1、1,Costing of hospital cases 医院病例的成本计算 Changchun, May 2011 长春，2011年五月 Mr. Jiri Nemec, key expert health management 吉利，医疗管理核心专家,2,Agenda 内容,Guiding principles of pricing定价的指导原则 Costing of in-patient health care住院治疗的费用计算 Allocation of costs to an individual case单个病例成本的分配 Conclusion 结论,3,Guiding princip
2、les of pricing 定价的指导原则,4,Starting point for pricing in statutory health insurance 强制医疗保险中定价的起点,actual costs of health care 医疗服务中的实际成本 versus 与 available funds of a purchaser 医疗服务购买者的可用资金 Solving of a discrepancy 弥补差额的解决方法 by decreasing costs (salaries) 通过减少成本（工资） by reducing range of covered service
3、s 通过减少覆盖（包含）的服务范围 by reducing availability (capacity of providers) 通过减少可用性（医院的能力）,5,Calculation of tariffs/prices for remuneration 报销费用/付费的价格,The basic rule for reimbursement can be expressed as follows: 报销的基本规则可用以下形式：Reimbursement + Cost sharing + Incentives = Costs + Profit 报销费用+费用分担+奖励=成本+收益,6,Co
4、sting of in-patient health care 住院治疗的费用,Why costing ? 成本计算的原因,Need to determine price for 需要为下列内容定价 per service 每项服务 per day 每天 per discharge 每项出院 per case 每项病例,8,Approaches to costing 成本计算的方法,costing studies based on actual costs 成本计算学是以精算为基础的 normative approach based on standards规范的方法是以标准为基础的 phys
5、icians, nurses per one bed 每床使用的医师、护士 standard salaries 标准的工资 combination of both 综合两者,Costing of in-patient care 住院治疗的成本计算,rather complicated organizational structure of hospitals 医院或复杂的组织结构 costing studies done only for a sample of hospitals (referential hospitals) 成本计算学仅仅只在一组抽样医院开展(参照医院） 10-25 %
6、hospitals in the sample usually sufficient 将10-25%的医院作为抽样一般地就足够了,Costs 成本,direct costs - attributable to individual hospital cases 直接成本直接归于医院病例 example- more expensive material, implanters 例如昂贵的材料，移植物 overhead costs allocated to individual hospital cases by some distribution mechanism 管理成本通过一些分配机制分摊
7、到每个的医院病例上 example-administrative cost, heating, maintenance 例如管理成本，取暖，维护和保养,Cost centres 成本点,the lowest level of organizational unit from the point of view of accounting 从会计的角度看，最低层次的组织单位 production cost centres (direct)-health care is actually delivered in them 生产成本点（直接）-医疗服务事实上送达的对象 indirect cost
8、centres support of production cost centres 间接成本点支持生产成本点,Production cost centres生产成本点,Standard ward 标准病房 Intensive care 重症护理 Dialysis 透析 Operational theatre 手术室 Anesthesia 麻醉 Delivery rooms 接生室 Cardiologic diagnostics and therapy 心外科诊断和治疗 Endoscopic diagnostics and therapy 内镜诊断和治疗 Radiology 放射 Labora
9、tories 化验 Other diagnostics (EKG,EEG, sonographo etc.) 其他诊疗（心电图，脑电图，超声波等等）,Indirect cost centres 间接成本点,overhead costs centres 管理成本点 Management 行政管理 Kitchen 伙食 laundry etc. 衣物清洗等等cost centres of medical infrastructure 医疗基础设施的成本点pharmacy 药房 central sterilization 集中消毒 internal transport of patients 病人内
10、部转送 orthopaedic work-shop etc.骨科工作室,Costs of cost centres 成本点的费用,own costs 自产成本 personnel costs of physicians 医师的人事成本 personnel costs of nurses 护士的人事成本 personnel cost of medical-technical services 医疗技术服务的人事成本 drug costs 药品成本 costs of implants and prostheses 移植和材料成本 costs of other medical material 其他
