JP2007241650A - System for calculating medical cost price for each patient and program for calculating medical cost price for each patient - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To solve the problems that input of detailed data and complicated calculation are needed to calculate medical cost prices, it is extremely troublesome and huge time and labor are demanded. <P>SOLUTION: In the system for calculating the medical cost for each patient, cost items such as a medical practice cost are classified into directly chargeable medical practice cost items which can be directly charged to the patients and first non directly chargeable medical practice cost items and second non directly chargeable medical practice cost items for items which can not be directly charged to the patients. For the latter items which can not be directly charged are proportionally divided to the respective patients by calculating a proportional division coefficient and performing weighting. The second non directly chargeable medical practice cost items are proportionally divided in one stage, and the second non directly chargeable medical practice cost items are proportionally divided in two stages. By the system relating to this invention, the labor required for a conventional medical cost price calculation method is reduced to about one-several tenths. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a system for efficiently performing medical costing and a program used for a system for efficiently performing medical costing.

  As the current global trend requires efficient utilization of medical resources, it is necessary to accurately grasp the cost of medical care. In addition, from the viewpoint of ensuring the safety and quality of medical care and the efficient use of limited resources, it is extremely important to understand the cost of medical care both at the management level of the medical institution and at the national level. It has become.

  In FIG. 7, the figure showing the outline | summary (refer nonpatent literature 1) of the medical cost calculation method generally employ | adopted conventionally is shown. In this calculation method, medical expenses (cost of the entire hospital) are roughly classified into expenses that can be directly imposed on individual patients and expenses that cannot be directly imposed on individual patients. The former is directly imposed on the patient. The latter will cost by department and allocate to patients using appropriate allocation criteria.

  In order to explain in detail, FIG. 8 shows a specific example of a direct and allocation structure. The material costs that are clearly used for which patient are directly charged to the patient, but the costs that cannot be directly applied to an individual patient are those directly related to the patient and the patient. Divide into indirect departments (such as administrative departments) that do not have individual relationships. In the indirect department, costs are directly assigned and allocated to the department as appropriate, and in the direct department, expenses are finally allocated to patients.

Yuichi Imanaka, "Cost calculation of medical care", Institute of Social Health, December 20, 2003

  In the cost calculation method described above, it is required to prepare a lot of detailed data and perform very complicated calculations at the stage of cost calculation for each department. It was. For this reason, many hospitals cannot perform departmental costing or submit detailed data, resulting in a problem that costing cannot be performed.

  The present invention has been made in order to solve the problems associated with medical cost calculation as described above, and an object thereof is to save labor for calculating patient-specific costs.

The medical cost calculation system for each patient according to the present invention made to solve the above problems is a system for calculating the medical cost cost for each patient,
a) a plurality of medical cost items belonging to any of the direct medical cost items, the first non-direct medical cost items, and the second non-direct medical cost items;
A plurality of function items provided for each second non-direct medical cost item;
Function item apportioning information indicating a calculation method for calculating a function item apportioning coefficient that is a weight of each function item with respect to the second non-direct medical cost item, based on input basic data;
A non-direct method indicating a non-direct item apportioning coefficient for calculating the first non-direct medical cost item or / and the non-direct item apportioning coefficient that is the weight of each item's patient cost for the function item based on the input basic data Division item apportionment information,
Means for storing
b) a function item apportioning coefficient calculating means for calculating a function item apportioning coefficient for each function item based on the input basic data and the function item apportioning information;
c) a non-direct item apportioning coefficient calculating means for calculating a non-direct item apportioning factor for each item based on the input basic data and the non-direct item apportioning information;
d) Based on the medical cost value by item, which is the cost for each medical cost item entered,
For the direct medical cost items, determine the patient cost for each item from the basic data,
For the first non-direct medical cost item, calculate the patient cost for each item by multiplying the medical cost value by item by the non-direct item apportioning coefficient,
For the second non-direct medical cost item, each functional item medical cost value is calculated by multiplying the item-specific medical cost value by the functional item apportioning coefficient, and the functional item medical cost value is allocated to the non-direct medical item cost value. And item-specific patient cost calculation means for calculating the item-specific patient cost by multiplying by a coefficient.

