【摘要】：研究背景近年來我國醫(yī)療改革在醫(yī)療保障、藥物制度、公共衛(wèi)生服務(wù)等重點(diǎn)領(lǐng)域取得明顯進(jìn)展,但醫(yī)療費(fèi)用依舊過高,為減輕百姓醫(yī)療負(fù)擔(dān)的任務(wù)任重道遠(yuǎn)。外因是變化的條件,內(nèi)因是變化的依據(jù),如何從醫(yī)院的角度出發(fā),研究其成本的變化對(duì)醫(yī)療費(fèi)用的影響,并采取相應(yīng)的管理措施,才能使公立醫(yī)院在不斷變化的外部環(huán)境中,真正實(shí)現(xiàn)其公益性,控制醫(yī)療費(fèi)用的增長。研究目的本研究通過對(duì)兩家樣本醫(yī)院的總成本與病種成本的測算,將成本與費(fèi)用進(jìn)行比較分析,探討目前醫(yī)院發(fā)展存在的問題以及成本的變化對(duì)醫(yī)療費(fèi)用的影響,為醫(yī)院管理發(fā)展和醫(yī)療費(fèi)用控制提供理論與數(shù)據(jù)的支持。研究方法選取寧夏回族自治區(qū)A縣、B縣2家縣級(jí)公立醫(yī)院作為樣本醫(yī)院,通過文獻(xiàn)復(fù)習(xí)、現(xiàn)場調(diào)查、經(jīng)濟(jì)學(xué)原理及方法、統(tǒng)計(jì)方法等對(duì)樣本醫(yī)院成本、病種成本進(jìn)行測算與比較分析,同時(shí)分析兩家醫(yī)院醫(yī)療費(fèi)用的構(gòu)成與影響因素,采用多元線性逐步回歸的方法研究醫(yī)院的主要成本要素對(duì)醫(yī)療費(fèi)用的影響。研究結(jié)果1.醫(yī)院總成本構(gòu)成與測量情況:兩家醫(yī)院均是勞務(wù)成本與其他成本為醫(yī)院的主要成本,A縣人民醫(yī)院勞務(wù)成本占比36.57%、其他成本占比26.55%。B縣人民醫(yī)院勞務(wù)成本占比31.78%、其他成本占比15.84%。2.病種成本測量情況:分別采用項(xiàng)目成本法、臨床路徑法、床日成本法對(duì)兩家醫(yī)院主要病種進(jìn)行測量,測量結(jié)果顯示,項(xiàng)目成本法與床日成本法測算的病種成本普遍高于病種的例均費(fèi)用,采用臨床路徑法測算的病種成本最低。3.醫(yī)療費(fèi)用的構(gòu)成與影響因素分析:兩家樣本醫(yī)院的醫(yī)療費(fèi)用主要由床位費(fèi)、診察費(fèi)、藥品費(fèi)、化驗(yàn)費(fèi)、護(hù)理費(fèi)、手術(shù)費(fèi)、檢查費(fèi)及其他費(fèi)用構(gòu)成,藥品費(fèi)與其他費(fèi)用為醫(yī)療費(fèi)用的主要組成部分。因子分析結(jié)果顯示,藥品費(fèi)用、其他費(fèi)用、檢查費(fèi)用為醫(yī)療費(fèi)用的主要影響因素。4.醫(yī)院總成本對(duì)醫(yī)療費(fèi)用的影響情況:通過多元線性逐步回歸建立的方程顯示A縣醫(yī)院醫(yī)務(wù)人員數(shù)量回歸系數(shù)為0.625,平均住院天數(shù)回歸系數(shù)為0.157,診療項(xiàng)目數(shù)量回歸系數(shù)為0.133,設(shè)備價(jià)值回歸系數(shù)為0.055。B縣醫(yī)院醫(yī)務(wù)人員數(shù)量回歸系數(shù)為0.699,平均住院天數(shù)回歸系數(shù)為0.245,診療項(xiàng)目數(shù)量回歸系數(shù)為0.201,設(shè)備價(jià)值回歸系數(shù)為0.102。說明醫(yī)院勞務(wù)人員數(shù)、設(shè)備價(jià)值、平均住院天數(shù)、診療項(xiàng)目數(shù)量等成本因素為醫(yī)療費(fèi)用的主要影響因素。建議1.加強(qiáng)縣級(jí)醫(yī)院醫(yī)療信息的管理與建設(shè)2.提高縣級(jí)醫(yī)院財(cái)務(wù)管理水平,推行全成本核算3.控制勞務(wù)成本與行政管理成本,提高醫(yī)院資源利用效率4.提升醫(yī)院人力資源管理水平,加強(qiáng)人才隊(duì)伍建設(shè)5.轉(zhuǎn)變傳統(tǒng)管理理念與方式,促進(jìn)臨床路徑管理的實(shí)施6.調(diào)整藥品價(jià)格,降低住院醫(yī)療費(fèi)用,提高醫(yī)院的運(yùn)行效率7.改革醫(yī)院薪酬制度,引導(dǎo)回歸公益性
[Abstract]:Background in recent years, China's medical reform has made significant progress in the key areas of medical security, drug system, public health services, but the medical costs are still too high, in order to reduce the burden of medical care for the people, the task is a long way away. External cause is the condition of change, and internal factor is the basis of change. How to study the influence of the change of cost on medical cost from the point of view of hospital, and take corresponding management measures, in order to make the public hospital in the constantly changing external environment, The real realization of its public welfare, control of the growth of medical costs. Objective the purpose of this study is to compare and analyze the total cost and the disease cost of the two hospitals, and to discuss the problems existing in the development of the hospital and the influence of the change of the cost on the medical cost. To provide theoretical and data support for hospital management development and medical cost control. Methods A county and B county hospitals in Ningxia Hui Autonomous region were selected as sample hospitals. Through literature review, field investigation, economic principles and methods, and