| 引用本文：郑大喜.基于成本核算的公立医院补偿机制改革——美国经验及对我国的启示[J].中国卫生政策研究,2014,7(7):56-62 |
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| 基于成本核算的公立医院补偿机制改革——美国经验及对我国的启示 |
| 投稿时间：2014-05-11 修订日期：2014-07-20 PDF全文浏览 HTML全文浏览 |
| 郑大喜 |
| 华中科技大学同济医学院附属同济医院 湖北武汉 430030 |
| 摘要:长期以来，我国公立医院财政补助不以成本核算为基础，主要按人员编制、床位数为标准进行补偿。本文介绍了美国结合成本核算进行公立医院补偿机制改革的主要历程：从以实际成本为基础获得适当补偿，发展为按标准临床项目诊疗分组预付费。我国公立医院补偿机制出现以下问题：财政补偿没有以医院成本核算为基础，医疗服务收费普遍低于成本，技术劳务价值在收费价格上未得到合理体现，存在“以药补医”现象。美国经验启示我国应当以成本为基础，理顺医疗服务比价关系，建立科学合理的医疗服务价格体系；借助全成本信息，合理制定财政补偿政策；依托病种成本核算和DRGs，参与定价和谈判，确定支付标准。 |
| 关键词:公立医院 财政补助 支付方式 成本核算 价格 激励 |
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| Compensation mechanism reform of public hospitals based on cost accounting：Experience from the United States and its implication for China |
| ZHENG Da-xi |
| Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
| Abstract:For a long time, public hospital financial subsidies in China are not based on cost accounting, mainly according to the staffs and beds. The paper introduces the main course of public hospital compensation mechanism reform based on cost accounting in USA: The compensation way develops from getting adequate compensation by using the actual cost to applying the standard clinical project payment based on diagnosis related groups. The compensation mechanism of public hospitals in China exist some problems as follows: the financial compensation is not based on hospital cost accounting, medical service charge is general below cost, technical labor value is not reflected fully, there still exists the phenomenon of "subsidizing hospitals by charging more medicine fees". suggestions have been proposed for compensation mechanism reform of public hospitals in China as follows: Adjusting the relationship of comparative price to establish a scientific and reasonable price system based on the cost; formulating a reasonable financial compensation policies with full cost information; participating in the negotiations in pricing and determining a reasonable standard of payment relying on cost accounting and DRGs. |
| Key words:Public hospital Financial subsidy Payment Cost accounting Price Incentive |
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