In the medical cost calculation system for each patient according to the present invention, since the amount of data that must be prepared for calculating the cost for each patient and the calculation that the user must perform are very small, There is no need to prepare detailed data covering all expenses across detailed departments or perform complicated and detailed calculations for each department.
In addition, the data prepared for the system according to the present invention is not new for ordinary hospitals and is often existing data. Therefore, the burden placed on the hospital using the system can be reduced.
Therefore, a huge amount of work that has conventionally required about several months to complete can be reduced to a work amount of about one day, and a very effective labor saving can be achieved. In addition, a reduction in the workload due to a reduction in the amount of work leads to a reduction in the possibility of an operator input error or operation error. In addition, the accuracy of the cost calculated by the system of the present invention is almost the same even when compared with the conventional system.

  And even hospitals that have not been able to perform cost accounting itself can now easily perform cost accounting, thereby promoting the efficiency of medical management. In addition, the quality of medical expenses management policy can be improved because data that will help optimize the value of medical fees, which are official prices, will be submitted.

  Embodiments of a patient-specific medical cost calculation system according to the present invention will be described below with reference to the drawings. FIG. 1 is a block diagram showing a main configuration of a computer system 1 according to the present embodiment. The computer system 1 includes a CPU 2, a memory 3, a display unit 4 including a CRT (Cathode Ray Tube) display and a liquid crystal display, a keyboard having character / number input keys and various function keys, and a mouse as a pointing device. The input unit 5 and the storage unit 6 are connected to each other. The storage unit 6 includes a storage medium including a magnetic recording medium, an optical recording medium, a semiconductor memory, and the like in which programs and data are stored in advance. This storage medium may be fixed to the storage unit 6 or may be detachable.

  The storage unit 6 stores an operating system (OS) 6a, a medical cost calculation program 6b for each patient, medical cost items 6c, function items 6d, function item apportioning information 6e, and non-direct item apportioning information 6f. . Details of these will be described later.

  The patient-specific medical cost calculation system according to the present invention includes functional item apportioning coefficient calculating means 11, non-direct item apportioning coefficient calculating means 12, and itemized patient cost calculating means 13. These are functions realized in software by the above-mentioned patient-specific medical cost calculation program 6b being executed by the CPU 2.

  In the cost calculation method by patient by the cost calculation system by patient according to the present invention, the cost used as the basis for cost calculation is classified into a plurality of items. In the present invention, this classification item is referred to as a medical cost item 6c. The medical cost item 6c includes, for example, personnel costs, material costs, rents, consignment costs, and depreciation costs. For example, the items in the income statement of the hospital accounting rules are classified into this item. It can be used as a guide. However, if an item that is considered to have a low influence on calculation of the final value (for example, depreciation expense) is set excessively finely, the burden on the user who has to prepare data increases. Therefore, it is necessary to make a determination in consideration of the balance between the finally calculated patient-specific cost error and the work amount of the user.

In the present invention, as a characteristic configuration, the medical cost item 6c is further classified into three types: a direct medical cost item, a first non-direct medical cost item, and a second non-direct medical cost item.
In the medical cost item 6c stored in the storage unit 6, each category item includes any of the direct medical cost item, the first non-direct medical cost item, and the second non-direct medical cost item. It also includes information indicating whether it belongs to.
The information regarding the medical cost item 6c is stored in the storage unit 6 when the user sets the information using the input unit 5 in advance. The medical cost item 6c can be customized at any time according to the hospital operation mode.
In the system of the present invention, the item-specific patient cost, which is the medical cost for each item, is different for each direct medical cost item, first non-direct medical cost item, and second non-direct medical cost item. Is calculated.

  The function item 6d is provided to further divide the second non-direct medical cost item into a plurality of items, and a plurality of function items 6d are set for one second non-direct medical cost item. For example, if the second non-direct medical cost item is “working status of pharmacist”, “Dispensing / adjustment”, “medicine guidance”, etc. can be set as function items. These function items 6 d are stored in the storage unit 6 when the user sets them in advance using the input unit 5. The function item 6d can also be appropriately customized at any time according to the hospital operation form or the like.

