医学课件costing of hospital cases 医院病例的成本计算

1 Costing of hospital cases 医院病例的成本计算 Changchun, May 2011 长春， 2011年五月 Mr. Jiri Nemec, key expert health management 吉利，医疗管理核心专家 Agenda 内容 n Guiding principles of pricing 定价的指导原则 n Costing of in-patient health care 住院治疗的费用计算 n Allocation of costs to an individual case 单个 病例成本的分配 n Conclusion 结论 2 Guiding principles of pricing 定价的指导原则 3 Starting point for pricing in statutory health insurance 强制医疗保险中定价的起点 n actual costs of health care 医疗服务中的实际成本 versus 与 n available funds of a purchaser 医疗服务购买者的可用资金 n Solving of a discrepancy 弥补差额的解决方法 q by decreasing costs (salaries) q 通过减少成本（工资） q by reducing range of covered services q 通过减少覆盖 （包含） 的服务范围 q by reducing availability (capacity of providers) q 通过减少可用性（医院的能力） 4 Calculation of tariffs/prices for remuneration 报销费用 /付费的价格 n The basic rule for reimbursement can be expressed as follows: n 报销的基本规则可用以下形式： Reimbursement + Cost sharing + Incentives = Costs + Profit 报销费用 +费用分担 +奖励 =成本 +收益 5 Costing of in-patient health care 住院治疗的费用 6 Why costing ? 成本计算的原因 Need to determine price for 需要为下列内容定价 q per service q 每项服务 q per day q 每天 q per discharge q 每项出院 q per case q 每项病例 Approaches to costing 成本计算的方法 n costing studies based on actual costs n 成本计算学是以精算为基础的 n normative approach based on standards n 规范的方法是以 标准 为基础的 q physicians, nurses per one bed q 每床使用的医师、护士 q standard salaries q 标准的 工资 n combination of both n 综合两者 8 Costing of in-patient care 住院治疗的成本计算 n rather complicated organizational structure of hospitals n 医院或复杂的组织结构 n costing studies done only for a sample of hospitals (referential hospitals) n 成本计算学仅仅只在一 组 抽样医院 开展 (参照医院） n 10-25 % hospitals in the sample usually sufficient n 将 10-25%的医院作为抽样 一般地就足够了 Costs 成本 n direct costs - attributable to individual hospital cases n 直接成本 直接归于 医院病例 q example- more expensive material, implanters q 例如 昂贵的材料，移植物 n overhead costs allocated to individual hospital cases by some distribution mechanism n 管理 成本 通过一些分配机制 分摊 到 每个 的医院病例 上 q example-administrative cost, heating, maintenance q 例如 管理成本， 取暖 ，维护和保养 Cost centres 成本点 n the lowest level of organizational unit from the point of view of accounting n 从会计的角度看，最低层次的组织单位 n production cost centres (direct)-health care is actually delivered in them n 生产成本点（直接） -医疗服务事实上送达的对象 n indirect cost centres support of production cost centres n 间接成本点 支持生产成本点 Production cost centres生产成本点 n Standard ward 标准病房 n Intensive care 重症护理 n Dialysis 透析 n Operational theatre 手术室 n Anesthesia 麻醉 n Delivery rooms 接生室 n Cardiologic diagnostics and therapy 心外科诊断和治疗 n Endoscopic diagnostics and therapy 内镜诊断和治疗 n Radiology 放射 n Laboratories 化验 n Other diagnostics (EKG,EEG, sonographo etc.) n 其他诊疗（心电图，脑电图，超声波等等） Indirect cost centres 间接成本点 n overhead costs centres 管理 成本点 q Management 行政 管理 q Kitchen 伙食 q laundry etc. 衣物清洗等等 n cost centres of medical infrastructure n 医疗基础设施的成本点 q pharmacy 药房 q central sterilization 集中消毒 q internal transport of patients 病人内部转 送 q orthopaedic work-shop etc.