【摘要】 目的:通过测算公立医院医疗服务项目成本,探究当前我国公立医院医疗服务收费不合理的程度,并提出相应的政策建议。方法:从全国医疗服务成本测算数据库中,按照地域分布和数据质量高的原则,选择了山东、浙江、安徽、陕西和云南5省的省、地市、区县级医院作为研究样本;采取阶梯分摊的全成本测算法测算36家医院3 488个医疗服务项目的成本,比较分析各类服务项目中能够收回成本的项目数所占比重,并拟合各类项目的成本收费比值频率分布图。结果:只有医技诊疗类中的超声检查、医学影像类服务项目的收费总体上能收回成本,其他类服务项目的收费总体上不易收回成本;各类服务中,收费低于成本与收费高于成本的项目同时存在。结论:降低医学影像、超声检查类项目的收费,适当提高能高度反映医务人员技术劳务价值项目的收费标准;增强成本测算在医疗服务定价过程中的指导作用,积极采用更先进的支付方式。更多还原

【Abstract】 Objective:Through estimating the medical service item cost of public hospital,discuss the distortion degree on medical service costs and provide relevant policy suggestion.Methods:According to the National Medical Service Cost Estimating data base,applying the principle of geographical distribution and high data quality,select provincial,city-level and district-level public hospitals from Shandong,Zhejiang,Anhui,Shanxi and Yunnan;using the total cost accounting method via step-down methodology to estimate the unit cost for 3 488 medical service items of 36 hospitals,calculate the proportion of cost-recovered medical services and fit the frequency distribution curve for the ratio(charge at cost) in each category of medical services.Results:Only ultrasonic examination and medical imaging medical services have cost advantage,the majority of other categories services are not easy to recover the cost;both cost-recovered medical services and non cost-covered medical services abounded in all categories services.Conclusion:Reducing the charges for ultrasonic examination and medical imaging medical services,appropriately increasing the charges for medical services which highly reflect the value of the technology and labor;enhancing the status of cost estimation in the medical service pricing process and using more advanced mode of payment for medical service.更多还原