我国医院成本核算与成本管理研究
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摘要
医院,这个担负着国家全体国民健康的特殊机构,随着国家新医改的不断深化,也要以其特殊的身份参与市场竞争,这就要求医院自身在坚持公益性首要地位的前提下,增收节支,不断改善医院的经营状况,谋求可持续发展。本文自2008年着手搜集我国医疗改革方面的信息,认为建立和完善我国医院的成本核算和管理是医疗改革的一项重要内容,从宏观和微观角度而言都有一定的现实意义。
本文首先综合分析了国内外医院的成本核算与成本管理的现状,剖析了当前我国医院在成本核算与成本管理中存在的不足,并结合对医疗服务的无形性、不确定性等特征分析,提出了医院成本核算与成本管理的总体思路,绘制出医院成本核算与成本管理框架图,初步构建了一套四级医院成本核算与成本管理模式,对2011年7月1日在全国试点医院执行的医院会计制度中涉及的医院总成本、科室成本、医疗服务项目成本和病种成本进行了详细的论述。其中,采用四级逐项分摊法计算科室成本,运用分类成本核算的方法确定不同的医疗服务项目成本和病种成本,并引入责任会计和预算管理思想,使这套模式充分体现责任控制理念,确保医院内部人人有责任、个个有指标,并在此基础上,就当前医院的成本管理提出具体的建议：提升医院管理者管理理念的内容和途径、完善医院成本分析方法、借鉴责任费用预算思想对管理费用进行控制、根据责任成本理论引入医院社会责任成本理念,最后,运用作业管理思想对医院成本核算与成本管理发展趋势进行了展望。
本文在最新颁布的医院会计制度基础上,丰富了医院成本核算方法和分摊机制,对医院各级成本的核算与管理进行了详细的探讨,并引入责任会计和预算管理的思想对当前医院成本管理提出了建议,以期对医院的经营管理提供理论支持。本文的不足之处是没有把调研的案例资料在文章中很好的体现,这也成为作者今后进一步研讨的课题。
Hospitals, the special agencies responsible for the health of all citizens of the country, along with the deepening of the new health reform, also compete in the market in its special status. This requires that the hospital's own public interest in upholding the primacy of the premise, to increase revenue and reduce expenses, improving the operating conditions of the hospital in pursuit of sustainable development. The article begins to collect the aspect of our country medical service reform information from 2008, thought that establishes and consummates our country hospital cost accounting and cost management is a medical reform important content, says from macroscopic and the microscopic angle has certain practical significance.
Firstly, the article have a comprehensive analysis of present situation in domestic and foreign hospital's cost accounting and cost management, analyzed the current insufficiency which exists in the cost accounting and the cost management of hospital, and combined with characteristics analysis of the medical service intangible nature, uncertainties and so on, proposed the general concept of hospital cost accounting, draw a hospital cost accounting and cost management framework diagram, initially constructed a set of four hospital cost accounting and cost management. On July 1,2011 implementation of the pilot hospitals in the country's hospitals involved in the accounting system, the total cost of the hospital, department costs, the cost of medical services and disease costs were discussed in detail. And, uses four levels to share the law to calculate the administrative offices cost item by item, using the classification cost accounting's method determined that the different medical service item cost and sickness plant the cost, and introduces responsibility accounting and the budget management thought that causes this set of patterns to manifest the responsibility control idea fully, guarantees hospital interior everybody has a responsibility, all has the target, and on this basis, proposed several ideas on the current hospital cost management:promotes the manage idea of the hospital superintendent in the content and the way, improve the analysis of hospital cost, profits from the responsibility expense budget thought to carry on the control to the overhead charge, introduces the hospital community responsibility according to the responsibility cost theory, finally, the use of operations management thinking on hospital cost accounting and cost management trends were discussed.
The article is on the basis of the latest issued hospital accounting system, enrich the hospital cost accounting methods and sharing mechanisms, have carried on the detailed discussion to the hospital every levels of cost's calculation and the management, and introduced responsibility accounting and the budget management thought, proposed individual several opinion points of the current hospital cost management, hoped that provide theoretical support to the management of the hospital. The deficiency of this article is not very good manifest the investigation and study case material in the article, this also has become the topic which the author further deliberated from now on.