骨科工作室 Costs of cost centres 成本点的费用 n own costs 自产成本 q personnel costs of physicians 医师的人事成本 q personnel costs of nurses 护士的人事成本 q personnel cost of medical-technical services q 医疗技术服务的人事成本 q drug costs 药品成本 q costs of implants and prostheses 移植和 材料 成本 q costs of other medical material 其他医疗材料成本 n re-allocated costs (from indirect cost centres) n 再分配成本（从间接成本核心中） Process of costing 费用计算的过程 Determination of own costs for all cost centres 对所有成本点的自产成本计算 Determination of reallocation keys 再分配原则的决定 Reallocation of costs of indirect cost centres 间接成本点费用的再分配 Allocation of total costs of direct costs centres to remuneration units 将直接成本点的总费用 加到支付机构上 Reallocation keys overhead cost centres 再分配原则 管理 成本点 Cost centre 成本点 Reallocation key 再分配原则 Property administration 财产管理 m2 of useful area 可用面积 Administration and management 行政和管理 number of employees 人员数量 IT 信息技术 number of employees人员数量 Kitchen 伙食 number of meals 就餐次数 Laundry 衣物清洗 kg of washing 清洗重量 Cleaning 清洁 m2 of cleaned area 清洁面积 Energy supply 电力供应 m2 of useful area 可用面积 In-house transport 院内搬运 number of transports 搬运 数量 Central store 集中存储 number of stored items 存储数量 Reallocation keys- costs centres of medical infrastructure 再分配原则 医疗基础设施成本点 Cost centre 成本点 Reallocation key 再分配原则 Archive 档案文件 number of documents 文件数量 Film laboratory 胶片冲洗室 number of documents 文件数量 Orthopaedic work-shop 骨科工作室 number of hours 时间 Medical library 医学图书 number of physicians 医师数量 Transport of patients 病人转移 number of transports 转移数量 Pharmacy 药房 number of orders 处方数量 Central sterilization 集中消毒 number sterilized units 消毒单位数量 Medical store 医疗仓库 number of stored items 存储数量 Supply of medical gasses 医疗气体供 应 consumed volume 消耗体积 Reallocation costs of indirect cost centres (1) 间接成本点的费用再分配 n mutual reallocation of costs 成本的相互再分配 q where n VNi are own costs of i-th cost centre VNi是 i-th 成本点的自产成本 n Ci are costs of i-th cost centre after the redistribution of costs n Ci 是费用再分配后， i-th 成本点的费用 n pij is share of consumption of the i-th centre on production of j-th cost centre n pij 表征的是 第 i个消费中心所消耗的占第 j个成本中心所生产出的比例 Reallocation costs of indirect cost centres (2)间接成本点的费用再分配 n stepped reallocation of costs 费用再分配的步骤 q reallocation is done in sequence of indirect costs centres (in descendant order according to their own costs) q 对间接成本按次序再分配（依据其自产成本的产出顺序） n direct reallocation of costs of indirect costs centres to production cost centres n 直接 把间接费用分摊到成本点上 n all cost interactions among indirect centres are neglected n 间接成本点的相互作用的费用不予以考虑 Determination of own costs of cost centres* 自产成本费用点的计算 Overhead cost centres 杂项费用点 Personnel costs 人事成本 Material costs 材料成本 Other costs 其他成本 Total own costs 总计次产成本 Administration 行政管理 56 000 1 000 12 000 69 000 Cleaning 清洁 18 000 7 000 5 000 30 000 Laundry 清洗衣物 9 000 6 000 12 000 27 000 Personnel cost (RMB) Material costs Production costs centres 生产成本点 Doctors 医生 Nurses 护士 Drugs (general) 药品（一般） Drugs (assigned) 药品（指定） Other material 其他材料 Surgical ward 外科手术区 200 000 350 000 300 000 20 000 1 500 Intensive care 重症护理 20 000 60 000 20 000 15 000 600 Operating theatre 手术室 30 000 40 000 3 000 2 000 * everything in thousands of RMB 所有以千元人民币计算 Determination of reallocation keys 再分配原则的确定 Cost centres 费用点 Administration 行政 Cleaning 清洁 Laundry 衣物 No. employees 员工数量 M 2 面积 Kg 公斤 Administration 行政 Cleaning 清洁 40 Laundry 清洗衣物 30 600 Surgical ward 外科室 900 15 000 750 000 Intensive care 重症护理 150 1 500 50 000 Operating theatre 手术室 50 400 20 000 Totally 合计 1 170 17 500 820 000 Cost centres费用点 