护理服务项目及价格的现状研究与对策

论文编号:HL233 论文字数:15794,页数:35

论文题目：护理服务项目及价格的现状研究与对策
摘  要
 研究背景：20世纪80年代美国始创了护理经济学，主要关注护理成本、价格、需求、供给及从不同角度对护理市场开发，护理成本核算，护理保险实施等进行了全面研究。我国护理经济学研究起步较晚，但各类护理人员已对护理人力资源，护理成本，护理服务效益等方面进行了探索，取得了初步成效。由于缺乏对护理价值的综合研究，在我国，护理服务价值尚未得到真正的体现，如诊疗、救治、监护、观察及基础护理技术的价值体现及表达。2001年国家卫生部、国家中医药管理局和国家发改委联合颁发的《全国医疗服务价格项目规范（试行）》（以下简称《规范》）是建国以来第一次由国家卫生和价格主管部门对全国医疗服务的价格项目进行统一规范，为改革我国医疗服务价格管理体制奠定了基础。然而经研究，此《规范》没有充分体现护理服务的价值。
 研究目的：通过对现行护理服务项目及价格的调查研究，引起更多护理同行的重视，加大此方面的研究力度，探讨增加护理服务项目的途径和护理服务成本核算的方法，逐步确立规范的护理服务项目体系及合理的护理服务价格体系；引起相关部门对护理服务成本和价值体现的关注，在修订《规范》时根据实际工作需要及患者的需求增加护理服务收费项目，在开展成本核算的基础上为护理服务项目合理定价。
 研究方法：采用统计表分析2003年版《安徽省医疗服务价格项目规范（试行）》中护理服务项目及价格的现状；依据美国护理干预服务项目分类原则，完成气管切开护理成本分类，核算了气管切开护理项目成本。
 研究结果：提出了增加护理服务项目的途径；例举了护理服务成本核算的方法；将气管切开护理分为7个项目，并核算出每单项成本。
 结论：护理服务价格项目缺少限制了护理质量的提高、影响了护理队伍的稳定、阻碍了护理学科的发展和导致医疗费用结构的畸形发展。应根据实际工作需要及患者的需求增加护理服务收费项目；在规范开展成本核算的基础上为护理服务项目合理定价。
关 键 词：护理服务项目；护理服务价格； 护理成本； 护理成本核算
论文类型：其它
 
 Title: Nurse service project and price present situation research and countermeasure
ABSTRACT
Backgroud:
 In the 1980s the US originated the nursing economic, mainly paid attention to the nursing cost, the price, the demand, the supplies and to nurses the market development from the different angle, the nursing cost accounting, the nursing insurance implementation and so on has conducted the comprehensive study. Our country nurses the economic research start to be late, but each kind of nursing staffs to have nursed the human resources, the nursing cost, aspects and so on nurse service benefit have carried on the exploration, has made the preliminary progress. Because lacks to nurses the value the synthetic study, in our country, the nurse service value not yet obtains true manifestation, like diagnosing and treating, the treatment, the guardianship, the observation and the foundation nursing technology''''s value manifests and expresses. since 2001 the National Medical department, the National Chinese medicine Administrative bureau and national Development and Planning Commission has issued "the Nation Medical service Price Project Standard (Implementation)" (hereafter refers to as "Standard") is jointly the founding of the nation first time carries on the unified regulations by the national health and the price Department responsible for the work to the nation medical service price project, to reform our country medical service price administration system to lay the foundation. However passes through the research, this "Standard" has not manifested the nurse service fully the value.
Objectives:
 Through causes to the present nurse service project and the price investigation and study nurses the colleague the value, enlarges this aspect research dynamics, the discussion increases the nurse service project the way and the nurse service cost accounting method, establishes the standard gradually the nurse service project system and the reasonable nurse service price system; Causes the related department the attention which manifests to the nurse service cost and the value, when revises "Standard" needs and patient''''s demand according to the practical work increases the nurse service fee item, in development cost accounting foundation for nurse service project fair pricing.
Methods:
 Used the statistical table to analyze in 2003 the version "the Anhui Province Medical service Price Project Standard (Implementation)" the nurse service project and the price present situation; Nurses the intervention service items classification principle based on the US, completes the tracheotomy nursing cost classification, has calculated the tracheotomy nursing item cost.    
Results:
 Proposed increases the nurse service project the way; The example has lifted the nurse service cost accounting method; Divides into 7 projects tracheotomy nursing, and calculates each single item cost. 
Conclusion:
 The nurse service price project lacked has limited the nursing quality enhancement; Has affected the nursing troop''''s stability; Has hindered the nursing discipline and the medical expense structure malformed development. Should need and patient''''s demand according to the practical work increases the nurse service fee item; In standard development cost accounting foundation for nurse service project fair pricing.
 KEY WORDS: nurse service project, nurse service price, nursing cost, nursing cost accounting
TYPE OF THESIS: Other

