公立医院经营成本习性与动因研究

[目的]采用本量利短期分析与面板回归分析方法,探讨成都市7家公立医院经营活动的短期成本习性特征及长期成本驱动因素,为进一步完善公立医院成本管理提供参考依据。[方法]收集成都7家公立医院2014年12月至2018年6月的财务数据与非财务数据,并利用本量利分析法和面板回归法对数据进行分析。[结果]①大规模医院和中小规模医院盈亏临界点分别为486 678.4人次和500 348.76人次,单位边际贡献分别为113.56元和75.52元。②产出动因分析表明,门诊人次对大规模医院呈现正相关、对中小规模医院呈现负相关;住院人次对大规模医院呈现负相关、对中小规模医院呈现正相关。③收入成本动因表明,技术劳务收入和检查检验收入对于两组医院的影响均为正相关,但药品耗材收入在大规模医院呈现负相关、中小规模医院呈现正相关。[结论]①区域内公立医院存在规模效应,中小规模医院面临更大经营风险。②大规模医院和中小规模医院经营成本驱动路径截然不同。建议加强区域内公立医院成本特征实证研究,建立与成本核算相适应的医疗服务定价方法,以成本控制为基础推动公立医院改善财务绩效和控制不合理医疗费用增长。

Study on operating cost behavior and motivation of public hospitals

Objective To explore the short-term cost characteristics and long-term cost drivers of seven public hospitals in Chengdu by means of cost-volume-profit short-term analysis and panel regression analysis so as to provide reference basis for further improvement of cost management in public hospitals. Methods Cost-volume-profit analysis and panel regression were used to analyze financial and non-financial data from Dec. 2014 to Jun. 2018 in 7 public hospitals in Chengdu. Results 1. The break-even point of large-scale hospitals and small and medium-sized hospitals was 486678. 4 and 500348. 76 person-time respectively,and contribution per unit was 113. 56 and 75. 52 yuan respectively. 2. The analysis of output cost drivers showed that it was positively correlated with outpatient person-time to large-scale hospitals,and negative correlated in small and medium-sized hospitals,it was negative correlated with hospitalization person-time in large-scale hospitals,and positively correlated small and medium-sized hospitals. 3. Income cost drivers showed that it was positively correlated with technical labor income and inspection and inspection income to the influence of two groups hospitals,but drug consumption income was negatively correlated with large-scale hospitals and positively correlated with small and medium-sized hospitals. Conclusions 1. There is scale effect in public hospitals in the region,small and medium-sized hospitals are facing greater operational risks. 2. Large-scale hospitals and small and medium-sized hospitals have distinct cost-driven paths. It suggests that to strengthen the empirical research on the cost characteristics of public hospitals in the region,establish pricing method for medical services which is suitable for cost accounting,and promote public hospitals to improve financial performance and control unreasonable medical expenses growth on the basis of cost control.