  In addition, the user sets the function item apportioning information 6 e in advance by using the input unit 5. The function item apportionment information 6e is set for each second non-direct medical cost item, and costs related to the second non-direct medical cost item to which a plurality of function items are related (medical cost for each item described later) (Value) is a method for calculating a function item apportioning coefficient, which is a base value for distributing the value to each function item. For example, the second non-direct medical cost item is “radiologist's labor cost”, and the functional items for this second non-direct medical cost item are “MRI”, “CT”, “X-ray”, etc. If set, the weight (function item apportioning coefficient) for each work of MRI, CT, X-rays, etc. according to the working situation of the radiographer, specifically, for example, the working hours of the engineer and the engineer actually An algorithm for calculating according to the operation time of each device is the function item apportioning information 6e. The function item apportionment information 6e can be customized at any time by the user for each second non-direct medical cost item.

  Further, the user sets the non-direct item apportioning information 6 f by the input unit 5. The non-direct item apportioning information 6f is a non-direct item apportioning factor that is a factor for distributing the cost related to the first non-direct medical cost item to each patient, or for distributing the above-described function item to each patient. This shows a calculation method (calculation algorithm). This non-direct item apportioning information 6f can be appropriately customized at any time by the user for each first non-direct medical cost item and for each function item.

  In the system according to the present invention, various items can be easily set and added in this way, and the method of calculating the distribution coefficient can be easily changed. Or, it can be customized with a high degree of freedom so as to be optimal for the usage of the system desired by the user (hospital).

In the present invention, various specific data used for calculating the distribution coefficient for each patient is referred to as basic data. The basic data includes, for example, a so-called profit and loss statement, personnel allocation data, medical fee billing data (so-called E and F files), departmental area data, and goods delivery status data.
The cost value of each item is referred to as an itemized medical cost value. The basic data and the medical cost value for each item are input by the user through the input unit 5 and are stored in the storage unit 6 as necessary.

  Hereinafter, the operation performed by the CPU 2 executing the patient-specific medical cost calculation program 6b in the system of the present invention will be described.

[Direct medical cost items (Figure 2)]
The cost included in the direct medical cost item is a cost that can be directly applied to an individual patient, that is, the cost required for each patient is obvious, for example, a material cost. The user uses the input unit 5 to input expenses for each patient as basic data. This basic data can also use so-called medical fee billing data. The CPU 2 determines the item-specific patient cost of the direct medical cost item by referring to the basic data.

[First non-direct medical expenses item (Figure 3)]
The cost included in the first non-direct medical cost item is a cost that cannot be directly applied to an individual patient like the above-mentioned direct medical cost item. Therefore, in the cost calculation system by patient according to the present invention, each patient is weighted (the non-direct item apportioning coefficient is calculated) in order to allocate the cost of the first non-direct medical cost item to the patient.

  A method for apportioning the expenses of the first non-direct medical expenses item to each patient will be described with reference to FIG. In the example of FIG. 4, the medical cost value for each item of the MRI depreciation cost, which is the first non-direct medical cost item, is input by the input unit 5 as “120000 (yen)”.

  On the other hand, the non-direct item apportioning information 6f is stored in the storage unit 6, and the non-direct item apportioning information 6f is allocated to the non-direct item apportioning item “MRI cost amortization expense”. The calculation method of the coefficient is shown. In this example, as a calculation method, a weight corresponding to the body part from which MRI was taken (the value of this weight is normally set in advance and included in the non-direct item apportioning information 6f) and the MRI. The non-direct item apportioning coefficient shall be calculated for each patient from the number of uses. Here, the CPU 2 refers to the basic data in order to calculate a specific value, and whether each patient used or not used the MRI. Based on such data, the non-direct item apportioning coefficient is calculated. The non-direct item apportion coefficient for patient A is 0.025, patient B is 0.0175, patient C is 0.04, and patient D is 0 (no MRI is used). Next, the CPU 2 calculates the item-specific patient cost for each patient by multiplying the item-specific medical cost value of 120,000 by each non-direct item apportioning coefficient. That is, in the example of FIG. 4, patient A is 3000 yen, patient B is 2100 yen, patient C is 4800 yen, patient D is 0 yen, and so on.

[Second non-direct medical expenses item (Figure 5)]
The expenses included in the second non-direct medical expenses item include, for example, personnel expenses. This is an expense that cannot be directly imposed on an individual patient, and that it is difficult to simply weight each patient as in the first non-direct medical cost item described above. In the present invention, for such items, as shown in FIG. 5, first, the function items are divided into functional items, the functional item medical cost value is calculated for each functional item, and weighting is performed for each functional item. The functional item medical cost value is distributed to patients.

