分类号F275密级公开
收藏编号___________学号190727043
学校代码10386编号_____________
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研究方向：财务管理
研究生姓名：高彦茜
指导教师、职称：冯丹教授
协助导师、职称：
所在学院：经济与管理学院
答辩委员会主席：石德金教授
二〇二二年六月
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自新一轮医改启动以来，国家出台一系列政策和要求，推动DRG 收付费制度
在各地的深入实施，鼓励试点医院通过医保支付方式改革优化运营管理方式。DRG
收付费的实施推动我国公立医院走进现代化医院管理模式，实行精细化管理有助
于实现我国公立医院内涵式发展。F 省自2020年3月划定三所省属公立医院率
先开展DRG 收付费制度改革试点工作，DRG 收付费为总额预付制，由此对公立医
院成本管理提出了新要求。
在以上背景下，本文选取F 省第三批DRG 试点医院——市属公立医院MC 医
院为研究对象，基于PDCA 循环理论探索构建一套DRG 背景下公立医院成本精细
化管理的方案。DRG 背景下精细化的成本管理不仅有助于医院充分发挥DRG 降本
增效的作用，还能为国家和医保部门相关政策的制定提供一定数据支持和实践经
验的参考作用。PDCA 循环作为一种重要的管理理念和管理模式，其先进性和实
用性逐步被专家学者认可并广泛运用于现代管理中，将PDCA 循环引入公立医院
成本管理中，不仅可以体现出成本管理的规律，还能够促进成本管理的流程化和
规范化，对公立医院成本精细化管理的实践有着重要的指导意义。
本文首先梳理研究背景，回顾DRG 收付费方式及公立医院成本管理相关文献。
其次厘清相关理论和概念，引入PDCA 循环、精细化管理、战略成本管理理论于
DRG 背景下公立医院成本管理中。再次整理我国医保支付方式改革历程，分析DRG
的核心优势，构建出DRG 背景下基于PDCA 循环的成本精细化管理的理论框架。
接着以问卷调查的形式，概括出目前我国公立医院成本管理中存在的普遍问题。
然后以MC 公立医院为案例研究对象，运用PDCA 循环四个阶段分别分析MC 医院
成本管理现状和存在的问题，在此基础上“由点及面”提炼出DRG 背景下公立医
院面临的机遇与挑战。紧接着为MC 医院设计出一套DRG 背景下基于PDCA 循环的
成本精细化管理方案。最后通过平衡计分卡的方法检验方案的实施效果，并提出
对我国公立医院成本精细化管理具有普适性的建议。
本文通过对DRG 背景下基于PDCA 循环理论的公立医院成本精细化管理方案
的设计与实践检验，为其他医院实施DRG 试点和成本精细化管理提供借鉴和经验
分享，为医保机构提供参考，对后续学者的研究也具有一定的参考价值。
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I
Research on cost refinement management of
public hospitals based on PDCA Cycle under DRG
background --taking MC Hospital as an example
Abstract
Since the launch of the new round of medical reform,the state has issued a series
of policies and requirements to promote the in-depth implementation of DRG payment
system in various regions and encourage pilot hospitals to optimize their operation and
management mode through the reform of medical insurance payment mode.The
implementation of DRG collection and payment promotes China's public hospitals to
enter the modern hospital management mode,and the implementation of fine
management is conducive to the convolution development of China's public hospitals.
Since March 2020,F province designated 3provincial public hospitals to take the lead
in DRG reform pilot.DRG collection and payment system is the total advance payment
system,thus proposing new requirements for the cost management of public hospitals.
Under the above background,this paper selected the third batch of DRG pilot
hospitals in F province --MC Hospital,a municipal public hospital,as the research
object,and explored and constructed a set of cost refinement management scheme of
public hospitals under the background of DRG based on PDCA cycle theory.The
refined cost management in the context of DRG not only helps hospitals give full play
to the role of DRG in reducing costs and increasing efficiency,but also provides certain
data support and practical experience reference for the formulation of relevant policies
by the state and medical insurance departments.As an important management concept
and mode,PDCA cycle has been gradually recognized and widely used in modern
management by experts and scholars.The introduction of PDCA cycle into cost
management of public hospitals can not only reflect the law of cost management,but
also promote the process and standardization of cost management.It has important
guiding significance to the practice of fine cost management in public hospitals.
This paper first sorts out the research background and reviews DRG collection and
payment methods and related literatures on cost management of public hospitals.
Secondly,the relevant theoretical basis and concepts are clarified,and the PDCA cycle,
refined management and strategic cost management theories are introduced into
II
the cost management of public hospitals under the background of DRG.The reform
process of medical insurance payment mode in China is sorted out again,the core
advantages of DRG are analyzed,and the theoretical framework of cost refinement
management based on PDCA cycle under the background of DRG is constructed.Then
in the form of questionnaire survey,generalize the common problems existing in the
cost management of public hospitals in China.Then,taking MC public hospital as the
case study object,using the four stages of PDCA cycle to analyze the current situation
and existing problems of MC hospital cost management,on this basis,the opportunities
and challenges faced by public hospitals under the background of DRG are extracted
"from point to surface".Then design a set of cost refinement management scheme based
on PDCA cycle under DRG background for MC hospital.Finally,the balanced
scorecard method is used to test the implementation effect of the scheme,and the
recommendations for the cost refinement management of public hospitals in China are
put forward.
This paper,through the design and practice test of the cost refinement management
scheme of public hospitals based on PDCA cycle theory under the background of DRG,
provides reference and experience sharing for other hospitals to implement DRG pilot
project and cost refinement management,provides reference for medical insurance
institutions,and has certain reference value for subsequent researches of scholars.
Key words:DRG payment method;PDCA cycle;Public hospitals;
Fine management;Cost management
III
目录
第一章绪论...............................................................................................1
1.1研究背景、目的及意义...................................................................1
1.1.1研究背景.....................................................................................1
1.1.2研究目的.....................................................................................3
1.1.3研究意义.....................................................................................3
1.2文献回顾...........................................................................................4
1.2.1DRG 收付费方式相关研究........................................................4
1.2.2DRG 背景下成本管理相关研究................................................6
1.2.4文献评述.....................................................................................7
1.3研究方法及思路...............................................................................8
1.3.1研究方法.....................................................................................8
1.3.2研究思路.....................................................................................9
1.4创新点.............................................................................................10
第二章相关概念与理论基础................................................................11
2.1概念界定.........................................................................................11
2.1.1医保支付方式...........................................................................11
2.1.2收付费.......................................................................................11
2.1.3DRG ...........................................................................................11
2.1.4DRG 收付费方式......................................................................11
2.1.5医院成本管理...........................................................................12
2.2理论基础.........................................................................................12
2.2.1PDCA 循环理论........................................................................12
2.2.2精细化管理理论.......................................................................13
2.2.3战略成本管理理论...................................................................13
2.3理论分析.........................................................................................14
2.3.1公立医院成本管理中PDCA 循环的运用..............................14
2.3.2公立医院成本精细化管理运用...............................................15
2.3.3战略成本管理在DRG 背景下的运用....................................15
2.3.4理论分析小结...........................................................................15
第三章DRG 背景下基于PDCA 循环的公立医院成本精细化管理的
理论框架.................................................................................................17
3.1我国医保支付方式改革历程........................................................17
3.2DRG 的核心优势............................................................................18
3.3DRG 背景下构建基于PDCA 循环的成本精细化管理的理论框架