本文首先综合分析了国内外医院的成本核算与成本管理的现状,剖析了当前我国医院在成本核算与成本管理中存在的不足,并结合对医疗服务的无形性、不确定性等特征分析,提出了医院成本核算与成本管理的总体思路,绘制出医院成本核算与成本管理框架图,初步构建了一套四级医院成本核算与成本管理模式,对2011年7月1日在全国试点医院执行的医院会计制度中涉及的医院总成本、科室成本、医疗服务项目成本和病种成本进行了详细的论述。其中,采用四级逐项分摊法计算科室成本,运用分类成本核算的方法确定不同的医疗服务项目成本和病种成本,并引入责任会计和预算管理思想,使这套模式充分体现责任控制理念,确保医院内部人人有责任、个个有指标,并在此基础上,就当前医院的成本管理提出具体的建议：提升医院管理者管理理念的内容和途径、完善医院成本分析方法、借鉴责任费用预算思想对管理费用进行控制、根据责任成本理论引入医院社会责任成本理念,最后,运用作业管理思想对医院成本核算与成本管理发展趋势进行了展望。
本文在最新颁布的医院会计制度基础上,丰富了医院成本核算方法和分摊机制,对医院各级成本的核算与管理进行了详细的探讨,并引入责任会计和预算管理的思想对当前医院成本管理提出了建议,以期对医院的经营管理提供理论支持。本文的不足之处是没有把调研的案例资料在文章中很好的体现,这也成为作者今后进一步研讨的课题。
Hospitals, the special agencies responsible for the health of all citizens of the country, along with the deepening of the new health reform, also compete in the market in its special status. This requires that the hospital's own public interest in upholding the primacy of the premise, to increase revenue and reduce expenses, improving the operating conditions of the hospital in pursuit of sustainable development. The article begins to collect the aspect of our country medical service reform information from 2008, thought that establishes and consummates our country hospital cost accounting and cost management is a medical reform important content, says from macroscopic and the microscopic angle has certain practical significance.
Firstly, the article have a comprehensive analysis of present situation in domestic and foreign hospital's cost accounting and cost management, analyzed the current insufficiency which exists in the cost accounting and the cost management of hospital, and combined with characteristics analysis of the medical service intangible nature, uncertainties and so on, proposed the general concept of hospital cost accounting, draw a hospital cost accounting and cost management framework diagram, initially constructed a set of four hospital cost accounting and cost management. On July 1,2011 implementation of the pilot hospitals in the country's hospitals involved in the accounting system, the total cost of the hospital, department costs, the cost of medical services and disease costs were discussed in detail. And, uses four levels to share the law to calculate the administrative offices cost item by item, using the classification cost accounting's method determined that the different medical service item cost and sickness plant the cost, and introduces responsibility accounting and the budget management thought that causes this set of patterns to manifest the responsibility control idea fully, guarantees hospital interior everybody has a responsibility, all has the target, and on this basis, proposed several ideas on the current hospital cost management:promotes the manage idea of the hospital superintendent in the content and the way, improve the analysis of hospital cost, profits from the responsibility expense budget thought to carry on the control to the overhead charge, introduces the hospital community responsibility according to the responsibility cost theory, finally, the use of operations management thinking on hospital cost accounting and cost management trends were discussed.
