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论文编号：	15524
作者编号：	2320224257
上传时间：	2025/6/16 15:29:30
中文题目：	L医院单病种成本核算研究
英文题目：	Research on the Single Disease Cost Accounting of L Hospital
指导老师：	王志红
中文关键字：	单病种成本核算；基于作业的参数分配法；DIP
英文关键字：	Single - disease Cost Accounting;Activity - based Parameter Allocation Method; DIP
中文摘要：	“十四五”规划明确DRG/DIP付费改革方向，L医院所在城市纳入DIP试点并于2022年起实施按病种分值付费结算，这意味着医院收入与病种直接挂钩，按病种成本核算成为医院适应改革、提升管理水平的关键。医保部门倾向于按病种付费支付方式，而医院通过单病种成本核算，能够提前掌握各病种的成本与收益情况，合理规划诊疗流程和服务内容，避免因医保支付政策变化而带来的经营风险，确保医院在医保政策框架内实现高质量发展。因此，单病种成本核算对于医疗机构而言，绝非可有可无的辅助工具，而是其在现代医疗市场竞争与管理中不可或缺的关键利器。 由过去的按项目付费转变为现在的按病种分值付费，DIP付费带来的收入来源的变化使医疗机构转变收入导向的理念，只有将收入与成本进行匹配才能与之相适应。本文通过分析L医院了成本核算现状，发现L医院现行科室成本核算存在无法反映病种盈亏、与DIP指标脱节、成本控制关键节点缺失的问题。缺少病种成本信息，在DIP背景下就无法将医保政策中的控费和激励机制与医疗机构实际成本控制情况相适应，不能够为医保支付标准提供参考，难以达到医保管理部门动态调整和持续优化支付方式改革的分组规则、分值测算提供依据的最优效果。为解决这些问题，本文提出基于作业的参数分配法在L医院单病种成本核算研究中有可行性。该方法整合作业成本法与传统参数分配法，设计基于作业的参数分配法用于单病种成本核算，按照“科室 - 作业 - 项目 - 病种”流程进行。以单侧腹股沟疝病种为例，经核算发现存在例均亏损，并针对不同科室项目提出了相应的成本控制策略。基于作业的参数分配法能为L医院精确反映病种盈亏，为DIP单病种盈亏分析提供数据，基于病种临床路径与DIP指标有效衔接，为成本控制提供了方向，同时能有效优化诊疗流程，避免过度医疗的行为，能够加强医保支付与成本核算的衔接。
英文摘要：	The 14th Five-Year Plan clearly defines the direction of the DRG/DIP payment reform. The city where Hospital L is located has been included in the DIP pilot program and has implemented settlement by disease scores since 2022. This means that the hospital's revenue is directly linked to diseases, and single-disease cost accounting has become the key for hospitals to adapt to the reform and improve management. The medical insurance department prefers the payment method by disease, and through single-disease cost accounting, hospitals can anticipate the costs and revenues of various diseases, plan diagnosis and treatment processes and service content rationally, avoid operational risks caused by changes in medical insurance payment policies, and ensure high-quality development within the framework of medical insurance policies. Therefore, single-disease cost accounting is not an optional tool for medical institutions but an essential key to modern medical market competition and management. The shift from the previous item-based payment to the current disease-score-based payment has changed the income sources of medical institutions, prompting them to change their income-oriented concept. Only by matching income with costs can they adapt. This paper analyzes the current situation of cost accounting in Hospital L and finds that the current department-based cost accounting cannot reflect disease profit and loss, is disjointed from DIP indicators, and lacks key cost control nodes. Without disease cost information, it is impossible to align the cost control and incentive mechanisms in medical insurance policies with the actual cost control situation of medical institutions under the DIP background, provide reference for medical insurance payment standards, or achieve the optimal effect of providing a basis for the dynamic adjustment and continuous optimization of the grouping rules and score calculations in the payment method reform by the medical insurance management department. To solve these problems, this paper proposes the feasibility of the parameter allocation method based on activities in the single-disease cost accounting research of Hospital L. This method integrates the activity-based costing method and the traditional parameter allocation method and designs a parameter allocation method based on activities for single-disease cost accounting, following the process of "department - activity - project - disease". Taking the unilateral inguinal hernia disease as an example, it is found that there is an average loss per case after accounting, and corresponding cost control strategies are proposed for different department projects. The parameter allocation method based on activities can accurately reflect the profit and loss of diseases for Hospital L, provide data for DIP single-disease profit and loss analysis, effectively connect with DIP indicators based on disease clinical pathways, provide a direction for cost control, optimize the diagnosis and treatment process, prevent over-medical treatment, and strengthen the connection between medical insurance payment and cost accounting.
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