问题：①成本核算机构设置的问题;②医院成本核算级次的划分问题;③管理费用的分摊问题;④成本核算数据与财务核算数据间的匹配问题。⑤内部定价规则的制定问题。就其原因：一医疗保障体制,二是医疗管理体制,三是如何降低医疗成本定位不够等。为此,应当针对成本核算中的难点,采取相应解决措施,以保证成本核算顺利推行。     

Use of specialty hospitals by Medicare beneficiaries, 1985.

Information is provided on the use and cost of inpatient services for Medicare beneficiaries discharged from participating specialty hospitals during 1985. Specialty hospitals include: psychiatric, general long-term, rehabilitation, children's, alcohol and drug, and Christian Science sanatoriums. Specialty units of short-stay hospitals are not included in the specialty hospital data presented in this article.     

Stability and change in career choices of junior doctors: postal questionnaire surveys of the United Kingdom qualifiers of 1993

OBJECTIVE: To report on stability and change in career choices of doctors, between 1 and 3 years after qualification. DESIGN: Postal questionnaire surveys. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the United Kingdom in 1993. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 and 3 years after qualifying. RESULTS: The overall pattern of career choices at year 3 differed a little from that at year 1. For example, choices for general practice increased from 26% to 29%, choices for medical specialties fell from 22% to 18%, and for surgical specialties they fell from 17% to 14%. However, because changes of choice between specialties tended to 'cancel out', the aggregated data masked much larger changes when considered at the level of individual doctors. Overall, 74% of respondents retained their year 1 career choice in year 3 (78% of men, 70% of women). Of doctors who chose a hospital specialty in year 1, 71% chose the same specialty in year 3, 18% had switched choice to another hospital specialty, and 9% had switched choice to general practice. The percentage who changed choice from hospital specialties to general practice between years 1 and 3 was lower in the 1993 cohort than in all previous cohorts. Of those whose year 1 choice of long-term career was general practice, 89% retained that choice in year 3 and 11% switched to other branches of medicine. Even by year 3, less than half of all respondents (and a smaller percentage of women than men) signified that their long-term choice of specialty was definite. In year 3, 78% of all respondents, and 79% of doctors from homes in the United Kingdom, intended definitely or probably to practise medicine in the United Kingdom for the foreseeable future, which represented little change from the figures in year 1. CONCLUSIONS: About a quarter of doctors change their career choice between years 1 and 3 after qualification, and less than half regard their choice in year 3 as definite. Flexibility is therefore needed, well beyond the first post-qualification year, to accommodate changes of choice. Where training opportunities in a hospital specialty are limited, doctors are now inclining, more than in the past, to switch to an alternative hospital specialty rather than to general practice.     

山东省基本药物制度对乡镇卫生院服务量及患者费用的影响研究：基于倍差法的分析

目的:研究山东省基本药物制度对乡镇卫生院服务量和患者就诊费用的影响。方法:收集以县为单位的山东省47个试点县与88个非试点县2009,2010两年乡镇卫生院平均服务量及患者费用情况,利用倍差法控制非干预因素,计算基本药物制度带来的净变化,并结合关键人物访谈资料。结果:使用倍差法控制了其他非基本药物制度因素干预后发现,试点县卫生院门诊人次数下降1 165.59人次,住院人次数下降26.78人次,患者门诊人均药品费用,住院人均药品费用,住院人均医疗费用分别下降7.11元,227.20元,6.86元,门诊人均医疗费用上升0.79元。结论:基本药物制度实施造成卫生院服务量下降,患者药品费用下降的背后暗藏隐患,关注患者医疗费用的变化趋势。     

基于多院区合理医疗点评体系的构建

随着国家医药卫生体制改革的不断深入,医疗保险支付方式、结算模式的改变推动着医院管理模式创新。医院从多院区特点入手,以患者为中心,探索合理医疗点评体系,构建同一专科同质化管理体系,促使科室有效控制病种成本及医院运营成本,提高了整体医疗质量,使不合理的医疗费用得到有效控制,为医院的长足发展提供了保障。     

Functional Independence Training Program: An Example of a Sub-acute Care Model for Patients Following Primary Joint Replacement

The Orthopaedic and Arthritic Hospital is a specialty instifution dedicated to the provision of elective reconstructive orthopaedic surgery and rehabilitation to individuals with musculoskeletal disorders. This facility is the largest volume joint replacement centre in Canada, performing over 1,000 hip and knee replacement/revision procedures annually. In 1995, the hospital established a Functional Independence Training (FIT) program — a seven-day reactivation program for patients following primary joint replcement. The program aims to promote early independence, improve functional level and return patients to normal activit as quickly and cost-effectively as possible. The program has received positive patient feedback and has demonstrate the potential to save the health care system approximately $479,655 annually through the reduction of 1,453 acute and rehabilitation hospital inpatient days, based on the hospital's annual primry joint replacement caseload.This program represents an established and successful sub-acute care model consistent with the Health Services Restructuring Commission's philosophy of “providing the right service in the right setting, which will lead to better, more appropriate care and better health outcomes at a more appropriate cost.”¹