The article is on the basis of the latest issued hospital accounting system, enrich the hospital cost accounting methods and sharing mechanisms, have carried on the detailed discussion to the hospital every levels of cost's calculation and the management, and introduced responsibility accounting and the budget management thought, proposed individual several opinion points of the current hospital cost management, hoped that provide theoretical support to the management of the hospital. The deficiency of this article is not very good manifest the investigation and study case material in the article, this also has become the topic which the author further deliberated from now on.
引文
[1]崔国萍.成本管理会计[D].河北教育出版社,2007
[2]崔国萍等.论我国医院成本核算与控制制度的建设[J].工业技术经济,2009,(10)
[3]向佳.卫生部等五部委联合发布《关于公立医院改革试点的指导意见》[J].中医药管理杂志,2010,(2)
[4]萧峰.公立医院改革试点方案再推迟[J].医院领导决策参考,2010,(4)
[5]尹爱田等.“以药补医”机制的现象分析及可控策略[J].中国卫生经济,2004,(9)
[6]解振锁.定额法与标准成本法之比较[J].财会月刊,2003
[7]王霄琳等.企业成本系统管理理念的构成[J].现代审计与会计,2006,(5)
[8]王慎刚等.关于现代企业系统成本管理模式的思考[J].经济技术协作信息,2006,(11)
[9]田霞.浅析新的成本理念对现代企业成本控制的影响[J].中央财经大学学报,2005,(1)
[10]刘建青等.“零”的追求—我国中小企业财务管理新理念[J].财会研究,2009,(22)
[11]王秉新.我国责任会计制度分析[J].经济技术协作信息,2009,(9)
[12]任月君.责任成本制度相关问题探讨[J].东北财经大学学报,2007,(3)
[13]徐小娟.基于源流管理思想的责任成本研究[M].中南大学,2008
[14]叶青,张朝宓.关于北美作业成本法实践现状的文献综述[J].上海立信会计学院学报,2007,(6)：44-50
[15]宫晶英.医院成本核算整体框架的构想[J].中国卫生经济,1996,15(3)：42-47
[16]朱小琴.战略成本管理与作业成本法的比较[J].财会月刊,2001,(12)：23-24
[17]国家计委,卫生部.医疗服务项目成本分摊测算方法(试行)[J].计价格[2001]1560号.2001
[18]程薇,房耕耘.中医医疗服务项目成本核算方法研究[J].中国中医药信息杂志,2002,9(12)：72-74
[19]韩璐.作业成本法测算医疗服务项目成本的探讨[D].[硕士学位论文].广州：中山大学流行病与卫生统计学.2003
[20]鲍玉荣,朱士俊等.作业成本法实施中作业成本核算研究[J].中医药管理杂志,2005,21(2)：100-101
[21]葛人炜,孟庆跃等.医院医疗辅助科室成本分摊办法新探[J].中国卫生事业管理,1999,15(1)：20-21
[22]查成名.基于作业思想的医院全成本核算模式研究——某市中心医院全成本核算的应用初探[D].[硕士学位论文].东南大学.2005
[23]厉永灏等.现行成本核算方法的比较研究[J].卫生经济研究,2010,(4)
[24]季磊.医疗服务成本核算研究综述[J].现代医院,2009,(3)
[25]李娟.医院全成本核算方法研究——以长沙市中心医院为例[D].湖南大学,2008
[26]卢涛等.医院二级奖金分配模式探讨：以H院为例[J].卫生经济研究,2010,(6)
[27]王秀江.医院成本核算管理探析[J].冶金财会,2009,(4)
[28]李瑞丽.对医院成本核算管理的几点思考[J].中国经贸,2009,(24)
[29]褚迪.医院会计核算存在的问题及对策[J].经济技术协作信息,2008,(35)
[30]刘辉等.作业成本法在中医院针灸诊疗项目中的应用[J].中医药管理杂志,2010,(2)
[31]苑萍等.医院全成本核算的重难点问题[J].解放军医院管理杂志,2007,(8)
[32]陈永琼.国有医院成本核算与控制探讨[J].实用医院临床杂志,2008,(6)
[33]王芳.医院全成本核算的探讨[J].中国医药导报,2008,(4)
[34]庞涛.医院财务管理之我见——用作业成本法看医院成本核算[J].中国医药管理杂志,2003,(5)
[35]刘国祥等.以临床路径为基础的小儿斜疝单病种成本核算[J].中国医院管理,2007,(9)
[36]应张瑾.建立医院社会责任成本的管理制度的构想[J].中小企业管理与科技,2008,(32)
[37]Larry K.Macdonald and Louis F.Reuter Ⅳ.A patient-specific approach hospital cost accounting [J]. Health Services Reasearch,1973, Summer:102-120
[38]Medhat A.Helmi and Murat N.Janju.Activity-based costing may reduce costs, aid planning [J]. Healtheare Financial Management,Nov 1991,45(11):95-96
[39]Chan Y-CL.Improving hospital accounting with activity-based costing[J].Health Care Management Review.1993,18(1):71-77
[40]Ramsey Iv J.Applying activity-based costing for hospitals[J].Hospital and Health Services Administration,1994,39(3):385-396
[41]Canby Iv J.Applying activity-based costing to healthcare settings [J]. Healthcare Financial Management.1995,49(2):50-56
[42]Baker JJ.Boyd GF.Activity-based costing in the operating room at Valley View[J].Hospital.J-Health-Care-Finance.1997,24(1):1-9
[43]Suneel Udpa.Activity-based costing for hospitals[J]. Healthcare Management Review.Summer 1996,21 (3):83-96
