基于中医优势病种临床路径的人力成本分析——以眩晕病(原发性高血压)为例  

Analysis of labor cost based on clinical pathway of traditional Chinese medicine dominant diseases:taking vertigo disease(essential hypertension)as an example

作　　者：卢艳英 黄玮熙 滕峻 梁惠敏 刘维 邓斌[1] 刘凡 颜艳君 张小朵 陈文 何杰 黄雪飞 李雪 LU Yanying;HUANG Weixi;TENG Jun;LIANG Huimin;LIU Wei;DENG Bin;LIU Fan;YAN Yanjun;ZHANG Xiaoduo;CHEN Wen;HE Jie;HUANG Xuefei;LI Xue(Shenzhen Bao’an District Hospital of Traditional Chinese Medicine,Shenzhen 518100,China)

机构地区：[1]深圳市宝安区中医院,广东深圳518100

出　　处：《现代医院》2023年第3期413-417,共5页Modern Hospitals

基　　金：广东省卫生经济学会科研课题项目:面上课题立项资助(2020-WJMZ-44)。

摘　　要：目的探讨深圳市某三甲公立中医院基于中医优势病种临床路径的人力成本。方法基于时间驱动作业成本法,以临床路径的标准化诊疗、护理流程为作业项目,以每一项作业项目消耗的时长为人力成本的分摊依据,随机追踪50例眩晕病(原发性高血压)病例的人力资源消耗,从医疗、护理、中医、西医、职称等不同角度核算分析基于临床路径诊疗的眩晕病(原发性高血压)病种的人力成本。结果在标准临床路径情况下,眩晕病患者从入院到出院整个流程过程中所需耗费的作业时间为4560 min,总人力成本为6059.84元;其中,医师和护理人员的作业时间分别为2060 min与2500 min,作业时间占比为45%、55%;医师治疗成本和护理成本分别为3589.24、2470.60元,人力成本权重系数分别为0.592、0.408;护理人员的作业时间长但人力成本权重系数更低。医师与护理单位时间人力成本分别为1.74元/min、0.99元/min;西医治疗与西医护理单位时间人力成本分别为2.06元/min、1.13元/min,中医治疗与中医护理单位时间人力成本分别为0.98元/min、0.59元/min,中医相关的诊疗或者护理项目的单位人力成本均低于西医相关的诊疗或护理项目。结论在病种分值付费改革背景下,基于临床路径结合时间驱动作业成本法,进行中医优势病种人力成本测算,能够明晰不同诊疗/护理项目的难易程度、风险程度以及工作量大小,有利于优化医疗人力资源配置,为单病种收费标准的制定提供科学的成本核算依据。Objective To explore the labor cost based on clinical pathway of traditional Chinese medicine dominant diseases in a tertiary public traditional Chinese medicine hospital in Shenzhen.Methods Based on the Time-Driven Activity-Based Costing method,the standardized diagnosis and treatment and nursing process of clinical pathway were taken as the operation activities,and the time consumed by each operation activities was taken as the allocation basis of labor cost.The human resource consumption of 50 cases of vertigo disease(essential hypertension)was randomly tracked.Lastly,the labor cost of vertigo disease(essential hypertension)based on clinical pathway was calculated and analyzed from the perspectives of medical treatment,nursing care,traditional Chinese medicine,western medicine and professional title.Results In the case of standard clinical pathway,the operation time of patients with vertigo from admission to discharge was 4560 minutes,and the total labor cost was 6059.84 yuan.Among them,the operating time of doctors and nurses was 2060 minutes and 2500 minutes,respectively,accounting for 45%and 55%of the operating time;The medical treatment cost and nursing cost were 3589.24 and 2470.60 yuan,respectively,and the weight coefficients of labor cost were 0.592 and 0.408,respectively.The working hours of nursing staff are longer but the weight coefficient of labor cost is lower.The labor costs per unit time of western medicine treatment and western medicine nursing were 2.06 yuan/min and 1.13 yuan/min,respectively.The labor costs per unit time of TCM treatment and TCM nursing were 0.98 yuan/min and 0.59 yuan/min,respectively.The unit labor cost of TCM related diagnosis and treatment or nursing projects was lower than that of western medicine related diagnosis and treatment or nursing projects.Conclusion Under the background of diagnosis-score payment reform,based on the clinical pathway,combined with time-driven activity-based costing method,the labor cost of dominant diseases of traditional Chinese medicine is cal

关 键 词：临床路径 时间驱动作业成本法 病种成本 人力成本 中医优势病种 

分 类 号：R197.32[医药卫生—卫生事业管理] R1-9[医药卫生—公共卫生与预防医学]