医院病例的成本计算

1、医院病例的成本计算2Agenda 内容nGuiding principles of pricing 定价的指导原则nCosting of in-patient health care 住院治疗的费用计算nAllocation of costs to an individual case 单个病例成本的分配nConclusion 结论3Guiding principles of pricing 定价的指导原则4Starting point for pricing in statutory health insurance 强制医疗保险中定价的起点nactual costs of health c

2、are 医疗服务中的实际成本versus 与navailable funds of a purchaser 医疗服务购买者的可用资金nSolving of a discrepancy 弥补差额的解决方法qby decreasing costs (salaries) q通过减少成本（工资） qby reducing range of covered servicesq通过减少覆盖（包含）的服务范围qby reducing availability (capacity of providers)q通过减少可用性（医院的能力）5Calculation of tariffs/prices for re

3、muneration 报销费用/付费的价格nThe 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6Costing of in-patient health care住院治疗的费用Why costing ? 成本计算的原因Need to determine price for 需要为下列内容定价qper serviceq每项服务qper da

4、yq每天qper dischargeq每项出院qper caseq每项病例8Approaches to costing 成本计算的方法ncosting studies based on actual costsn成本计算学是以精算为基础的nnormative approach based on standardsn 规范的方法是以标准为基础的qphysicians, nurses per one bed q每床使用的医师、护士qstandard salariesq标准的工资ncombination of bothn综合两者 Costing of in-patient care住院治疗的成本计算

5、nrather complicated organizational structure of hospitalsn医院或复杂的组织结构ncosting 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）n10-25 % 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ndirect costs - attributable to individual hospita

6、l casesn直接成本直接归于医院病例qexample- more expensive material, implantersq例如昂贵的材料，移植物noverhead costs allocated to individual hospital cases by some distribution mechanismn管理成本通过一些分配机制分摊到每个的医院病例上qexample-administrative cost, heating, maintenanceq例如管理成本，取暖，维护和保养Cost centres 成本点nthe lowest level of organizatio

7、nal unit from the point of view of accountingn从会计的角度看，最低层次的组织单位nproduction 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nindirect cost centres support of production cost centresn间接成本点支持生产成本点Production cost centres生产成本点nStandard ward 标准病房nIntensive care 重症护理n

8、Dialysis 透析nOperational theatre 手术室nAnesthesia 麻醉nDelivery rooms 接生室nCardiologic diagnostics and therapy 心外科诊断和治疗nEndoscopic diagnostics and therapy 内镜诊断和治疗nRadiology 放射nLaboratories 化验nOther 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noverhead costs centres

9、 管理成本点qManagement 行政管理qKitchen 伙食qlaundry etc. 衣物清洗等等ncost centres of medical infrastructuren医疗基础设施的成本点qpharmacy 药房qcentral sterilization 集中消毒qinternal transport of patients 病人内部转送qorthopaedic work-shop etc.骨科工作室Costs of cost centres 成本点的费用nown costs 自产成本qpersonnel costs of physicians 医师的人事成本qperson

10、nel costs of nurses 护士的人事成本qpersonnel cost of medical-technical servicesq医疗技术服务的人事成本qdrug costs 药品成本qcosts of implants and prostheses 移植和材料成本qcosts of other medical material 其他医疗材料成本nre-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 f

11、or 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

12、 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

13、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 hou

14、rs 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 co

15、sts 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 nVNi are own costs of i-th cost centren VNi是i-th 成本点的自产成本 Ci are costs of i-th cost centre after the redistribution of costs Ci 是费用再分配后，i-th 成本点的费用 pij is share of consumption of the i-th centre on production

16、of j-th cost centre 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jjijiiCpVNCReallocation costs of indirect cost centres (2)间接成本点的费用再分配nstepped reallocation of costs 费用再分配的步骤qreallocation 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

17、direct reallocation of costs of indirect costs centres to production cost centresn直接把间接费用分摊到成本点上nall cost interactions among indirect centres are neglectedn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 co

18、sts其他成本Total own costs总计次产成本Administration行政管理56 0001 00012 00069 000Cleaning清洁18 0007 0005 00030 000Laundry清洗衣物9 0006 00012 00027 000Personnel cost (RMB)Material costsProduction 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 00

19、0350 000300 00020 0001 500Intensive care 重症护理20 00060 00020 00015 000600Operating theatre 手术室30 00040 0003 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M2 面积Kg 公斤Administration 行政

20、 Cleaning 清洁40 Laundry 清洗衣物30600 Surgical ward 外科室90015 000750 000Intensive care 重症护理1501 50050 000Operating theatre 手术室5040020 000Totally 合计1 17017 500820 000Cost centres费用点Reallocation keysAdministration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%8

21、5,7%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 000Reallocation 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Administration1st 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 00032 359

22、 Laundry 衣物清洗27 00028 76929 879 Surgical ward 外科区 53 07780 813108 141Intensive care重症护理 8 84611 62013 442Operating theatre手术室 2 9493 6884 417Totally 合计126 000126 000126 000126 00032 359 = 30 000 + 69 000 * 3.4 %29 879 = 28 769 + 32 359 * 3.4 %108 141 = 80 813 +29 879 * 91.5 %(1)(2)(3)* everything in

23、 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 000350 000300 00020

24、 00015 000108 141993 141Intensive care重症护理20 00060 00020 00015 0006 00013 442134 442Operating theatre手术室30 00040 0003 000 2 0004 41779 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24Allocation of costs of direct cost centres to an individual hospita

25、l 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

26、单位分配病例费用Allocation keys for costs of individual hospital casesProduction cost centre生产成本点Personnel costsMaterial costsPhysicians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 ca

27、re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

28、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 000350 000300 00020 00015 000108 141Intensive care重症护理20 00060 00020

29、00015 0006 00013 442Operating theatre手术室30 00040 0003 000 2 0004 417Personnel 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）500875750382702 433 Intensive care (per hour) 重症护理（每小时）200600200601341 194Operating theatre (per hour)手术室（每小时）1 5002 0001501002213 971Total costs 总成本总成本 (thousand RMB)Costs per unit每单位成本 (RMB)/ 400 000/ 100 000Det