单病种定价与实际成本的比较研究  

Comparative Study on Pricing and Actual Cost of Single Disease

作　　者：龙琴英 邬卫东 刘莉 魏先江 李敏 袁有树 LONG Qinying;WU Weidong;LIU Li;WEI Xianjiang;LI Min;YUAN Youshu(Health Management Teaching and Research Office,Department of Basic Medicine,Guizhou Nursing Vocational College,Guiyang Guizhou 550000,China;Party Committee Office,Guizhou University of Traditional Chinese Medicine,Guiyang Guizhou 550000,China;Department of Medical Insurance,the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang Guizhou 550000,China;School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]贵州护理职业技术学院基础医学部健康管理教研室,贵州贵阳550000 [2]贵州中医药大学党委办公室,贵州贵阳550000 [3]贵州中医药大学第一附属医院医保科,贵州贵阳550000 [4]北京中医药大学中医学院,北京100029

出　　处：《中国卫生标准管理》2023年第1期97-101,共5页China Health Standard Management

摘　　要：目的研究单病种定价与实际成本的差异,指出现行单病种付费制度存在的问题,为促进按病种付费政策的顺利开展提供对策建议。方法以贵州某三甲医院单胎顺产单病种为例,将该院2020年出院主诊断为“单胎顺产”且符合样本要求的产妇,分为W、H及B组,采用卫生经济学成本核算方法,进行产妇及病种成本核算,运用SPSS 19.0统计学软件对成本数据进行统计分析。结果在W、H组中,单病种付费组产妇的人均住院成本明显低于非单病种付费组,且差异均有统计学意义(P<0.05)。单病种-W、H及B的实际成本为5632.19、5972.35、5859.29元,依次比其医保定价高2432.19、1812.35及2019.29元,每收治1例该单病种产妇,A院依次需承担43.18%、30.35%、34.46%的亏损率。结论实施单病种付费管理有助于促使医院主动控制成本,但经病种成本核算,该病种的实际成本明显比其定价高。基于此,文章从改进病种定价方法,建立价格定期调整机制;加强临床路径管理;扩大单病种付费试点;推动医保支付方式升级;实施病种成本管理,推进医院精细化管理等提出建议,以促进按病种付费政策的顺利开展。Objective To Study the difference between disease pricing and actual cost,point out the problems in the current single-disease payment system,and provide countermeasures and suggestions for promoting the smooth implementation of the disease-based payment policy.Methods In this study,a singlepregnancy in a tertiary A hospital in Guizhou Province was taken as an example.The mothers who were discharged from the hospital in 2020 who were diagnosed as“single child delivery”and met the sample requirements were divided into groups W,H,and B.The article adopts the cost accounting method of health economics to calculate the cost of parturient and disease,and use SPSS 19.0statistical software tostatistically analyze the cost data.Results In groups W and H,the per capita hospitalization costs of women in the single-disease payment group were lower than those in the nonsingle-disease payment group,and the differences were statistically significant(P<0.05).The actual cost of a single disease type-W,H,and B was 5632.19,5972.35,and 5859.29 yuan,which was 2432.19,1812.35 and 2019.29 yuan higher than their disease prices in turn.According to the pricing and payment of medical insurance diseases,hospital A had to bear the loss rate of 43.18%,30.35%,and 34.46%for each case of the single-disease mother admitted to the hospital.Conclusion The implementation of singledisease payment will help hospitals to take the initiative to carry out cost control.However,after calculating the cost of the disease,the actual cost of the disease is significantly higher than the pricing of the disease.Based on this,this article proposes suggestions from improving disease pricing methods,establishing regular price adjustment mechanisms,strengthening clinical path management,expanding single-disease payment pilots,and promoting the upgrading of medical insurance payment methods,implementing disease cost management,etc.Promote the smooth development of the disease-based payment policy.

关 键 词：按病种付费 单病种付费 单胎顺产 单病种 成本核算 实际成本 病种定价 

分 类 号：R197[医药卫生—卫生事业管理]