Recently, the National Health Commission, the State Administration of Traditional Chinese Medicine, and the National Bureau of Disease Control and Prevention jointly researched and formulated the "Guidance Manual for Cost Accounting of Public Hospitals" to encourage public hospitals to carry out multi-dimensional and multi-level cost accounting. Cost accounting of public hospitals can not only help hospitals find cost control points and optimize resource allocation, but also provide data support for health investment and financial compensation, medical service formulation and supervision, medical insurance payment policy improvement, and performance evaluation of public hospitals.
In the on-site inspection of the "**Hospital Evaluation Standards (2022 Edition)", there is an assessment of whether the hospital implements full cost accounting management. The implementation of full cost accounting management can help hospitals find cost control points, optimize resource allocation, analyze the causes of losses, reduce financial risks, and improve the efficiency of medical resource utilization.
Notice on Printing and Distributing the Cost Accounting Guidance Manual for Public Hospitals" clearly statesBy the end of 2025, we will strive to achieve the cost accounting of medical service projects, disease cost accounting, and DRG cost accounting in all hospitalsand actively promote the application of cost accounting results, build a cost control index system, and provide high-quality cost data support for refined operation management and scientific decision-making.
Combined with the "Guidance Manual for Cost Accounting of Public Hospitals" and the application cases of cost accounting of public hospitals released by the Ministry of Finance, CDSREPORT summarizes and sorts out the main methods, application conditions and hospital benefits of cost accounting of medical service projects, hoping to help hospitals choose the appropriate method to carry out cost accounting of medical service projects.
What is the cost accounting of medical service items:This course is a medical service program provided by each department of the hospitalThe process of collecting and allocating various expenses and calculating the unit cost of each medical service item. The object of cost accounting is the medical service fee items issued by the competent departments of medical services, health administrative departments and traditional Chinese medicine, excluding drugs and health materials that can be charged separately.
In terms of accounting methodology,The cost accounting methods of medical service projects mainly include three categories: activity cost method, equivalent coefficient method and parameter allocation methodDifferent types of healthcare services can choose different costing methods depending on their cost drivers.
Activity costing
Activity costing refers to a cost calculation method that measures operation performance and resource utilization by tracking and recording all operation activities of a medical service project. The method is activity-centric and allocates elements based on cost driversIt embodies the principle of "service consumes jobs, and jobs consume resources".
Operation refers to important activities and behaviors that have relatively independent significance in the process of medical servicesEach process or link in the process of medical services, such as diagnosis and treatment, surgery (disinfection, exploration), nursing, etc., can be regarded as operations. A cost driver is a measure of an event or activity that causes a cost to occur, and can be divided into resource drivers and activity drivers. A resource driver is a measure of the relationship between resource consumption and an activity, and is the basis by which resource costs are allocated to an activity. Activity costing can be subdivided into traditional activity costing and time-driven activity based costing (TDABC) according to the driver settings.
The disadvantages of the activity costing method are that the workload is huge, the input cost is high, the model modification is difficult, the cross-work is difficult to clearly define, and the incomplete or inaccurate data affect the implementation of this method. Estimated Activity Costing (TDABC) unifies resource drivers and activity drivers in traditional ABC, and uses "time" as a measurement tool to allocate costs. This makes TDABC more concise, scalable, and flexible, and easy to be understood and accepted by all kinds of data users, especially non-financial professionals, and administrators.
In the hospital application case, the hospital that carried out TDABC also achieved the following points: the active participation of clinical departments to provide clear and identifiable operations, operation resource consumption, processes, and operation chains; The foundation of informatization construction is good, and various data are provided in a timely and accurate manner; Synergies between functional departments. The above conditions ensure the implementation of the scheme and the integrity and accuracy of the data. Among them, the clinical department has management awareness and active participation is an important condition for application.
Equivalent coefficient method
The equivalent coefficient method is based on the department unit during the determined accounting periodA typical medical service item is selected as a representative item, and its cost equivalent number is "1", which is used as the standard equivalent, and other items are compared with the representative items, and then the cost equivalent value of each item is obtained, and then the cost of each item is calculated
Compared with the activity costing method, the equivalent coefficient method has a relatively simple accounting process. Compared with the parameter allocation method, the cost accounting results are relatively accurate, which better solves the problems of project cost accounting and the large difference between the accounting results and the actual resource consumption.
