基于RBRVS和TDABC法的胆囊结石单病种护理的成本核算

Study on single disease nursing cost accounting of gallstone based on RBRVS and TDABC methods

目的核算腹腔镜下手术治疗胆囊结石的护理成本,为制定其收费标准提供科学依据,同时为核算其他单病种护理成本提供思路和方法学指导。方法在核算出胆囊结石“核算项目”成本的基础上,测量“核算项目”的操作频次,将“核算项目”与其操作频次的乘积相加,获得胆囊结石单病种护理成本。“核算项目”的核算步骤:将护理项目分为“核算项目”和“分摊项目”;“核算项目”的成本等于其人力成本、材料成本、间接成本和“分摊项目”的人力成本和材料成本之和;借鉴资源为基础相对价值量表法(RBRVS)核算护理项目的人力成本;利用时间驱动作业成本法(TDABC)分摊“分摊项目”成本和间接成本。结果腹腔镜下手术治疗胆囊结石的单病种护理成本为1615.11元,实际收费为1043.00元,成本回收率为66%。结论腹腔镜下手术治疗胆囊结石的现行收费与成本核算结果之间存在差距,不能完全体现护理人员的劳动价值。

Objective To calculate the nursing cost of laparoscopic gallstone to provide a scientific basis for formulating the charging standard,meanwhile provide the ideas and methodological guidance for accounting the nursing costs of other single diseases.Methods On the basis of calculating the cost of the"accounting item"of gallstone,the operation frequency of"accounting item"was measured,and the product of the"accounting item"and its operation frequency were added together to obtain the single disease nursing cost of gallstone.The accounting steps for"accounting items":the nursing items were divided into"accounting items"and"apportion items";the cost of"accounting items"was equal to the sum of the labor costs,material costs,indirect costs,and human costs and material costs of"apportion items".Based on the RBRVS method,the human cost of the nursing project was accounted;the TDABC method was used to share the cost and indirect cost of the"apportion item".Results The nursing cost of laparoscopic gallstone was 1615.11 Yuan,the actual charge was 1043.00 Yuan,and the cost reclaim rate was 66%.Conclusion There is a gap between the current charges and the cost calculation results for the operative treatment of gallstone under laparoscopy,which cannot entirely reflect the labor value of nurse.