中图分类号： 学科分类号：

密级：公开 论文编号： 37_125200_Z1045632015000271_LW

硕 士 学 位 论 文 （专业学位）

我国公立医院全成本核算研究

作者姓名：侯 伟 学科专业：公共管理硕士（MPA） 指导教师：毕秀玲（教授） 合作导师: 王 毅 培养学院：MPA 学院

二 〇一五 年四月

Research on the Imple mentation of Full Cost Accounting in Public Hospitals of China

A Dissertation Submitted for the Degree of Master of Public Administration

Candidate ： Hou Wei

Supervisor ： Prof. Bi Xiuling

School of MPA

Shandong University of Finance and Economics

中图分类号： 密级：公开 学科分类号： 论文编号： 37_125200_Z1045632015000271_LW

硕 士 学 位 论 文

我国公立医院全成本核算研究

作 者 姓 名： 侯 伟 申请学位级别：管理学硕士 指导教师姓名： 毕秀玲 职 称：教 授 学 科 专 业： 公共管理硕士(MPA) 研 究 方 向：政府管理 学 习 时 间： 自 2013 年 4 月 17 日 起至 2015 年 6 月 30 日 止 学位授予单位： 山东财经大学 学位授予日期： 2015 年 6 月

山东财经大学学位论文独创性声明

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摘 要

摘 要

随着市场经济体制的不断发展和医疗改革的不断深入，我国公立医院面对新的挑 战和机遇，应按照市场经济发展的要求进行改革，其中包括成本核算制度的改革。目 前我国公立医院的成本管理制度和方法存在许多方面的缺陷，如大多数公立医院对成 本核算仅局限于对成本进行简单的分摊，没有把医疗消耗、管理费用等项目的成本分 摊计入医疗成本中。而全成本核算不仅对医院临床科室成本进行核算，还对医辅科室、 医技科室、行政后勤部门的成本进行统一核算。实行全成本核算是公立医院适应市场 经济发展的必然结果，是参与医疗改革的首要因素，是医院可持续发展的重要支撑力。 公立医院开展全成本核算，有助于减少成本消耗，降低医疗成本，提供真实成本信息， 更新管理和决策理念，提高医院核心竞争力，增强医院生存和发展能力。

目前，我国公立医院采用的全成本核算方法，还处于探索研究阶段，缺少完善的 核算体系和统一标准。以往大多数公立医院对成本的核算仅停留在奖金核算的基础 上，没有真正实现成本核算的全面化，全成本核算的实质是把成本按照科室性质进行 分摊归集，最终将所有科室成本相加得出医院实际总成本的方法。

本文在查阅国内外相关文献的基础上，提出公立医院采用全成本核算方法的理论 依据，在总结国外成本核算方式方法的基础上，结合我国具体医疗状况和西方国家的 理论成果，通过实际工作和调查，对公立医院成本核算的现状进行分析，引入全成本 核算思想，提出实行全成本核算的必要性与方法。最后结合实践工作，以济南市中医 医院为例，分析公立医院开展全成本核算存在的不足以及改进的措施。

论文的创新点体现为，采用科室成本核算法对医院临床科室、医辅科室、医技科 室和行政后勤部门等发生的全部成本进行会计核算，从而对医院成本进行全方位管 理，系统全面地反映医院的经营成果和成本状况。以医疗改革为背景，以成本核算相 关理论为基础，提出采用三级分摊的方法，对各科室成本逐项逐级进行分摊，计算出 各科室的全部成本，最终得出全院总成本，对医院的成本进行系统核算。 关键词：公立医院；成本管理；全成本核算

I

我国公立医院全成本核算研究

Abstract

With the continuous development of market economy system and the deepening of the medical reform, public hospital faced with new challenges and opportunities in our country, should according to the demands of the development of market economy reform, including the reform of the system of cost accounting. At present there are a lot of shortcomings in our country's public hospitals in the cost of management system and methods, for example, most public hospitals are only limited to the simple share of the cost in cost accounting and have not put the cost of medical consumption and management cost and other projucts into the medical treatment cost. And total cost accounting not only include the cost of hospital clinical departments, but also cover the unified cost of the departments of paramedical, medical technology, administrative and logistics. Carried out the total cost accounting is the inevitable result of the public hospitals adapt to the development of market economy and the primary factor of involving in health care reform and an important support for the sustainable development of hospital. Public hospitals carry out the total cost accounting helps to reduce the cost of consumption and the medical cost, and provide the true cost information, and renew the ideas of management and decision-making, and improve the core competitive power and strengthen the abilities of survival and development in hospitals.