The equivalent coefficient method is mainly suitable for the cost accounting of medical service projects with a high degree of standardization of the operation process and resource consumption process, the total cost of the project is easy to collect, the typical representative project with the cost equivalent of "1" is easy to be selected through technical difficulty and risk factors, and the equivalent coefficient is calculated by quantifiable indicators for other projects.
The equivalent coefficient method does not have a high dependence on the degree of informatization, and is suitable for the cost allocation of some inspection and laboratory projects with a high degree of standardization, hospital-wide general projects and internal service items provided by medical auxiliary departments(e.g. laundry, disinfection, etc.). For hospitals with a good information foundation and more refined and accurate department cost accounting, the inspection projects provided by platform departments such as laboratory departments, radiology departments, and operating rooms can also be integrated with the equivalent coefficient method to carry out project cost accounting on the basis of the operation cost method, which can further optimize the medical business process, accurately control costs, and reduce patient costs while improving the accuracy of cost accounting.
The difficulty of the equivalent coefficient method lies in how to determine the cost equivalent coefficient of each medical project, the equivalent coefficient has a great impact on the cost of medical service items, and the cost structure of different types of medical service items is quite different. Determining the cost equivalent coefficient of different cost items can appropriately improve the accuracy of cost allocation by the equivalent coefficient method, and at the same time, it can also more objectively and truly reflect the process and difference of resource consumption of clinical business activities, and provide data support for unit cost control and dynamic adjustment.
Parameter allocation method
The parameter allocation method (also known as the cost proportion coefficient method) refers to the calculation method that finally allocates the cost of each department unit to the medical service project by setting a certain allocation parameter. According to the different allocation parameters, the parameter allocation method can be divided into income distribution coefficient method, operation time distribution coefficient method, workload distribution coefficient method, etc.
Among them, the income distribution coefficient method takes the proportion of the income of each medical service project to the total income of the department unit (excluding the income of drugs and the income of separately charged sanitary materials) as the proportion of the distribution cost, and it is necessary to first calculate the total income of the medical service project and the total income of the medical service project of the department to obtain the income distribution coefficient of the project, and then calculate the total cost of the project and the unit cost according to the distribution coefficient. The operation time allocation coefficient method and the workload allocation coefficient method are to take the proportion of the operation time or workload of each medical service project to the total operation time or workload of the department unit as the proportion of the allocation cost, and the calculation process is similar to the income distribution coefficient method.
Allocation rate = total cost of medical services in a department The sum of the allocation parameters of medical services in the department (such as total operating hours, total workload, total revenue).
The total cost of a medical service = the allocation rate of the medical service allocation parameter
The three parameter allocation methods have a low degree of subjectivity in parameter setting, and the accounting process is relatively simple. The more parameters and the finer the granularity, the higher the accuracy of cost accounting, which can be used as a reference for more detailed management decisions on the internal operation of the hospital, but the greater the accounting workload.
Accurate accounting of the cost of medical service projects is conducive to clinical and medical technology departments to grasp the actual development and resource consumption of medical service projects in a timely manner, and continuously optimize the clinical path through the iterative update of the medical service project operation library. In the actual development, the hospital can select the appropriate cost accounting method for medical service projects based on the actual business situation.
Taking a tertiary hospital as an example, the comprehensive strength of the hospital ranks among the top hospitals in China, and it was approved as a national high-quality development pilot hospital in 2021. When costing medical service projects, the hospital divides medical service projects into three categories: hospital-wide projects, specialty projects, and platform projects, and selects different cost accounting methods for different types of medical service projects according to their different cost drivers. For example, for hospital-wide items such as heating fees, air-conditioning cooling fees, bed fees, and ** fees, the hospital adopts the cost equivalent method of accounting. For the general examination items carried out in the ward schedule, such as consultation fees, nursing fees, dressing changes, injections, etc., the cost proportion coefficient method is adopted. For platform projects such as laboratory department, radiology department, operating room, etc., the operation cost method is adopted.
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