  A method for apportioning the cost of the second non-direct medical cost item to each patient will be described from a specific example with reference to FIG. In the example of FIG. 6, the medical cost value for each item of the pharmacist's personnel cost, which is the second non-direct medical cost item, is input by the input unit 5 as “3000000 (yen)”.

  The function item 6d is stored in the storage unit 6, and the function item 6d stores the type of the function item related to the second non-direct medical cost item “pharmacist labor cost”. Here, it is assumed that “dispensing / adjustment (hospitalization)”, “medicine guidance (hospitalization)”, and the like are predetermined as examples of function items. Further, the function item apportioning information 6e is stored in the storage unit 6, which shows a method for calculating the function item apportioning coefficient relating to the second non-direct medical cost item “personnel cost of pharmacist”. In this example, as this calculation method, the function item apportioning coefficient is obtained for each function item from the working status (working hours, etc.) of the pharmacist, which is basic data. Here, it is assumed that the CPU 2 calculates the function item apportioning coefficient of the function item “dispensing / adjustment (hospitalization)” as 0.3 and the function item apportioning coefficient of “medicine guidance (hospitalization)” as 0.05 by referring to the basic data. . Next, the CPU 2 calculates each functional item medical cost value by multiplying each functional item proportional coefficient by 3000000, which is the medical cost value by item of the pharmacist's labor cost. In the example of FIG. 6, “dispensing / adjustment (hospitalization)”: 900000 (yen), “medicine instruction (hospitalization)”: 150000 (yen).

Next, the function item medical cost value related to each function item “dispensing / adjustment (hospitalization)”, “medication instruction (hospitalization)”, etc. is distributed to each patient. Here, only the former function item “dispensing / adjustment (hospitalization)” will be described. The CPU 2 calculates a non-direct item apportioning coefficient based on the non-direct item apportioning information 6f stored in the storage unit 6 and the basic data. In the example shown in FIG. 6, the non-direct item apportioning coefficient is determined based on the number of dispensing cases. As a result, the non-direct item apportioning coefficient of patient A is 0.002, and patient B is 0.0018.
Finally, the CPU 2 calculates the patient cost by item of each patient by multiplying each non-direct item apportioning coefficient by 150000 which is the functional item medical cost value. That is, in the example of FIG. 6, patient A is 1800 yen, patient B is 1620 yen, and so on.
Similarly, the CPU 2 calculates the patient cost for each patient item for other function items such as “medicine instruction (hospitalization)”.

Thus, in the patient-specific medical cost calculation system according to the present invention, the item-specific patient cost is calculated for each medical cost item or for each function item. Therefore, it is possible to perform aggregation and analysis by an arbitrary method based on the patient cost for each item.
For example, by using the OLAP (Online Analytical Processing) tool as the aggregation method,
・ Comparison of cost and income, income and expenditure analysis, calculation of profit ratio ・ Calculation of cost and income by department, ward, and doctor ・ Drill-up / drill-down on hierarchical data such as department, expense item, date, etc. Data analysis and processing can be performed easily, and the calculated results can be displayed graphically.

  As mentioned above, although embodiment of the medical cost calculation system classified by patient of this invention was described, this is only an example and it is clear that it may improve and change suitably in the mind of this invention.

  In the medical cost calculation system by patient of the present invention, when the user performs various inputs using the input unit 5, the input screen displayed on the display unit 4 is a spreadsheet (spreadsheet software) display screen. And good. As a result, many users can intuitively use the system of the present invention with basically the same operation as operating spreadsheet software that they are familiar with. This is effective in reducing the possibility of input errors and increasing work efficiency. Of course, the patient-specific medical cost calculation program of the present invention may be configured to operate on a spreadsheet application.

In the above description, the patient-based medical cost calculation system according to the present invention is a system using a stand-alone computer. However, a system using a data communication network such as a LAN, WAN, or the Internet may be used. In the case of this form, the storage unit 6 is provided in the server, and the server and a plurality of client computers are connected to each other so that data communication is possible.
In this system form, various basic data and itemized medical cost values are transmitted from each client computer to the server, and the CPU of the server stores them in a predetermined area of the storage unit 6. As a result, data of departments that are physically distant from each other can be transmitted through the network, so that it is possible to reduce labor compared to a stand-alone system configuration.

