医院病例的成本计算

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Costingofhospitalcases

医院病例的成本计算

Agenda内容Guidingprinciplesofpricing定价的指导原则Costingofin-patienthealthcare住院治疗的费用计算Allocationofcoststoanindividualcase

单个病例成本的分配Conclusion结论2Guidingprinciplesofpricing

定价的指导原则3Startingpointforpricinginstatutoryhealthinsurance

强制医疗保险中定价的起点4Calculationoftariffs/pricesforremuneration

报销费用/付费的价格Thebasicruleforreimbursementcanbeexpressedasfollows:

报销的基本规则可用以下形式：

Reimbursement+Costsharing+Incentives

=

Costs+Profit报销费用+费用分担+奖励=成本+收益5Costingofin-patienthealthcare

住院治疗的费用6Whycosting?成本计算的原因Needtodeterminepricefor需要为下列内容定价perservice每项服务perday每天perdischarge每项出院percase每项病例Approachestocosting

成本计算的方法costingstudiesbasedonactualcosts成本计算学是以精算为基础的normativeapproachbasedonstandards

规范的方法是以标准为基础的physicians,nursesperonebed每床使用的医师、护士standardsalaries标准的工资combinationofboth综合两者8Costingofin-patientcare

住院治疗的成本计算Costs成本directcosts-attributabletoindividualhospitalcases直接成本—直接归于医院病例example-moreexpensivematerial,implanters例如—昂贵的材料，移植物overheadcosts–allocatedtoindividualhospitalcasesbysomedistributionmechanism管理成本—通过一些分配机制分摊到每个的医院病例上example-administrativecost,heating,maintenance例如—管理成本，取暖，维护和保养Costcentres成本点thelowestleveloforganizationalunitfromthepointofviewofaccounting从会计的角度看，最低层次的组织单位productioncostcentres(direct)-healthcareisactuallydeliveredinthem生产成本点（直接）--医疗服务事实上送达的对象indirectcostcentres–supportofproductioncostcentres间接成本点—支持生产成本点Productioncostcentres生产成本点Standardward标准病房Intensivecare重症护理Dialysis透析Operationaltheatre手术室Anesthesia麻醉Deliveryrooms接生室Cardiologicdiagnosticsandtherapy心外科诊断和治疗Endoscopicdiagnosticsandtherapy内镜诊断和治疗Radiology放射Laboratories化验Otherdiagnostics(EKG,EEG,sonographoetc.)其他诊疗（心电图，脑电图，超声波等等）Indirectcostcentres间接成本点overheadcostscentres管理成本点Management行政管理Kitchen伙食laundryetc.衣物清洗等等costcentresofmedicalinfrastructure医疗基础设施的成本点pharmacy药房centralsterilization集中消毒internaltransportofpatients病人内部转送orthopaedicwork-shopetc.骨科工作室Costsofcostcentres成本点的费用Processofcosting费用计算的过程Determinationofowncostsforallcostcentres对所有成本点的自产成本计算Determinationofreallocationkeys再分配原则的决定Reallocationofcostsofindirectcostcentres间接成本点费用的再分配Allocationoftotalcostsofdirectcostscentrestoremunerationunits将直接成本点的总费用加到支付机构上Reallocationkeys–overheadcostcentres再分配原则—管理成本点Costcentre成本点Reallocationkey再分配原则Propertyadministration财产管理m2ofusefularea可用面积Administrationandmanagement行政和管理numberofemployees人员数量IT信息技术numberofemployees人员数量Kitchen伙食numberofmeals就餐次数Laundry衣物清洗kgofwashing清洗重量Cleaning清洁m2ofcleanedarea清洁面积Energysupply电力供应m2ofusefularea可用面积In-housetransport院内搬运numberoftransports搬运数量Centralstore集中存储numberofstoreditems存储数量Reallocationkeys-costscentresofmedicalinfrastructure

再分配原则—医疗基础设施成本点Costcentre成本点Reallocationkey再分配原则Archive档案文件numberofdocuments文件数量Filmlaboratory胶片冲洗室numberofdocuments文件数量Orthopaedicwork-shop骨科工作室numberofhours时间Medicallibrary医学图书numberofphysicians医师数量Transportofpatients病人转移numberoftransports转移数量Pharmacy药房numberoforders处方数量Centralsterilization集中消毒numbersterilizedunits消毒单位数量Medicalstore医疗仓库numberofstoreditems存储数量Supplyofmedicalgasses医疗气体供应consumedvolume消耗体积Reallocationcostsofindirectcostcentres(1)间接成本点的费用再分配

mutualreallocationofcosts成本的相互再分配

whereVNiareowncostsofi-thcostcentre

VNi是i-th成本点的自产成本

Ci

arecostsofi-thcostcentreaftertheredistributionofcosts

Ci

是费用再分配后，i-th

成本点的费用

pij

isshareofconsumptionofthei-thcentreonproductionofj-thcostcentre

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Reallocationcostsofindirectcostcentres(2)间接成本点的费用再分配Determinationofowncostsofcostcentres*