Reallocation keys Administration行政 Cleaning清洁 Laundry衣物 Administration行政 Cleaning清洁 3,4% Laundry清洗衣物 2,6% 3,4% Surgical ward外科室 76,9% 85,7% 91,5% Intensive care重症护理 12,8% 8,6% 6,1% Operating theatre手术室 4,3% 2,3% 2,4% 91.5 % = 750 000 / 820 000 Reallocation of costs of indirect cost centres* 间接成本点的费用再分配 Cost centres 成本点 Own costs自产成本 Administration 1st step 行政 第一步 Cleaning 2nd step 清洁 第二步 Laundry 3rd step 衣物 第三步 Administration 行政 69 000 Cleaning 清洁 30 000 32 359 Laundry 衣物清洗 27 000 28 769 29 879 Surgical ward 外科区 53 077 80 813 108 141 Intensive care 重症护理 8 846 11 620 13 442 Operating theatre 手术室 2 949 3 688 4 417 Totally 合计 126 000 126 000 126 000 126 000 1. 32 359 = 30 000 + 69 000 * 3.4 % 2. 29 879 = 28 769 + 32 359 * 3.4 % 3. 108 141 = 80 813 +29 879 * 91.5 % (1) (2) (3) * everything in thousands of RMB 所有以千元人民币计算 Recapitulation of costs of direct cost centres* 直接成本点的费用再分配 Personnel cost 人事成本 Material costs 材料成本 Overhead costs 杂项 Total costs 合计 Production cost centres 生产成本点 Doctors 医生 Nurses 护 士 Drugs (general) 药品（一般） Drugs (assigned) 药品（指定 ) Other material 其他材料 Surgical ward 外科区 200 000 350 000 300 000 20 000 15 000 108 141 993 141 Intensive care 重症护理 20 000 60 000 20 000 15 000 6 000 13 442 134 442 Operating theatre 手术室 30 000 40 000 3 000 2 000 4 417 79 417 * everything in thousands of RMB 所有以千元人民币计算 Allocation of costs to an individual case 单独病例成本的分配 24 Allocation of costs of direct cost centres to an individual hospital case 对个别医院的直接成本点的费用分配 Determination of costs of direct cost centres 直接成本点的费用确定 Determination of allocation keys and their unit costs 分配原则和其单位成本的确定 Determination of costs of the case in units of the allocation keys 根据分配原则单位决定病例费用 Allocation of costs for the case based on the units of allocation keys 根据分配原则单位分配病例费用 Allocation keys for costs of individual hospital cases Production cost centre 生产成本点 Personnel costs Material costs Physicians 医师 Nurses 护士 Technicians 技师 Drugs 药品 medical material 医疗材料 Standard ward 标准病房 length of stay 住院时长 normative nursing time 标准护理时间 length of stay 住院 天数 normative nursing time 标准护理时长 Intensive care 重症护理 weighted number of hours of intensive care 重症护理时间的加权 Dialysis 透析 weighted number of dialysis 透析数的加权 Operation theatres 手 术室 duration of an operation in hours 手术时间的持续时长 Anaesthesia 麻醉 duration of anaesthesia including preparatory time 包括准备时间的麻醉时长 Delivery rooms 产房 duration of a stay in the room in hours 在病房的时长 Costs per units of allocation keys 每单位成本的分配原 则 Personnel cost人事成本 Material costs材料成本 Overhead costs 杂项成本 Production cost centres 生产成本点 Doctors 医生 Nurses 护士 Drugs (general) 药（一般） Drugs (assigned) 药（指定） Other material 其他材料 Surgical ward 外科病房 200 000 350 000 300 000 20 000 15 000 108 141 Intensive care 重症护理 20 000 60 000 20 000 15 000 6 000 13 442 Operating theatre 手术室 30 000 40 000 3 000 2 000 4 417 Personnel costs 人事成本 Material costs 材料成本 Overhead costs 杂项成本 Totally 总计Production cost centres 生产成本点 Doctors 医生 Nurses护 士 Drugs (general)药品 （一般） Other material 其他材料 Surgical ward (per day of stay) 外科病房（每日） 500 875 750 38 270 2 433 Intensive care (per hour) 重症护理 （每小时） 200 600 200 60 134 1 194 Operating theatre (per hour) 手术室（每小时） 1 500 2 000 150 100 221 3 971 Total costs 总成本 (thousand RMB) Costs per unit 每单位成本