11、医疗材料成本 re-allocated costs (from indirect cost centres) 再分配成本（从间接成本核心中）,Process of costing 费用计算的过程,Determination of own costs for all cost centres 对所有成本点的自产成本计算,Determination of reallocation keys 再分配原则的决定,Reallocation of costs of indirect cost centres 间接成本点费用的再分配,Allocation of total costs of direct c
12、osts centres to remuneration units 将直接成本点的总费用加到支付机构上,Reallocation keys overhead cost centres 再分配原则管理成本点,Reallocation keys- costs centres of medical infrastructure 再分配原则医疗基础设施成本点,Reallocation costs of indirect cost centres (1) 间接成本点的费用再分配,mutual reallocation of costs 成本的相互再分配where VNi are own costs o
13、f i-th cost centreVNi是i-th 成本点的自产成本Ci are costs of i-th cost centre after the redistribution of costsCi 是费用再分配后，i-th 成本点的费用 pij is share of consumption of the i-th centre on production of j-th cost centre pij 表征的是 第i个消费中心所消耗的占第j个成本中心所生产出的比例,Reallocation costs of indirect cost centres (2)间接成本点的费用再分配,
14、stepped reallocation of costs 费用再分配的步骤 reallocation is done in sequence of indirect costs centres (in descendant order according to their own costs) 对间接成本按次序再分配（依据其自产成本的产出顺序） direct reallocation of costs of indirect costs centres to production cost centres 直接把间接费用分摊到成本点上 all cost interactions among
15、indirect centres are neglected 间接成本点的相互作用的费用不予以考虑,Determination of own costs of cost centres* 自产成本费用点的计算,* everything in thousands of RMB 所有以千元人民币计算,Determination of reallocation keys 再分配原则的确定,91.5 % = 750 000/ 820 000,Reallocation of costs of indirect cost centres* 间接成本点的费用再分配,32 359 = 30 000 + 69
16、000 * 3.4 % 29 879 = 28 769 + 32 359 * 3.4 % 108 141 = 80 813 +29 879 * 91.5 %,(1),(2),(3),* everything in thousands of RMB 所有以千元人民币计算,Recapitulation of costs of direct cost centres* 直接成本点的费用再分配,* everything in thousands of RMB 所有以千元人民币计算,Allocation of costs to an individual case 单独病例成本的分配,24,Alloca
17、tion of costs of direct cost centres to an individual hospital case 对个别医院的直接成本点的费用分配,Determination of costs of direct cost centres 直接成本点的费用确定,Determination of allocation keys and their unit costs 分配原则和其单位成本的确定,Determination of costs of the case in units of the allocation keys 根据分配原则单位决定病例费用,Allocati
18、on of costs for the case based on the units of allocation keys 根据分配原则单位分配病例费用,Allocation keys for costs of individual hospital cases,Costs per units of allocation keys 每单位成本的分配原则,Total costs 总成本 (thousand RMB),Costs per unit 每单位成本 (RMB),/ 400 000,/ 100 000,Determination of costs for a case based on
19、units of allocation keys (1) 根据分配原则单位决定病例费用,hospital case #n: 医院病例7 days in the surgical ward 在外科病房7天54 hours on intensive care unit 在重症护理单位54小时2 hours on operating theatre 在手术室2小时assigned drugs for 2 000 RMB 2000元的指定药品special implants for 10 000 RMB 10000元的特殊移植,Determination of costs of a case base
20、d on units of allocation keys (2)根据分配原则单位决定病例费用,Costs of case #n = 病例成本7 * 2 433 + 54 * 1 194 + 2 * 3 971 + 2 000 +10 000 = 111 470 RMB,Conclusion 结论,pricing in statutory health insurance systems is based on available funding and/or costs 法定医疗保险系统的定价是基于现有的资金和/或费用 costing of health care is important for all modes of remuneration of hospital care: 医疗服务成本对所有医疗服务报销模式都是重要的： per service 每项服务 per day 每天 per discharge 每个出院 per case 每个病例,31,Thanks for your attention 感谢您的关注,