自产成本费用点的计算Overheadcostcentres杂项费用点Personnelcosts人事成本Materialcosts材料成本Othercosts其他成本Totalowncosts总计次产成本Administration行政管理5600010001200069000Cleaning清洁180007000500030000Laundry清洗衣物900060001200027000Personnelcost(RMB)MaterialcostsProductioncostscentres生产成本点Doctors医生Nurses护士Drugs(general)药品（一般）Drugs(assigned)药品（指定）Othermaterial其他材料Surgicalward外科手术区200000350000300000200001500Intensivecare重症护理20000600002000015000600Operatingtheatre手术室30000400003000

2000*everythinginthousandsofRMB所有以千元人民币计算

Determinationofreallocationkeys

再分配原则的确定Costcentres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

Cleaning清洁40

Laundry清洗衣物30600

Surgicalward外科室90015000750000Intensivecare重症护理150150050000Operatingtheatre手术室5040020000Totally合计117017500820000Costcentres费用点ReallocationkeysAdministration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%

Surgicalward外科室76,9%85,7%91,5%Intensivecare重症护理12,8%8,6%6,1%Operatingtheatre手术室4,3%2,3%2,4%91.5%=750000/820000Reallocationofcostsofindirectcostcentres*

间接成本点的费用再分配Costcentres成本点Owncosts自产成本Administration1ststep行政第一步Cleaning2ndstep清洁第二步Laundry3rdstep衣物第三步Administration行政69000

Cleaning清洁3000032359

Laundry衣物清洗270002876929879

Surgicalward外科区

5307780813108141Intensivecare重症护理

88461162013442Operatingtheatre手术室

294936884417Totally合计12600012600012600012600032359=30000+69000*3.4%29879=28769+32359*3.4%108141=80813+29879*91.5%(1)(2)(3)*everythinginthousandsofRMB所有以千元人民币计算

Recapitulationofcostsofdirectcostcentres*

直接成本点的费用再分配Personnelcost人事成本Materialcosts材料成本Overheadcosts杂项Totalcosts合计Productioncostcentres生产成本点Doctors医生Nurses护士Drugs(general)药品（一般）

Drugs(assigned)药品（指定)Othermaterial其他材料Surgicalward外科区2000003500003000002000015000108141993141Intensivecare重症护理20000600002000015000600013442134442Operatingtheatre手术室30000400003000

2000441779417*everythinginthousandsofRMB

所有以千元人民币计算Allocationofcoststoanindividualcase

单独病例成本的分配24Allocationofcostsofdirectcostcentrestoanindividualhospitalcase对个别医院的直接成本点的费用分配Determinationofcostsofdirectcostcentres直接成本点的费用确定Determinationofallocationkeysandtheirunitcosts分配原则和其单位成本的确定Determinationofcostsofthecaseinunitsoftheallocationkeys根据分配原则单位决定病例费用Allocationofcostsforthecasebasedontheunitsofallocationkeys根据分配原则单位分配病例费用AllocationkeysforcostsofindividualhospitalcasesProductioncostcentre生产成本点PersonnelcostsMaterialcostsPhysicians医师Nurses护士Technicians技师Drugs药品medicalmaterial医疗材料Standardward标准病房lengthofstay住院时长normativenursingtime标准护理时间lengthofstay住院天数normativenursingtime标准护理时长Intensivecare重症护理weightednumberofhoursofintensivecare重症护理时间的加权Dialysis透析weightednumberofdialysis透析数的加权Operationtheatres手术室durationofanoperationinhours手术时间的持续时长Anaesthesia麻醉durationofanaesthesiaincludingpreparatorytime包括准备时间的麻醉时长Deliveryrooms产房durationofastayintheroominhours在病房的时长Costsperunitsofallocationkeys每单位成本的分配原则Personnelcost人事成本Materialcosts材料成本Overheadcosts杂项成本Productioncostcentres生产成本点Doctors医生Nurses护士Drugs(general)药（一般）Drugs(assigned)药（指定）Othermaterial其他材料Surgicalward外科病房2000003500003000002000015000108141Intensivecare重症护理20000600002000015000600013442Operatingtheatre手术室30000400003000

20004417Personnelcosts人事成本Materialcosts材料成本Overheadcosts杂项成本Totally总计Productioncostcentres生产成本点

Doctors医生Nurses护士Drugs(general)药品（一般）Othermaterial其他材料Surgicalward(perdayofstay)外科病房（每日）500875750382702433Intensivecare(perhour)重症护理（每小时）200600200601341194Operatingtheatre(perhour)手术室（每小时）150020001501002213971Totalcosts总成本(thousandRMB)Costsperunit每单位成本(RMB)/400000/100000Determinationofcostsforacasebasedonunitsofallocationkeys(1)根据分配原则单位决定病例费用hospitalcase#n: