| China's health sector reform has changed the situations in which the hospitals are operated. On one hand, government financial policy is still not clear and subsidies to hospitals account only around 8%. On the other hand, the mechanism for public hospital relying on drugs will be radically changed. Escalation of medical costs has been one of the most important barriers for health care utilization. Therefore, it is very important to improve medical treatment quality and efficiency, control the cost and go the "less consuming more benefit" way. Now in China, there is no effective quantitative method in hospital cost management because the scientific management aroused too late, the study on hospital cost control, especially on the setting of standard cost and its implementing method, are still on a probing stage. The main tasks of this study is to account and analyze the hospital fixed cost and variable cost and its cost framework, adopt the short-term cost function to account the lowest average cost for hospital, analyze the influential factors of the average cost differentia, and propose the feasible measures for the hospital cost control.This paper takes two 3-A hospitals in Jiangxi province as samples. The data we used are collected by the State Development and Reform Admission and Ministry of Health. They have conducted a hospital treatment cost investigation across several provinces, and we also used the data from the complementary 2005 investigation one. This study analyzed 5 same sample departments from the 2 hospitals. It introduced a gradually-apportion method to analyze the fixed and variable cost in every hospitals and sample departments. It relatively used a cost accounting software and short-term cost function model to account the actual average cost and standard cost in every sample department and analyzed the cost differentia concerning the efficiency and staff structure and quantity index.The main results of this study include: (l)Through the fixed cost and variable cost analysis, it's known that the fixed cost accounts for larger proportion in the total medical treatment cost. The depreciation and fixed labor cost accounts for more proportion in the fixed cost; and the sanitation material expenditure and variable salary accounts for larger proportion in variable cost. As for department variable cost, except the above two costs, the surgery expenditure which belongs to the clinical laboratory's apportionment of expenses accounts for larger proportion. (2)Through the relationship analysis between the occupation rate of hospital beds and unit cost differentia, it's known that the department with higher occupation rate of beds has the less unit bed-day cost differentia. When occupation rate of beds and the staff structure and quantity are considered together, it's found that occupation rate of beds is the main factor which influences the cost differentia, and then the staff structure and quantity. (3)Through the unit cost differentia analysis in every sample department of the 2 hospitals, it's known that ophthalmic department in hospital A has the largest bed-day cost differentia, and the digestant internal medicine has the smallest one. In hospital B, maternity department has the largest bed-day cost differentia, and the surgery has the smallest one. The average bed-day cost differentia of Surgery department, Cardiac department, Ophthalmic department in hospital A are larger than the one in hospital B. Thereinto, bed-day depreciation and bed-day salary are the main factors to cause that result. (4) The staff structure and quantity has the "shuttle form", that is to say, the professors, junior doctors and the nursing staff lack but the assistant professors exceed the limit which leads to the high bed-day salary differentia.Conclusions and policy suggestions include: (1) Strength the hospital fixed-assets management. Feasibility analysis for cost-effectiveness should be conducted before the equipment buying. Some proper methods should be adopted to pick up the depreciation in according with its expiring limit and characteristic. (2) improve the medical treatment service quality ,construct the harmonious environment and raise the service efficiency to a even higher level to attract the patients. (3) Strictly control the sanitation material entrance and exit, build the bidding stock system for sanitation material and the low-value easy-exhausting materials. Dominate the entrance, regulate the service procedure inside the department, and put it into the assessment standard for staff to achieve the low-consuming and high-efficiency goal of the materials. (4) rationally regulate the staff structure and make out the proper staff structure standard in according with every hospital's own actual conditions. |