  In the previous example, basically, a client-specific medical cost calculation program (which may be a client program having a different function from the patient-specific medical cost calculation program installed on the server side) is also installed on each client computer. Need to be. However, the system of the present invention uses the medical cost calculation system for each patient even from a computer in which the medical cost calculation program for each patient is not installed by accessing a predetermined web server using various browsers for browsing web pages. Of course, it is possible to adopt a so-called ASP (Application Service Provider) type system form.

The block diagram which shows the principal part structure of the computer system by one Embodiment of this invention. The conceptual diagram of the calculation method of the patient cost according to item based on the expense of a direct medical care expense item. The conceptual diagram of the calculation method of the patient cost according to item based on the expense of the 1st nondirect medical expenses item. The conceptual diagram of the method of calculating the patient cost according to item from the MRI depreciation expense which is an example of the 1st non-direct medical cost item. The conceptual diagram of the calculation method of the patient cost according to item based on the expense of the 2nd non-direct medical expenses item. The conceptual diagram of the method of calculating the patient cost according to item from the labor cost of the pharmacist who is an example of the 2nd non-direct medical cost item. The figure which shows the outline | summary of the conventional medical cost calculation method. Detailed direct charge and allocation structure example of conventional medical costing method.

Explanation of symbols

1 ... computer system 2 ... CPU
3 ... Memory 4 ... Display unit 5 ... Input unit 6 ... Storage unit 6b ... OS
6b ... Medical cost calculation program by patient 6c ... Medical cost item 6d ... Functional item 6e ... Functional item apportioning information 6f ... Non-direct item apportioning information

Claims (3)

A system for calculating medical costs for each patient,
a) a plurality of medical cost items belonging to any of the direct medical cost items, the first non-direct medical cost items, and the second non-direct medical cost items;
A plurality of function items provided for each second non-direct medical cost item;
Function item apportioning information indicating a calculation method for calculating a function item apportioning coefficient that is a weight of each function item with respect to the second non-direct medical cost item, based on input basic data;
A non-direct method indicating a non-direct item apportioning coefficient for calculating the first non-direct medical cost item or / and the non-direct item apportioning coefficient that is the weight of each item's patient cost for the function item based on the input basic data Division item apportionment information,
Means for storing
b) a function item apportioning coefficient calculating means for calculating a function item apportioning coefficient for each function item based on the input basic data and the function item apportioning information;
c) a non-direct item apportioning coefficient calculating means for calculating a non-direct item apportioning factor for each item based on the input basic data and the non-direct item apportioning information;
d) Based on the medical cost value by item, which is the cost for each medical cost item entered,
For the direct medical cost items, determine the patient cost for each item from the basic data,
For the first non-direct medical cost item, calculate the patient cost for each item by multiplying the medical cost value by item by the non-direct item apportioning coefficient,
For the second non-direct medical cost item, each functional item medical cost value is calculated by multiplying the item-specific medical cost value by the functional item apportioning coefficient, and the functional item medical cost value is allocated to the non-direct medical item cost value. An itemized patient cost calculating means for calculating an itemized patient cost by multiplying by a coefficient,
A medical cost calculation system for each patient, characterized by comprising: It is used in a system for calculating the cost of medical expenses for each patient.
b) a function item apportioning coefficient calculating means for calculating a function item apportioning coefficient for each function item based on the input basic data and the function item apportioning information;
c) a non-direct item apportioning coefficient calculating means for calculating a non-direct item apportioning factor for each item based on the input basic data and the non-direct item apportioning information;
d) Based on the medical cost value by item, which is the cost for each medical cost item entered,
For the direct medical cost items, determine the patient cost for each item from the basic data,
For the first non-direct medical cost item, calculate the patient cost for each item by multiplying the medical cost value by item by the non-direct item apportioning coefficient,
For the second non-direct medical cost item, each functional item medical cost value is calculated by multiplying the item-specific medical cost value by the functional item apportioning coefficient, and the functional item medical cost value is allocated to the non-direct medical item cost value. An itemized patient cost calculating means for calculating an itemized patient cost by multiplying by a coefficient,
Medical cost calculation program by patient to make it function. A recording medium for use in a system for calculating a medical cost cost for each patient, on which the medical cost calculation program for each patient according to claim 2 is recorded.

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