I 摘要 近年来，我国医疗服务价格上涨明显，不仅超出了GDP增幅，也超过了社 会平均工资的增幅。如果不加控制，可能会使医保资金收不抵支。一些和成本 严重背离的不合理的政府定价，导致医院追求高利润项目来弥补低利润项目的 收入不足。医保支付以往也基本按项目付费，这也诱使医院叠加项目过度诊疗。 财政部对公立医院的投入减少，与此同时，允许医院以药养医并开展特需服务 弥补投入不足。这对医院的经营策略产生了重大影响。医院需要多开药才能多 收入，同时，开展特需服务又使得公立医院的公益性淡化。这些现象导致医院 过去几年不合理医疗费用迅速增长。 为了解决这些问题，相关部门实施了多种政策设法解决。在经历了数次失 败改革后，国家医保局提出了DRG付费。医保DRG预付费与传统的按照项目 后付费不同，医院需要向价值管理要效益，向成本管控要效益，向病案首页管 理要效益，从传统的追求粗放式追求增收的绩效激励模式，向追求内涵质量效 益型转变，倒逼医院进行管理模式变革。DRG支付按照预付费，需要追求内涵 质量效益增长，更加关注精细化运营，加强成本管控为主导。因此，为了平稳 顺利过渡此次改革浪潮，迎接DRG带来的机遇和挑战，精细化医院管理模式， 鉴于X医院目前的全成本核算现状，提出了此次研究的全成本核算方案的优化 策略。 为了研究X医院在DRG下的全成本核算方案的优化策略，本文采用了案例 分析法和文献分析法，通过界定全成本核算的相关概念，了解和掌握DRG的前 世今生，分析X医院进行全成本核算的必要性以及目前的现状，总结提炼出了 X医院在DRG下的全成本核算中折射出的问题，通过分析这些问题成因，找到 了X医院在DRG下进行全成本核算优化方案所面临的困难，为了如期完成优化 方案及其目标，提出了相对应的保障措施以及风险控制，最后对优化方案进行 了效果评价。 但是基于目前X医院发展程度的局限性，未能真正的进行实际的全成本核 算。在DRG真正正式实施之后，相关部门将会出台统一的核算标准，届时可以 根据统一的标准和理论体系，核算医院的全成本情况。这样的核算数据将会更 X医院在DRG下的全成本核算方案的优化研究摘要 II 加可靠和全面，在此基础上为医院的精细化管理和发展提供具有针对性的建议 将会更加准确而富有意义。 关键词：全成本核算；DRG；案例分析法；方案优化研究。 X医院在DRG下的全成本核算方案的优化研究Abstract III Abstract Inrecentyears,thepriceofmedicalservicesinChinahasincreasedsignificantly,not onlyexceedingthegrowthrateofGDP,butalsoexceedingthegrowthrateofsocial averagewage.Ifnotcontrolled,themedicalinsurancefundmaynotbeabletooffset theexpenditure.Someunreasonablegovernmentpricing,whichdeviatesfromthecost seriously,leadshospitalstopursuehighprofitprojectstomakeupfortheincome shortageoflowprofitprojects.Inthepast,thepaymentofmedicalinsurancewas basicallybasedontheproject,whichalsoinducedthehospitaltooverprinttheproject foroverdiagnosisandtreatment.TheMinistryofFinance'sinvestmentinpublic hospitalshasbeenreduced.Atthesametime,hospitalsareallowedtosupportdoctors withdrugsandcarryoutspecialservicestomakeupforthelackofinvestment.This hasasignificantimpactonthehospital'sbusinessstrategy.Hospitalsneedtoprescribe moredrugstogetmoreincome.Atthesametime,thedevelopmentofspecialservices makespublichospitals'publicwelfaredesalination.Thesephenomenahaveledtothe rapidgrowthofunreasonablemedicalexpensesinhospitalsinthepastfewyears. Inordertosolvetheseproblems,therelevantdepartmentshaveimplementedvarious policiestotrytosolvethem.Afterseveralfailedreforms,theNationalHealth InsuranceBureauproposedDRGpayment.Differentfromthetraditionalpayment aftertheproject,theDRGprepaymentofmedicalinsuranceneedstobenefitfrom valuemanagement,costcontrol,medicalrecordfrontpagemanagement,fromthe traditionalperformanceincentivemodeofextensivepursuitofincomeincreasetothe pursuitofconnotativequalityandbenefit,whichforcesthehospitaltochangeits managementmode.DRGpaymentneedstopursuethegrowthofconnotation,quality andbenefit,paymoreattentiontorefinedoperation,andstrengthencostcontrolasthe leadingfactors.Therefore,inordertosmoothlytransitionthereformwave,meetthe opportunitiesandchallengesbroughtbyDRG,andrefinethehospitalmanagement mode,inviewofthecurrentsituationofthefullcostaccountingofXHospital,the optimizationstrategyofthefullcostaccountingschemeofthisstudyisproposed. X医院在DRG下的全成本核算方案的优化研究Abstract IV InordertostudytheoptimizationstrategyofthefullcostaccountingschemeofX HospitalunderDRG,thispaperusescaseanalysisandliteratureanalysis,through definingtherelevantconceptsofthefullcostaccounting,understandingand masteringthepastandpresentlifeofDRG,analyzingthenecessityandcurrent situationofthefullcostaccountingofXHospital,andsummarizingtheproblems reflectedinthefullcostaccountingofXHospitalunderDRGwhichareanalyzed, andthedifficultiesfacedbytheoptimizationschemeofthefullcostaccountingofX HospitalunderDRGarefound.Inordertocompletetheoptimizationschemeandits objectivesontime,thecorrespondingsafeguardmeasuresandriskcontrolareput forward.Finally,theeffectoftheoptimizationschemeisevaluated. However,duetothelimitationofthedevelopmentdegreeofXHospital,theactual fullcostaccountinghasnotbeencarriedout.AftertheimplementationofDRG, relevantdepartmentswillissueunifiedaccountingstandards,whichcanbeusedto calculatethetotalcostofthehospitalaccordingtotheunifiedstandardsand theoreticalsystem.Suchaccountingdatawillbemorereliableandcomprehensive, andonthisbasis,itwillbemoreaccurateandmeaningfultoprovidetargeted suggestionsforthefinemanagementanddevelopmentofthehospital. Keywords:Fullcostaccounting;DRG;Caseanalysis;Studyontheoptimizationof scheme. X医院在DRG下的全成本核算方案的优化研究目录 V 目录 摘要.............................................................................................................I ABSTRACT.................................................................................................III 第一章绪论...............................................................................................1 第一节研究背景及意义..................................................................................1 一研究背景..............................................................................................................1 二研究意义..............................................................................................................3 第二节国内外研究现状..................................................................................4 一国内研究现状......................................................................................................4 二国外研究现状......................................................................................................5 第三节研究内容和方法..................................................................................5 一研究内容和论文结构..........................................................................................5 二研究方法和创新点..............................................................................................7 第二章核心概念和相关理论...................................................................8 第一节DRG的历史沿革...................................................................................8 一什么是DRG...........................................................................................................8 二DRG的发展历程...................................................................................................8 三DRG的现实意义和影响.....................................................................................11 第二节医院成本的相关概念........................................................................12 一医院成本............................................................................................................12 二医院成本核算....................................................................................................12 三医院全成本核算................................................................................................13 第三节成本核算的理论基础........................................................................13 X医院在DRG下的全成本核算方案的优化研究目录 VI 一传统的成本核算理论........................................................................................13 二现代成本核算管理理论....................................................................................14 第三章X医院全成本核算的现状分析.....................