基于时间驱动作业成本法的产科医疗项目成本分析

Comparative Analysis of Obstetric Medical Srrvice Project Cost Accounting Based on Time-driven Activity-based Costing

目的:探索时间驱动作业成本法在医院成本核算中的应用效果及可行性。方法:通过分析时间驱动作业成本法的原理及测算模型,选取某三级甲等公立医院产科主要医疗服务项目成本核算为对象,利用样本医院2019年1-6月的财务数据,将时间作为成本动因,应用时间驱动作业成本法来核算各医疗服务项目成本,结合现行的项目收费标准,进行医疗服务项目成本和服务效率对比分析。结果:在22项产科主要的医疗服务项目中,12项医疗项目亏损,8项盈利,且差异较大,其中收益率最差的项目是入院护理,依次术前准备、肌肉注射、皮下注射、皮内注射、胎心监护、吸氧、出院护理、静脉注射、产科检查、挂号、就诊登记检查、常规护理、疑难病例会诊。通过计算得出的有效产能为1553256元,其中450666元是闲置产能,服务效率为70.99%。结论:时间驱动作业成本法可用于医疗服务项目成本核算及管理中,利用时间因素将资源分配到医疗项目,能够简化核算步骤提高成本核算的准确性,测算的成本更符合实际成本,也为医院开展医疗服务项目定价和成本管理提供数据支撑和参考。

Objective:To explore the effect and feasibility of application of Time-driven Activity-based Costing(TDABC)in hospital cost accounting.Methods:Through the analysis of the principle and model of TDABC,it studies a third rate public hospital obstetric major medical service cost accounting.Based on the financial data of the hospital from January to June 2019,and taking time as the cost driver,it conducts cost accounting of medical service projects with TDABC.Meanwhile,comparative study is conducts between medical service cost and efficiency,taking into account the current fee standards.Results:12 out of 22 obstetric medical service project are losing money while 8 projects are making money,with great difference.Projects that yield the worst input-output ratio are in-hospital care,which includes in turn,preoperative preparation,intramuscular injection,subcutaneous injection,intradermal injection,cardiac care,oxygen,hospital nursing,intravenous injection,maternity hospital inspection,registration,registration examination,routine nursing consultation,difficult case diagnosis.The effective capacity obtained through calculation is 1553256 yuan,of which 450666 is idle capacity.Service efficiency is 70.99%.Conclusion:TDABC can be applied to medical service cost accounting and management.Application of the time factor into resource allocation in health care can help to simplify calculation procedures to improve the accuracy of cost accounting.Cost calculated in this way is in line with the actual cost,which provides data support and references for hospital medical service pricing and cost management.