期刊信息
友情链接
热门文章
基于DRG的公立医院精细化成本管控实践探讨
发布人：yaot 发布时间：2023/2/1 11:45:28 浏览次数：1437次
——吴镝娅 张丽华 刘艳 蔡林
【摘要】分析DRG病种成本，可进一步优化医院成本管控。通过建立项目叠加法联合作业成本法的DRG病种成本核算方式，充分运用DRG病种成本核算结果进行同一病种不同学科间、同一病种不同治疗方式、临床路径入径和未入径、病种盈亏平衡等比较分析，以挖掘DRG成本管控难点。经实践，病案首页质量提高，DRG相关运营指标得以改善，医院运行效率和患者满意度进一步提高。为优化医院资源配置，帮助科室明确学科发展方向，提升医疗效率，建议制定临床科室个性化DRG管理方案，合理规避成本管控风险点，完善成本管理考核机制。
【关键词】公立医院；DRG；成本管控；病种成本
中图分类号：R197.323文献标识码：B
Practice of Lean Cost Control in Public Hospitals Based on Diagnosis Related Group/WU Diya,ZHANG Lihua,LIU Yan,et al.//Chinese Health Quality Management，2023,30(1):39-43
AbstractBy analyzing the cost of Diagnosis Related Group (DRG), hospital cost control can be further optimized. By establishing the cost accounting method of DRG diseases with the combination of project overlay method and actionable costing method, the cost accounting results of DRG diseases were fully used to compare and analyze the same disease among different disciplines, the entry and out of clinical pathways, and the profit and loss balance of diseases, so as to explore the difficulties in the cost control of DRG. Through practice, the quality of the first page of medical records had been improved, the relevant operating indicators of DRG had been improved, and the hospital's operating efficiency and patient satisfaction had been further improved. In order to optimize the allocation of hospital resources, help departments clarify the direction of discipline development and improve medical efficiency, it was suggested to develop a personalized DRG management scheme for clinical departments, reasonably avoid the risk points of cost control and improve the cost management assessment mechanism.
Key words Public Hospital;Diagnosis Related Group (DRG)；Cost Control；Disease Cost
Firstauthor's address Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
传统按项目付费方式下的成本管控通常侧重于事后控制，缺乏事前预警机制。目前，基于疾病诊断相关分组（Diagnosis Related Group，DRG）支付方式下的成本核算主要采用自上而下、项目叠加、成本收入3种方法。ZN医院选择项目叠加法与作业成本法相结合的方式进行DRG病种成本核算。项目叠加法精细化程度和准确性高，但存在对项目设置合理性要求较高,对人力成本计算、工时分配等易产生偏差等缺陷［1］。结合作业成本法后，可以精确计入直接成本、间接成本，有助于分析作业中各环节耗费资源的合理性，识别增值与非增值、有效作业与无效作业，督促医院不断优化临床路径及流程［2］。本研究介绍了该院DRG病种成本核算方法及流程，将DRG病种成本结果在不同模式下进行比较分析，以期为绩效评价和战略预算管理提供有效依据，实现事前、事中、事后全流程管理。
……