目的:探讨按疾病诊断相关分组(Diagnosis Related Groups,DRG)支付方式下时间驱动作业成本法在公立医院科室成本管控中的重点应用价值.方法:以广西百色市妇幼保健院作为案例医院,将案例医院的产科医疗项目成本作为研究对象,分析时间驱动作业成本法在DRG支付方式下的适用性、有效性及潜在问题,为公立医院的成本管理和提升医疗服务质量提供实践经验和理论支持.通过对DRG支付方式下时间驱动作业成本法成本费用管理进行评价分析,总结案例医院产科医保付费模式的改革成果,为提高医院医疗服务质量与降低科室成本费用提供数据支持.结果:在2023年1月—12月间案例医院产科总成本为1268.26万元,其中最高的为人力成本.产科主要医疗服务项目共计16项,其中10项医疗项目盈利,6项亏损,收益率最差的项目是穿刺,其他依次是产科检查、挂号就诊登记、疑难病例会诊、出院护理和术前准备.结论:时间驱动作业成本法作为一种成本管理方法在公立医院中具有广阔的应用前景和实用价值.通过实施DRG支付方式与时间驱动作业成本法相结合的成本管理策略,医院可以有效控制成本、优化资源配置和提高医疗服务质量.
The Exploration on the TD-ABC Application under DRG Payment Mode in Department Cost Management of Public Hospitals
Objective:To explore the application value of Time-Driven Activity-Based-Costing (TD-ABC) under Diagnosis Related Groups (DRG) payment mode in department cost management of public hospitals. Methods:The medical project cost of obstetrics department in Baise Maternal and Child Health Hospital in Guangxi was selected as the research object between January and December 2023. The medical service quality and department cost management were studied to explore the applicability,effectiveness and potential problems of TD-ABC under DRG payment mode so as to provide practical experiences and theoretical support for cost management and improvement of medical service quality in public hospitals. The cost management in obstetrics department of Baise Maternal and Child Health Hospital in Guangxi after implementation of TD-ABC under DRG payment mode was evaluated,and reform results of medical insurance payment mode were presented to provide data support for improving medical service quality and reducing department cost. Results:In Obstetrics Department of Baise Maternal and Child Health Hospital in Guangxi between March 2023 and March 2024,the total cost was 12.6826 million yuan,and labor cost was the highest. In all the 16 main medical service items,there were 10 profitable items and 6 defective items. The item with the worst yield rate was puncture,followed by obstetric examination,medical registration,consultation of difficult cases,discharge nursing and preoperative preparation. Conclusion:As a new cost management method,TD-ABC has broad application prospect and practical value in public hospitals. Application of TD-ABC under DRG payment mode in cost management can control cost more effectively,optimize allocation of resources and improve quality of medical service.
public hospitalDiagnosis Related Groups (DRG) payment modeTime-Driven Activity-Based-Costing (TD—ABC)cost management