目  录
1 绪论 1
1.1背景及意义………………………………………………………………………….1
 1.1.1 研究背景. 1
     1.1.2 研究的意义………………………………………………………………….1
 1.2 研究的目的及目标…………………………………………………………………2
     1.2.1研究的目的………………………………………………………………… .2
     1.2.2 研究的目标………………………………………………………………….2
 1.3 关键词及定义………………………………………………………………………2
     1.3.1 关键词……………………………………………………………………….2
     1.3.2 定义………………………………………………………………………… 2
 1.4 文献回顾…………………………………………………………………………....3
     1.4.1国外护理成本研究的发展历程…………………………… ……………… 3
     1.4.2国内护理成本研究状况…………………………………………… ……….4
     1.4.3国内外护理服务项目研究状况……………………………………… …….4
     1.4.4国内护理成本研究存在的问题……………………………………………..5
2研究设计……………………………………………………………………………..……..6
2.1研究对象……………………………………………………………………….……6
 2.2一般资料……………………………………………………………………………6
 2.2.1护理服务项目及价格的研究资料…………………………………….……6
     2.2.2 气管切开护理项目成本核算的研究资料………………………………….6
 2.3 研究方法……………………………………………………………………………6
 2.4 研究步骤……………………………………………………………………………7
     2.4.1 准备阶段…………………………………………………………………….7
     2.4.2 实施阶段…………………………………………………………………….7
     2.4.3 总结阶段…………………………………………………………………….7
3研究结果……………………………………………………………………………………8
3.1护理服务的价格项目偏少…………………………………………………………8
 3.2 医疗服务与护理服务收费未分开…………………………………………………9
 3.3 捆绑式收费，项目内容不具体……………………………………………………9
 3.4 项目调整不及时………………………………………………………………….10
 3.5 护理服务价格严重偏离成本………………………………………………… .…10
4 讨论……………………………………………………………………………………….11
    4.1对护理服务项目进行了较全面的研究………………………………………...…11
 4.2 分离了医疗和护理服务项目……………………………………………..………11
 4.3 科学地护理项目分类………………………………………………………….…11.
 4.4 成本核算方法有待统一………………………………………………………….12
 4.5 如何考虑护理用品成本…………………………………………………………12
 4.6 科学计算人力成本………………………………………………………………..12
5. 推论及建议………………………………………………………………………………14
   5.1推论………………………………………………………………………….………14
        5.1.1 限制了护理质量的提高……………………………………………..…….14
     5.1.2 影响了护理队伍的稳定………………………………………………..….14
     5.1.3 阻碍了护理学科的发展…………………………………………………...15
     5.1.4 导致医疗费用结构的畸形发展……………………………………….…..15
 5.2 建议………………………………………………………………………………..16
     5.2.1 提高对护理成本管理的认识…………………………………………..….16
     5.2.2 扩大护理价格项目范围…………………………………………………...16
     5.2.3 开展规范、统一的护理成本核算研究……………………………………17
     5.2.4 合理制定护理服务价格…………………………………………………...17
     5.2.5 及时增加新项目………………………………………………………...…17
     5.2.6 开放特需护理服务………………………………………………………...17
致    谢…………………………………………………………………………………….19
参考文献…………………………………………………………………………………….21
附    录…………………………………………………………………………………….23