缅甸拥有200张床位的公立医院的医疗服务单位成本：医院预算中起重要作用的因素是什么？
Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?
作者信息
Than Thet Mon, Saw Yu Mon, Khaing Moe, Win Ei Mon, Cho Su Myat, Kariya Tetsuyoshi, Yamamoto Eiko, Hamajima Nobuyuki
机构信息
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
出版信息
BMC Health Serv Res. 2017 Sep 19;17(1):669. doi: 10.1186/s12913-017-2619-z.
BACKGROUND
Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately.
METHODS
A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010.
RESULTS
The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals.
CONCLUSION
The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.
背景
成本信息对于有效分配医疗保健支出、估算未来预算分配以及设定用户费用以启动新的融资系统至关重要。缅甸正处于政治转型期，并试图在2030年前实现全民健康覆盖。本研究从提供者角度评估了该国两家公立医院的医疗服务单位成本。该研究还分析了医院的成本结构，以便合理分配和管理预算。
方法
在缅甸拥有200张床位的马圭教学医院（MTH）和彬马那综合医院（PMN GH）进行了一项基于医院的横断面研究，研究时间为2015 - 2016财政年度。采用逐步成本核算方法计算每住院日和每次门诊就诊的单位成本。成本使用Microsoft Excel 2010进行计算。
结果
两家医院各科室每住院日的单位成本差异很大。在PMN GH，儿科病房每住院日的单位成本为28,374缅元（27.60美元），耳鼻喉科病房为1,961,806缅元（1908.37美元）。在MTH，内科病房每住院日的单位成本为19,704缅元（19.17美元），眼科病房为168,835缅元（164.24美元）。PMN GH每次门诊就诊的单位成本为14,882缅元（14.48美元），而MTH为23,059缅元（22.43美元）。关于成本结构，药品和医疗用品在MTH中是最大组成部分，而设备在PMN GH中是最大组成部分。MTH的外科病房和PMN GH的眼科病房消耗了医院总成本的大部分。
结论
单位成本受患者对医院服务的利用率、可用资源的效率、提供的医疗服务类型以及医生的医疗实践影响。MTH和PMN GH之间也发现了成本结构差异。研究结果提供了有关公立医院医疗成本的基本信息，可用于有效利用可用资源。
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