公立医院单位成本、成本结构对收支结余的影响研究  

Research on the Impact of Unit Cost and Cost Structure on Income and Expenditure Balance in Public Hospitals

作　　者：张爱玲[1] 谭华伟 ZHANG Ai-ling;TAN Hua-wei(Yantaishan Hospital,Yantai,Shandong,264003,China)

机构地区：[1]烟台市烟台山医院,山东烟台264003 [2]华中科技大学同济医学院医药卫生管理学院,武汉430030

出　　处：《中国卫生经济》2022年第7期83-87,共5页Chinese Health Economics

基　　金：重庆市社会科学规划项目(2020YBGL98、2019YBJJ033);重庆市制度创新项目(cstc2020jsyj-zzysb AX0043)。

摘　　要：目的:比较不同等级公立医院患者成本及其结构,并探讨成本管理策略对医院收支结余的影响。方法:利用公立医院科室成本数据,经过三级分摊后计算临床门诊类和临床住院类科室患者单位成本与结构;采用多元回归分析不同成本管理策略对收支结余的影响机制。结果:2019年样本市三级医院门诊诊次成本、每出院患者单位成本、每床日单位成本分别为296元、13802元和1565元,分别是二级医院的1.24倍、1.63倍和1.49倍;不同等级医院之间医疗服务成本差异显著低于药品耗材成本。门诊诊次成本、出院患者单位成本、床日单位成本、人员经费占比、药品耗材费占比对医院收支结余影响具有统计学意义(P<0.05)。结论:临床门诊类科室内部存在医疗服务定价的交叉补贴效应,需采取差异化和低成本领先战略的分类治理策略。Objective:To compare the cost and structure of patients in different grades of public hospitals,and to explore the impact of cost management strategy on hospital balance of income and expenditure.Methods:Based on the cost data of departments in public general hospitals,unit cost and structure of outpatient and inpatient departments were calculated after three-level apportionment.Multiple regression was used to analyze the influence mechanism of different cost management strategies on balance of income and expenditure.Results:In 2019,the outpatient visit cost,unit cost per discharged patient and unit cost per bed day in tertiary hospitals in the sample city were 296 yuan,13802 yuan and 1565 yuan,respectively,which were 1.24 times,1.63 times and 1.49 times of secondary hospitals.The multiple differences of medical service cost among different grades of hospitals were significantly lower than the costs of drug consumables.The cost of outpatient visits,each cost of discharged patients,each cost of bed day,proportion of personnel funds and proportion of drug consumables cost had statistical significance on the hospital’s balance of expenditure(P<0.05).Conclusion:The cross-sub sidy effect of medical service pricing existed in clinical outpatient departments.The categorized governance strategy of differentiation and low-cost leadership strategy should be adopted.

关 键 词：公立医院 患者单位成本 成本结构 收支结余 交叉补贴 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] D922.26[政治法律—经济法学]