發(fā)布時(shí)間：2018-04-20 22:22

  本文選題：單病種 + 成本核算��； 參考：《長(zhǎng)沙理工大學(xué)》2014年碩士論文

【摘要】：隨著醫(yī)療衛(wèi)生體制改革的深入和醫(yī)療保險(xiǎn)制度改革的推進(jìn),醫(yī)院如何在保持其公益性定位的前提下,增收節(jié)支、控制醫(yī)療衛(wèi)生成本、提高醫(yī)療服務(wù)質(zhì)量,從而實(shí)現(xiàn)可持續(xù)發(fā)展是醫(yī)院亟待解決的難題。本文從醫(yī)院的成本核算入手,特別是通過(guò)對(duì)單病種成本核算的研究,對(duì)解決這一難題具有一定理論和實(shí)踐指導(dǎo)意義。本文從公立醫(yī)院醫(yī)療改革現(xiàn)狀出發(fā),回顧了按病種付費(fèi)方式和單病種成本核算的相關(guān)文獻(xiàn)。以病種分型、醫(yī)院成本管理理論等理論為基礎(chǔ),對(duì)單病種和單病種成本核算的相關(guān)概念進(jìn)行界定,用充分的理論支持,分析了單病種成本核算的必要性和現(xiàn)有核算方法的利弊,然后結(jié)合我國(guó)公立醫(yī)院的現(xiàn)狀,并以此為依據(jù),構(gòu)建公立醫(yī)院?jiǎn)尾》N成本核算模型。本文選取湖南省某三級(jí)甲等醫(yī)院急性心肌梗死單病種為案例進(jìn)行研究,以2011-2013年間該病種患者的住院費(fèi)用和患者情況等相關(guān)數(shù)據(jù)作為研究樣本進(jìn)行案例分析。首先,將構(gòu)建的單病種成本核算模型運(yùn)用于案例病種,核算353例患者的成本,然后對(duì)病種成本的構(gòu)成、成本與患者社會(huì)特征、成本與患者臨床特征的關(guān)系進(jìn)行描述性統(tǒng)計(jì)分析,最后采用多元線性回歸方法分析單病種成本的影響因素,并驗(yàn)證單病種成本與患者情況的相關(guān)性,并在此基礎(chǔ)上生成該病種成本的測(cè)算模型。案例分析的結(jié)果表明：在我國(guó)現(xiàn)有的醫(yī)院會(huì)計(jì)制度下,單純從醫(yī)院的角度研究單病種成本的核算模型,不能滿足醫(yī)療改革的需要。從醫(yī)院和患者雙方面入手,研究單病種成本核算模型,醫(yī)務(wù)人員可以將就診患者的各項(xiàng)情況轉(zhuǎn)化成對(duì)應(yīng)參數(shù)代入成本測(cè)算模型中,測(cè)算出不同情況的患者選擇不同治療方案時(shí)產(chǎn)生的成本。該模型用于輔助醫(yī)生根據(jù)患者病情預(yù)測(cè)治療過(guò)程將會(huì)耗用的醫(yī)院成本,指導(dǎo)醫(yī)生在保證有效的治療措施的前提下,盡量控制醫(yī)療費(fèi)用,幫助患者家屬選擇治療最適合的治療方案。同時(shí)也可以為醫(yī)保部門(mén)定價(jià)提供科學(xué)的參考依據(jù)。單病種成本測(cè)算模型的構(gòu)建無(wú)疑將是造福社會(huì)、醫(yī)院和病患家庭的“多贏”之措。
[Abstract]:With the deepening of the reform of the medical and health system and the promotion of the reform of the medical insurance system, how to increase the income and reduce the expenditure, control the cost of medical and health care, and improve the quality of medical service under the premise of maintaining its public welfare orientation, Therefore, the realization of sustainable development is a difficult problem to be solved urgently in hospitals. This paper starts with the cost accounting of the hospital, especially through the study of the cost accounting of the single disease, which has a certain theoretical and practical significance to solve this difficult problem. Starting from the current situation of medical reform in public hospitals, this paper reviews the related literature on the way of paying for each disease and the cost accounting of single disease. Based on the theory of disease classification and hospital cost management, this paper defines the related concepts of single disease and single disease cost accounting, and analyzes the necessity of single disease cost accounting and the advantages and disadvantages of existing accounting methods with sufficient theoretical support. Then, based on the current situation of public hospitals in China, the cost accounting model of single disease in public hospitals is constructed. This paper selects the single disease of acute myocardial infarction in a hospital of Grade 3A in Hunan Province as a case study, taking the hospitalization cost and patient condition of patients with this disease from 2011 to 2013 as the case study samples. Firstly, the single disease cost accounting model is used to calculate 353 patients' cost, and then the relationship between the cost and the social characteristics, the relationship between the cost and the clinical characteristics is analyzed. Finally, the multivariate linear regression method was used to analyze the factors affecting the cost of single disease, and to verify the correlation between the cost of single disease and the patient's condition. The results of the case study show that under the present hospital accounting system, the study on the cost accounting model of single disease from the hospital perspective can not meet the needs of medical reform. Starting from both hospital and patient, the cost accounting model of single disease is studied. The medical staff can convert each condition of the patient to the corresponding parameter into the cost calculation model. The cost of choosing different treatment options for patients with different conditions was estimated. The model is used to assist doctors to predict the hospital cost that will be consumed by the treatment process according to the patient's condition, and to guide doctors to control the medical cost as far as possible while ensuring effective treatment measures. Help the patient's family to choose the most suitable treatment. At the same time, it can also provide a scientific reference for the health care sector pricing. The construction of single disease cost calculation model will benefit the society, hospital and patient family.
【學(xué)位授予單位】：長(zhǎng)沙理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R197.322

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本文編號(hào)：1779711