發(fā)布時間：2018-05-05 03:27

  本文選題：獨立血液凈化中心 + 成本�。� 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過比較不同醫(yī)療機構(gòu)血液凈化服務(wù)的運行成本、收支結(jié)余及服務(wù)量等方面存在的差異,并對差異背后存在的原因進(jìn)行分析。發(fā)現(xiàn)獨立血液凈化中心的機構(gòu)運行優(yōu)勢,為完善獨立血液凈化機構(gòu)準(zhǔn)入及醫(yī)保支付標(biāo)準(zhǔn),鼓勵社會力量積極舉辦獨立設(shè)置血液凈化機構(gòu)提供客觀的決策依據(jù),指導(dǎo)優(yōu)質(zhì)醫(yī)療服務(wù)下沉至基層。探索適宜的成本核算路徑,為今后類似醫(yī)療服務(wù)成本核算提供方法借鑒。方法:編制訪談提綱,對相關(guān)科室負(fù)責(zé)人進(jìn)行訪談。了解綜合醫(yī)院與獨立設(shè)置血液凈化中心血液凈化醫(yī)療資源配置情況、血液凈化患者數(shù)量及變化趨勢、血液凈化服務(wù)開展種類及每類服務(wù)收費標(biāo)準(zhǔn)和醫(yī)保報銷等現(xiàn)況發(fā)現(xiàn)機構(gòu)運行中存在的困難和問題;了解兩類機構(gòu)信息化建設(shè)、成本管理、日常工作數(shù)據(jù)記錄等情況。通過自主設(shè)計的成本數(shù)據(jù)采集表,采集相關(guān)數(shù)據(jù),計算兩類機構(gòu)血液凈化科室直接成本,并確定行政后勤科室、相關(guān)醫(yī)輔科室直接成本,按照《醫(yī)院財務(wù)制度》規(guī)定的分項逐級分步結(jié)轉(zhuǎn)的辦法計算出血液凈化科室全成本。以工作量和項目難度系數(shù)作為分?jǐn)傁禂?shù)求得不同種類的血液凈化服務(wù)項目成本。采用比較分析法對兩類機構(gòu)血液凈化資源配置情況、血液凈化服務(wù)收入、成本構(gòu)成及收支結(jié)余等情況進(jìn)行比較,找出差異較大的部分,剖析產(chǎn)生差異的原因。結(jié)果:數(shù)據(jù)分析結(jié)果顯示,一個季度運行期間,市醫(yī)院血液凈化科收支結(jié)余25.14萬元,收支結(jié)余率15.96%,市級獨立血液凈化中心收支結(jié)余21.97萬元,收支結(jié)余率15.71%;縣醫(yī)院血液凈化科收支結(jié)余16.4萬元,收支結(jié)余率13.84%,縣級獨立血液凈化中心收支結(jié)余28.68萬元,收支結(jié)余率24.03%。兩家獨立血液凈化中心均可以實現(xiàn)良性運轉(zhuǎn)。結(jié)論:調(diào)研點獨立血液凈化中心配有開展血液凈化服務(wù)的醫(yī)療衛(wèi)生資源,并與醫(yī)保部門對接,維持穩(wěn)定的血液凈化患者流量。通過采取合理的血液凈化服務(wù)收費價格,控制機構(gòu)運行成本,均實現(xiàn)了較高比例的收支結(jié)余,其中縣級獨立血液凈化中心收支結(jié)余率為23.04%,為四家機構(gòu)中最高。兩家獨立血液凈化中心的檢查化驗收入均比同區(qū)域的醫(yī)院高,而綜合醫(yī)院血液凈化科藥品成本均比同區(qū)域的血液凈化中心高,反映獨立血液凈化中心重視評估患者病情,及時將病情較為復(fù)雜的患者轉(zhuǎn)至綜合醫(yī)院接受治療,控制醫(yī)療風(fēng)險的發(fā)生。獨立血液凈化中心主要為病情較為穩(wěn)定的患者提供血液凈化服務(wù),可作為方便患者的血液凈化服務(wù)分級診療機構(gòu),完善血液凈化服務(wù)提供體系,緩解目前血液凈化供需緊張局面。同時,綜合醫(yī)院可以發(fā)揮急救和治療危重病癥的功能,承擔(dān)更多復(fù)雜病情患者的血液凈化治療。
[Abstract]:Objective: to compare the operating cost, balance of income and expenditure and service volume of blood purification service in different medical institutions, and analyze the reasons behind the differences. It is found that the operation advantage of the independent blood purification center can provide an objective decision basis for perfecting the admission of the independent blood purification institution and the payment standard of medical insurance, and encouraging the social forces to organize and set up the blood purification organization independently. To guide the quality of medical services to sink to the grass-roots level. To explore the appropriate path of cost accounting to provide reference for the cost accounting of similar medical services in the future. Methods: the outline of interview was compiled and the responsible persons of relevant departments were interviewed. To understand the allocation of medical resources for blood purification in general hospitals and independently set up blood purification centers, the number of patients with blood purification and the trend of changes, The types of blood purification services and the current situation such as charging standard for each type of service and medical insurance reimbursement etc. The difficulties and problems in the operation of the two organizations are found, and the information construction, cost management and daily work data record of the two types of institutions are understood. The direct cost of blood purification department of two kinds of institutions is calculated through the cost data acquisition table designed by oneself, and the direct cost of administrative logistics department and related medical assistant department is determined. The total cost of blood purification department was calculated according to the method of carrying forward step by step by step in accordance with the regulation of hospital financial system. The cost of different kinds of blood purification services was obtained by using workload and project difficulty coefficient as the sharing coefficient. This paper compares the distribution of blood purification resources, the income of blood purification service, the composition of cost and the balance of income and expenditure between the two kinds of institutions by means of comparative analysis, finds out the big difference and analyzes the reasons for the difference. Results: the results of data analysis showed that the balance of revenue and expenditure of blood purification department of municipal hospital was 251400 yuan, the balance rate of income and expenditure was 15.96 yuan, and the balance of income and expenditure of municipal independent blood purification center was 219700 yuan during a quarterly operation. The balance rate of income and expenditure was 15.71 yuan, the balance of income and expenditure of blood purification department of county hospital was 164000 yuan, the balance rate of income and expenditure was 13.84%, the balance of income and expenditure of county independent blood purification center was 286800 yuan, and the balance rate of income and expenditure was 24.03 yuan. Two independent blood purification centers can achieve benign operation. Conclusion: the independent blood purification center is equipped with the medical and health resources to carry out blood purification service and docking with the medical insurance department to maintain a stable blood purification patient flow. By adopting reasonable price of blood purification service and controlling the operating cost of the organization, a high proportion of the balance of income and expenditure was realized, and the balance rate of the independent blood purification center at the county level was 23.04, which was the highest among the four institutions. The examination income of the two independent blood purification centers was higher than that of the hospitals in the same region, and the cost of drugs in the blood purification departments of the general hospitals was higher than that of the blood purification centers in the same region, which reflected the importance attached by the independent blood purification centers to the evaluation of the patients' condition. Timely transfer the more complicated patients to the general hospital for treatment, to control the occurrence of medical risks. The independent blood purification center mainly provides blood purification services for patients with relatively stable condition. It can be used as a convenient blood purification service grading organization for diagnosis and treatment, and perfect the blood purification service providing system. Ease the current tension between supply and demand for blood purification. At the same time, the general hospital can play the role of first aid and treatment of critical disease, undertake more complex patients blood purification treatment.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.322

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