statistical methods, the cost of the sample hospitals was analyzed. At the same time, the composition and influencing factors of medical expenses in two hospitals were analyzed, and the influence of main cost factors on medical expenses was studied by the method of multiple linear stepwise regression. Results 1. The composition and measurement of total hospital cost: the labor cost and other cost are the main cost of the hospital, and the labor cost of the people's Hospital in A County is 36.57%. Other costs account for 26.55.B county people's hospital labor costs account for 31.78meters, other costs account for 15.84.2. Cost measurement of disease species: project cost method, clinical path method and bed day cost method were used to measure the main diseases in two hospitals, and the results showed that, The cost calculated by item cost method and bed day cost method is generally higher than the average cost of disease cases, and the cost calculated by clinical pathway method is the lowest. Analysis of the composition and influencing factors of medical expenses: the medical expenses of the two sample hospitals are mainly composed of bed fee, medical examination fee, drug fee, laboratory fee, nursing fee, operating fee, examination fee and other expenses. Drug and other expenses are the main components of medical expenses. Factor analysis showed that the cost of drugs, other costs, and the cost of testing were the main factors affecting medical expenses. 4. The effect of total hospital cost on medical cost: the regression coefficient of hospital medical staff was 0.625 and the regression coefficient of average hospitalization days was 0.157, according to the equation established by multivariate linear stepwise regression. The regression coefficient of number of diagnosis and treatment items was 0.133, the regression coefficient of equipment value was 0.055.B, the regression coefficient of medical staff was 0.699, the regression coefficient of average days in hospital was 0.245, the regression coefficient of quantity of diagnosis and treatment items was 0.201. The regression coefficient of equipment value is 0.102. The cost factors such as the number of service personnel, the value of equipment, the average length of stay in hospital, the number of diagnosis and treatment items are the main influencing factors of medical expenses. Recommendation 1. Strengthening the management and construction of medical information in county-level hospitals. We will improve the financial management level of county-level hospitals and implement full cost accounting. Control labor cost and administrative cost, improve hospital resource utilization efficiency 4. 5. Improve the level of human resources management in hospitals, strengthen the construction of talent team 5. 5. To change the traditional management concepts and methods, promote the implementation of clinical pathway management 6. 5. Adjust drug price, reduce hospitalization medical expenses, improve the efficiency of hospital operation. Reform the hospital salary system and guide the return to public welfare
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.322

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本文編號(hào)：2398150