Abstract: Background　Hospice care is one of the important livelihood issues，which is related to the life quality of patients，medical value orientation，and social civilization progress.Hospice care inpatient wards have been set in Shanghai since 2012 and "hospice care" has been included in the municipal government's practical projects.And a hospice care model with community health service centers as the main body has been formed at present.Objective　To explore the feasibility of paying for per bed day of hospitalization of hospice care in community health service centers and to further promote the continuous development of hospice care by taking Changzheng Community Health Service Center as an example.Methods　The homepage information on medical records of discharged patients from hospice care department in Changzheng Community Health Service Center from 2013 to 2017 were collected.A questionnaire was developed for gathering the cost data.A one-week follow-up survey was conducted among physicians，nurses，medical social workers and social volunteers in the department of hospice care.Direct cost per bed day of hospice care was calculated using relevant cost accounting method.Results　There were 491 discharged patients from hospice care department in Changzheng Community Health Service Center during 2013 and 2017.Two of them，who were hospitalized for 1 522 days（2017） and 191 days（2014），respectively，were excluded from the analysis and finally included 489 people.There were 435（88.96%） patients with tumor，15（3.07%） with circulation system diseases，12（2.45%） with respiratory system diseases.Length of stay of the 489 discharged patients spread over 0.5 to 89.0 days，with an average of 15.60 days.Medical expense of the 489 discharged patients ranged from 35 yuan to 23 628.56 yuan，with an average of 4 827.29 yuan.Medical expense per bed day of the 489 discharged patients spread over 67.47 yuan to 2 594.96 yuan，with an average of 309.40 yuan.Direct cost per bed day of hospice care in the Changzheng Community Health Service Center in 2017 was 530.05 yuan，including human cost of 309.11 yuan（58.32%），medicine cost of 144.60 yuan（27.28%），depreciation cost of equipment of 25.81 yuan（4.87%），material cost of 22.40 yuan（4.23%），building depreciation of 17.39 yuan（3.28%） and other costs of 10.74 yuan（2.02%）．Conclusion　The expenses per diem of inpatient in hospice care department in Changzheng Community Health Service Center are relatively stable，which meets the requirements of per diem payment.

Key words: Community health centers, Community health services, Hospice care, Per diem payment, Costs and cost analysis, Shanghai

摘要： 背景　安宁疗护关乎患者的生命质量，关乎医学的价值取向和社会的文明进步，是一个重要的民生问题。上海从2012年开始设立“舒缓疗护”病房并将“临终关怀”列入市政府实事项目，目前已形成以社区卫生服务中心为运营主体的安宁疗护模式。目的　以上海市普陀区长征镇社区卫生服务中心为样本，探索社区卫生服务中心安宁疗护住院服务按床日付费的可行性，进一步推进安宁疗护事业的不断发展。方法　提取2013—2017年上海市普陀区长征镇社区卫生服务中心安宁疗护科所有出院患者病案首页信息；设计调查表采集成本相关数据信息，并对安宁疗护科医生、护士、护理员、医务社工和社会志愿者进行1周的追踪调查；应用床日成本核算方法对2017年安宁疗护住院服务床日直接成本进行测算。结果　上海市普陀区长征镇社区卫生服务中心2013—2017年累计出院患者491例。其中2例住院天数分别为1 522 d（2017年）、191 d（2014年），分析中予以剔除，最终纳入489例。489例患者入院诊断主要包括肿瘤435例（88.96%）、循环系统疾病15例（3.07%）、呼吸系统疾病12例（2.45%）等；住院天数0.5~89.0 d，平均住院天数15.60 d；医药费用35.00~23 628.56元，平均医药费用为4 827.29元；每床日医药费用67.47~2 594.96元，平均每床日医药费用309.40元。2017年上海市普陀区长征镇社区卫生服务中心安宁疗护每床日直接成本为530.05元，其中人力成本309.11元（58.32%），药品成本144.60元（27.28%），设备折旧成本25.81元（4.87%），耗材成本22.40元（4.23%），建筑物折旧成本17.39元（3.28%），其他成本10.74元（2.02%）。结论　上海市普陀区长征镇社区卫生服务中心安宁疗护住院患者每床日费用差异较小、日均费用相对稳定，较符合按床日收付费标准和要求。

关键词: 社区卫生中心, 社区卫生服务, 安宁疗护, 按床日付费, 成本及成本分析, 上海市