县级结核病定点医院成本核算及补偿分析

Cost accounting and reimbursement of tuberculosis control services at county level designated TB hospitals

目的:了解县级综合医院承担结核病定点医院任务的成本及其补偿情况。方法:选择东部和西部两家县级结核病定点医院为研究对象,采用全成本和四级阶梯分摊法核算新增的结核病门诊诊疗服务成本和结核病管理服务成本。结果:2008年两家医院结核病门诊诊疗服务所投入的全成本分别为每诊次185.58元和257.48元,结核病门诊服务收入分别为每诊次155.00元和161.07元,无法弥补全成本,亏损额分别为每诊次30.58元和96.41元。结核病管理服务所投入的全成本分别为每例患者360.70元和271.23元,管理服务无任何收入可以补偿,其成本即为亏损。结论:建议对承担结核病定点医院任务的县级综合医院,应建立全成本基础上的分类补偿政策。管理服务成本应当由政府承担,门诊服务成本可以由医疗保障来补偿,并适当提高补偿水平。

Objectives： To describe cost of Tuberculosis（TB） care and control incurred by designated TB hospitals, and the reimbursement of that cost. Methods： 2 designated TB hospitals at county level in 2 provinces from eastern and western China were selected for the study. Structured questionnaires were completed by the two hospitals. The whole cost and ladder apportionment of expenses methods were employed to account cost of TB care and control incurred by these hospitals. Data on income charged from TB patients was collected from Health Information System of designated hospitals. Results ： In 2008, the whole cost per outpatient visit of TB diagnosis and treatment service of the 2 designated TB hospital was 185.85 and 257.48 RMB respectively, while the hospitals＇ income from each out- patient visit was 155.00 and 161.07 RMB. This resulted in a deficit of 30.58 and 96.41 RMB. The whole cost per TB patient of TB management service was 360.70 and 271.23 RMB with no income to cover the cost. Therefore the deficit was the same as the whole cost. Conclusions ： To maintain the success of PPM DOTS, the deficit of TB control services incurred by hospitals should be reimbursed by two ways based on the whole cost. The deficit of TB manage- ment service should be reimbursed by government budget, and the deficit of TB outpatient visit might be reimbursed by social medical insurance with a higher reimbursement rate.