资源消耗会计与收费项目分类调整的研究

A study of resource consumption accounting and regulating of charge categorise

目的北京市拟实施住院病人按诊断相关组的预定额支付制度（DRGs-PPS）改革，为了测算各DRG病组的成本，探讨一套科学、合理的出院病人医疗服务收费分类标准。方法资源消耗会计。按照主要执业人员类别、服务流程和消耗的资源对各项目进行分类；医用耗材被单独列示，突出了医务人员服务价值；考虑新分类对原有类别的兼容性，将部分原有类别又加以细分。结果将医疗服务过程划分为医疗、手术、护理、影像、检验、管理、辅助医疗、药剂等作业类，在原有的出院病人调查表19项收费分类基础上调整为31项。结论通过规范医疗服务项目收费分类，达到医疗收入数据统计口径一致，且如实反映医疗、手术、护理、影像、检验、管理、药剂等作业类的收人情况，为政府制定相关政策提供决策依据；为DRGs的权重调整奠定了基础。

Objective Beijing plans to run a DRGs-PPS pilot. Cost estimation of each DRG group needs a set of scientific reasonable standards for inpatient charge category. Methods Resource consumption accounting. Classify charge item by practitioners, services, resourees; medical consumables are singled out to emphasize the value of medical personnel＇s services; some of old categories are subdivided in order to be compatible with new categories. Results 19 old charge categories of patient discharge chart turn to 31 new items by dividing medical service into treatment, surgery, nursing, imaging, examination, management, paramedic, pharmacy, etc. Conclusion Regulating the charge categories of services, medical data is more consistent by using the same statistical coverage. Also it accurately present the incoming of all operations-- treatment, surgery, nursing, imaging, examination, management, paramedic, pharmacy, etc. It gives government directions of decision-making to adjust the weight of DRG groups.