公立醫(yī)院成本管理存在的問(wèn)題、原因與對(duì)策研究

劉春波 魯孝正 楊穎 魯嘯軍

[摘 要]隨著政府對(duì)醫(yī)院的補(bǔ)償逐漸減少，藥品加成逐漸取消，使得長(zhǎng)期以來(lái)忽略成本管理的公立醫(yī)院面臨既要保持自身公益性又要實(shí)現(xiàn)經(jīng)濟(jì)效益、既要注重短期目標(biāo)又要長(zhǎng)期可持續(xù)發(fā)展的問(wèn)題，公立醫(yī)院如何提高自身競(jìng)爭(zhēng)力、實(shí)現(xiàn)資源最優(yōu)化配置受到社會(huì)的廣泛關(guān)注。從公立醫(yī)院成本管理概念內(nèi)涵的視角，以成本管理的體系、方法、人才結(jié)構(gòu)、信息系統(tǒng)為切入點(diǎn)，探討了公立醫(yī)院成本管理存在的問(wèn)題以及產(chǎn)生這些問(wèn)題的原因，并給出了對(duì)策建議。

[關(guān)鍵詞]公立醫(yī)院;成本管理;戰(zhàn)略發(fā)展

[中圖分類(lèi)號(hào)]F23

[文獻(xiàn)標(biāo)識(shí)碼]A

[文章編號(hào)]2095-3283（2019）11-0116-07

Abstract： With the gradual reduction of government compensation for hospitals and the gradual cancellation of drug addition， public hospitals， which have long neglected cost management， are facing the problems of maintaining their own public welfare， realizing economic benefits， focusing on short-term goals and long-term sustainable development. How to improve their competitiveness and realize optimal allocation of resources has attracted widespread attention. From the perspective of the connotation of the concept of cost management in public hospitals， this paper discusses the existing problems in cost management in public hospitals and the reasons for these problems， starting with the cost management system， cost management methods， cost management personnel structure and cost management information system， and gives some countermeasures and suggestions to solve the existing problems.

Keywords： strategic development of cost management in public hospitals

一、引言

改革開(kāi)放以來(lái)，我國(guó)醫(yī)療水平取得了舉世矚目的成就。然而，在深化醫(yī)療體制改革的過(guò)程中，成本管理問(wèn)題變得日益嚴(yán)峻，嚴(yán)重阻礙了醫(yī)療體制改革的順利進(jìn)行和公立醫(yī)院的可持續(xù)性發(fā)展。降低的政府補(bǔ)償與醫(yī)院旺盛的發(fā)展需求之間的矛盾，使公立醫(yī)院成本管理改革成為了一條必經(jīng)之路。一方面，醫(yī)院的收入主要是通過(guò)服務(wù)收費(fèi)、藥品加成、財(cái)政補(bǔ)助三個(gè)渠道獲得。針對(duì)長(zhǎng)期以來(lái)公立醫(yī)院通過(guò)藥品加成的方式增加收入、通過(guò)財(cái)政補(bǔ)貼保持醫(yī)院公立性的現(xiàn)象，中央政府先后出臺(tái)了《中共中央國(guó)務(wù)院關(guān)于深化醫(yī)藥衛(wèi)生體制改革的意見(jiàn)》《“十三五”深化醫(yī)藥衛(wèi)生體制改革規(guī)劃》《關(guān)于全面推開(kāi)公立醫(yī)院綜合改革工作的通知》等多項(xiàng)配套政策，“醫(yī)藥分離”、“藥品零差率”、“新政府補(bǔ)償機(jī)制”的態(tài)勢(shì)已經(jīng)形成。……