Research On The Cost Accounting Of Shanghai’s Medical Services Item

Under the background of vigorously promoting the reform of health policy by government and breaking the predicament that hospital supports medical by drugs, "National medical services price item specification (2012 edition)" (hereinafter referred to as version of national 2012 specification) was officially promulgated, and it required every province and city to make adjustments based on it. This paper takes "Shanghai medical institutions medical services items price and price compilation (2010)" (hereinafter referred to as Shanghai 2010 compilation) and the docking of national 2012 version of standards as a starting point to analyze the differences between them, and integrates Shanghai characteristics under the framework of the national norms; through the analysis on the factors affecting the total cost of 8 tertiary hospitals in Shanghai eight, this paper determines the main direction to account the project cost; by taking the score of the degree of risk and degree of difficulty of the project in national norms as reference, and combining with cost equivalent method and work cost method, this paper explores scientific and reasonable entry methods of project costs; this paper measures and calculates the actual cost of the project in sample hospitals, and makes comparative studies with the current charging criterion, so as to provide scientific basis for the project price adjustments.Sources of topicThe topic comes from three projects under the series of "Shanghai public hospital cost accounting applied research" instituted by Shanghai Health Development Research Center:1. For "Research on Shanghai medical services price specification and the convergence of national," the results have been incorporated into Green Book of "Shanghai Health Policy Research Annual Report (2014)"; 2. "Research on Shanghai medical institution academy-level cost"; 3. "Research on the cost accounting for Shanghai’s public medical services projectData sourceThe research data under this topic comes from below three sources:1. Financial statements of National Health Family Planning under National Health Family Planning Commission;2. Annual Financial report for Shanghai medical institutions.3. Sample hospital’s annual financial statements.Research content1. This paper carries out comparative study between Shanghai 2010 assembly and national 2012 specification, analyzes regulatory framework and characteristics of project elements, and determines the docking adjustment methods, so as to provide policy recommendations for the formulation of new project specification for Shanghai.2. Based on all kinds of financial data from eight tertiary general hospitals in Shanghai in 2004-2013, this paper analyzes the main factors affecting the total cost of the hospital, so as to determine the research direction for the project cost accounting.3. On the basis of section office’s two-level cost accounting, this paper carries out classification calculation on the 50 selected medical service projects. This paper also makes a comparison between the actual cost after calculation and the current charging criterion, analyzes the project cost structure, and determines price adjustment trend, so as to provide a scientific basis for project pricing.Research methods1. Expert consultation methodBefore, during and after the implementation of topic, the author participates in the weekly meetings of a working group established by Shanghai health development research center, so as to master the latest information merged by two versions of standards; the author also collects each professional expert’s opinios and suggestions for adjustment and project in Shanghai hospitals. Combining with the conclusion of literature analysis, the author determines the docking methods for the projects in different categories.2. Stepwise regression analysis methodThe regression analysis method of hospital’s total cost eliminates the variables in turn which has no significant impact on hospital’s total cost, and finally determines the indicators which have significantly correlation with the cost of change, so as to provide research direction for the next step of project cost accounting.3. The method of project cost accounting based on national frameworkOn the basis of cost equivalent method, taking the degree of difficulty and degree of risk in national 2012 specification as equivalent point project, this paper account the direct cost of the project based on the labor cost and hygiene materials cost where sample hospitals make actual measurement; this paper also account projects’ indirect costs according to the proportion of survey project in hospital services, and the cost of buildings and equipment in project operation, and finally gets the actual cost of the project.Research resultsl.In the framework of 2012 version national standardization, Shanghai medical services norms should be adjusted in project name, connotation, charge unit and other factors after docking. Among them, the project connotation is the focal point of docking, while whether or not the supplies should be charged together with the project is a difficult point.2.During 2004-2013, the total cost of tertiary hospitals in Shanghai shows a rising trend in the law. Through the analysis on various types of data, we found that cost of materials, expended, the patient cumulative actual occupied bed days, and every door emergency room visits cost are major factors affecting hospital’s total cost.3.The cost component ratio of different types of medical services projects is different. The proportion of labor costs in examination project and nursing project is the highest; the equipment depreciation costs of chemical examination project and examination project account for a larger proportion; the surgery cost mainly consists of labor costs and health materials.4.Under the current tariff level, the returns-ratio of average cost of various medical services in Shanghai is not high, in which the prices of examination project, nursing project, treatment project and some surgical projects are much lower than the actual costs. While the income of chemical examination project, examination project and beds project could basically covers the costs.Conclusions1. Must combine with local conditions, reserve characteristics, adjust unfitness, add potential application, and delete obsolete or small scope for the opposing connection of two versions under framework of national 2012 version specification.2. Should analyze the main factors of the total cost of hospital based on each constituent element of hospital and medical services, and preserve uniformity to the direction of the price adjustment for the project at the same time.3. The accounting methods of the costing of different projects should be different. The primary and secondary project cost structure can determine the nature and the dominant factors of price, and the difference between actual estimated costs and charge standards can determine the scope of price adjustment.4. Should appropriately raise prices for the project reflecting the value of technical work and its cost is lower than the actual charge standards. Should cut prices for the project relying on large medical equipment and high price consumables, and its actual cost is higher than charge standard, and should translate the price for the project with similar and cost price.