中文摘要：

目的：通过测算公立医院医疗服务项目成本，探究当前我国公立医院医疗服务收费不合理的程度，并提出相应的政策建议。方法：从全国医疗服务成本测算数据库中，按照地域分布和数据质量高的原则，选择了山东、浙江、安徽、陕西和云南5省的省、地市、区县级医院作为研究样本；采取阶梯分摊的全成本测算法测算36家医院3488个医疗服务项目的成本，比较分析各类服务项目中能够收回成本的项目数所占比重，并拟合各类项目的成本收费比值频率分布图。结果：只有医技诊疗类中的超声检查、医学影像类服务项目的收费总体上能收回成本，其他类服务项目的收费总体上不易收回成本；各类服务中，收费低于成本与收费高于成本的项目同时存在。结论：降低医学影像、超声检查类项目的收费，适当提高能高度反映医务人员技术劳务价值项目的收费标准；增强成本测算在医疗服务定价过程中的指导作用，积极采用更先进的支付方式。

英文摘要：

Objective： Through estimating the medical service item cost of public hospital, discuss the distortion degree on medical service costs and provide relevant policy suggestion. Methods： According to the National Medical Service Cost Estimating data base, applying the principle of geographical distribution and high data quality, select provincial, city-level and district-level public hospitals from Shandong, Zhejiang, Anhui, Shanxi and Yunnan; using the total cost accounting method via step-down methodology to estimate the unit cost for 3 488 medical service items of 36 hospitals, calculate the proportion of cost-recovered medical services and fit the frequency distribution curve for the ratio（charge at cost） in each category of medical services. Results： Only ultrasonic examination and medical imaging medical services have cost advantage, the majority of other categories services are not easy to recover the cost; both cost-recovered medical services and non cost-covered medical services abounded in all categories services. Conclusion： Reducing the charges for ultrasonic examination and medical imaging medical services, appropriately increasing the charges for medical services which highly reflect the value of the technology and labor; enhancing the status of cost estimation in the medical service pricing process and using more advanced mode of payment for medical service.