[44]Libemum.A.Rotarius.T.A new cost allocation method for hospital-based clinical laboratories transfusion services[J].Implications for transfusion medicine. Transfusion.2005 (45)1684-1688
[45]Evren AGYAR.A practical application of activity-based costing in an urology department.7th Global Conference On Business & Economics.2007,(Oct):13-14
[2]崔国萍等.论我国医院成本核算与控制制度的建设[J].工业技术经济,2009,(10)
[3]向佳.卫生部等五部委联合发布《关于公立医院改革试点的指导意见》[J].中医药管理杂志,2010,(2)
[4]萧峰.公立医院改革试点方案再推迟[J].医院领导决策参考,2010,(4)
[5]尹爱田等.“以药补医”机制的现象分析及可控策略[J].中国卫生经济,2004,(9)
[6]解振锁.定额法与标准成本法之比较[J].财会月刊,2003
[7]王霄琳等.企业成本系统管理理念的构成[J].现代审计与会计,2006,(5)
[8]王慎刚等.关于现代企业系统成本管理模式的思考[J].经济技术协作信息,2006,(11)
[9]田霞.浅析新的成本理念对现代企业成本控制的影响[J].中央财经大学学报,2005,(1)
[10]刘建青等.“零”的追求—我国中小企业财务管理新理念[J].财会研究,2009,(22)
[11]王秉新.我国责任会计制度分析[J].经济技术协作信息,2009,(9)
[12]任月君.责任成本制度相关问题探讨[J].东北财经大学学报,2007,(3)
[13]徐小娟.基于源流管理思想的责任成本研究[M].中南大学,2008
[14]叶青,张朝宓.关于北美作业成本法实践现状的文献综述[J].上海立信会计学院学报,2007,(6)：44-50
[15]宫晶英.医院成本核算整体框架的构想[J].中国卫生经济,1996,15(3)：42-47
[16]朱小琴.战略成本管理与作业成本法的比较[J].财会月刊,2001,(12)：23-24
[17]国家计委,卫生部.医疗服务项目成本分摊测算方法(试行)[J].计价格[2001]1560号.2001
[18]程薇,房耕耘.中医医疗服务项目成本核算方法研究[J].中国中医药信息杂志,2002,9(12)：72-74
[19]韩璐.作业成本法测算医疗服务项目成本的探讨[D].[硕士学位论文].广州：中山大学流行病与卫生统计学.2003
[20]鲍玉荣,朱士俊等.作业成本法实施中作业成本核算研究[J].中医药管理杂志,2005,21(2)：100-101
[21]葛人炜,孟庆跃等.医院医疗辅助科室成本分摊办法新探[J].中国卫生事业管理,1999,15(1)：20-21
[22]查成名.基于作业思想的医院全成本核算模式研究——某市中心医院全成本核算的应用初探[D].[硕士学位论文].东南大学.2005
[23]厉永灏等.现行成本核算方法的比较研究[J].卫生经济研究,2010,(4)
[24]季磊.医疗服务成本核算研究综述[J].现代医院,2009,(3)
[25]李娟.医院全成本核算方法研究——以长沙市中心医院为例[D].湖南大学,2008
[26]卢涛等.医院二级奖金分配模式探讨：以H院为例[J].卫生经济研究,2010,(6)
[27]王秀江.医院成本核算管理探析[J].冶金财会,2009,(4)
[28]李瑞丽.对医院成本核算管理的几点思考[J].中国经贸,2009,(24)
[29]褚迪.医院会计核算存在的问题及对策[J].经济技术协作信息,2008,(35)
[30]刘辉等.作业成本法在中医院针灸诊疗项目中的应用[J].中医药管理杂志,2010,(2)
[31]苑萍等.医院全成本核算的重难点问题[J].解放军医院管理杂志,2007,(8)
[32]陈永琼.国有医院成本核算与控制探讨[J].实用医院临床杂志,2008,(6)
[33]王芳.医院全成本核算的探讨[J].中国医药导报,2008,(4)
[34]庞涛.医院财务管理之我见——用作业成本法看医院成本核算[J].中国医药管理杂志,2003,(5)
[35]刘国祥等.以临床路径为基础的小儿斜疝单病种成本核算[J].中国医院管理,2007,(9)
[36]应张瑾.建立医院社会责任成本的管理制度的构想[J].中小企业管理与科技,2008,(32)
[37]Larry K.Macdonald and Louis F.Reuter Ⅳ.A patient-specific approach hospital cost accounting [J]. Health Services Reasearch,1973, Summer:102-120
[38]Medhat A.Helmi and Murat N.Janju.Activity-based costing may reduce costs, aid planning [J]. Healtheare Financial Management,Nov 1991,45(11):95-96
[39]Chan Y-CL.Improving hospital accounting with activity-based costing[J].Health Care Management Review.1993,18(1):71-77
[40]Ramsey Iv J.Applying activity-based costing for hospitals[J].Hospital and Health Services Administration,1994,39(3):385-396
[41]Canby Iv J.Applying activity-based costing to healthcare settings [J]. Healthcare Financial Management.1995,49(2):50-56
[42]Baker JJ.Boyd GF.Activity-based costing in the operating room at Valley View[J].Hospital.J-Health-Care-Finance.1997,24(1):1-9
[43]Suneel Udpa.Activity-based costing for hospitals[J]. Healthcare Management Review.Summer 1996,21 (3):83-96
[44]Libemum.A.Rotarius.T.A new cost allocation method for hospital-based clinical laboratories transfusion services[J].Implications for transfusion medicine. Transfusion.2005 (45)1684-1688
[45]Evren AGYAR.A practical application of activity-based costing in an urology department.7th Global Conference On Business & Economics.2007,(Oct):13-14