At present, the total cost accounting methods of public hospitals using in our country is still in the exploratory stage, and lacking a sound accounting system and a unified standard. Most of the previous public hospital cost accounting only remains on the basis of the accounting of the bonus, and not really realize the overall cost accounting. The essence of full cost accounting is the cost in accordance with the department of properties assessed separately, thus the actual total cost of hospital is obtained by adding the cost of hospital.

This paper provides the theory evidence of adopting the method of total cost accounting for public hospitals based on referring to the relevant literature at home and abroad. On the basis of summing up the method of cost accounting in foreign countries and combining concrete medical situation in our country with the theoretical results of western countries, this paper introduces the concept of total cost accounting via the actual work and survey, which analyses the current situation of cost accounting of public hospitals and puts forward the necessity and method of carrying out total cost accounting. And finally, combining the practical work and taking Jinan City Hospital of Traditional Chinese Medicine as an example, this paper analyses the deficiencies and improving measures exist in carrying out the total cost accounting for public hospitals.

The innovation points embodied in the paper is adopt the method of department cost accounting financial account of all the cost in the hospital clinical departments, medical auxiliary department, medical technology departments and administrative departments and other department accounting, so it can get the total cost of comprehensive management of the hospital costs and reflect the operating results of the hospital and the cost in system and comprehensively. With the background of health care reform and the basis of the related theory of cost accounting, three-level apportionment method is presented in this paper, apportion them item by item for each department cost, calculate the full cost of each department, finally it is concluded the total cost and the unified accounting of the cost in the hospital.

Key words : Public Hospitals；Cost Management；Total Cost Accounting

II

目 录

目 录

第1章 绪论··································································································· 1
1.1 研究背景及意义················································································· 1
1.1.1 研究背景······················································································ 1
1.1.2 研究意义······················································································ 2
1.2 文献综述··························································································· 2
1.2.1 关于医院成本核算方法选择的相关研究·············································· 2
1.2.2 关于全成本核算对策的相关研究······················································· 3
1.2.3 总体评价······················································································ 5
1.3 技术路线与研究内容·········································································· 5
1.3.1 技术路线······················································································ 5
1.3.2 研究内容······················································································ 6
1.4 研究方法与创新点·············································································· 7
1.4.1 研究方法···················································································· 7
1.4.2 创新点························································································· 7
第2章 医院成本核算相关理论········································································ 8
2.1 成本核算相关概念界定······································································· 8
2.1.1 成本···························································································· 8
2.1.2 成本核算······················································································ 8
2.1.3 全成本核算··················································································· 8
2.2 医院成本核算与全成本核算的比较······················································ 9
2.2.1 相同点························································································· 9
2.2.2 不同点························································································· 9
2.3 医院全成本核算的必要性···································································· 10
2.4 医院全成本核算的理论基础································································ 10
2.4.1 委托代理理论················································································ 10
2.4.2 战略成本管理理论·········································································· 11
小结········································································································ 12
第3 章 我国公立医院成本核算现状分析·························································· 13
3.1 我国公立医院成本核算现状································································ 13
3.1.1 普遍分析······················································································ 13
3.1.2 个案分析······················································································ 13
3.2 我国公立医院成本核算中存在的问题·················································· 14
3.2.1 医院成本核算观念比较落后····························································· 14
3.2.2 缺乏成熟的医院成本核算理论和方法················································· 15
3.2.3 医院成本核算的项目范围和口径不一致·············································· 15

III

我国公立医院全成本核算研究

3.2.4 医院成本核算的基础管理工作薄弱···················································· 15
3.3 我国公立医院成本核算必然改革的原因分析········································ 16
3.3.1 外部原因····················································································· 16
3.3.2 内部原因····················································································· 16
小结········································································································ 17
第4 章 公立医院全成本核算的框架设计·························································· 18
4.1 公立医院全成本核算的意义································································ 18
4.1.1 全成本核算是新医疗改革的需要······················································· 18
4.1.2 全成本核算是指导政府进行多渠道经济补偿的需要······························· 18
4.1.3 全成本核算是公立医院科学管理的需要·············································· 19
4.1.4 全成本核算是提高社会效益和经济效益的需要····································· 19
4.1.5 全成本核算是完善医院分配制度的需要·············································· 19
4.1.6 全成本核算是强化科室管理的需要···················································· 19
4.2 公立医院全成本核算的原则································································ 20
4.2.1 全过程性····················································································· 20
4.2.2 全员性························································································ 20
4.2.3 全要素性····················································································· 20
4.3 公立医院全成本核算的方法································································ 20
4.3.1 科室成本核算方法········································································· 21
4.3.2 医疗项目成本核算法······································································ 21
4.3.3 病种成本核算法············································································ 21
4.3.4 床日、诊次成本核算法··································································· 21
4.4 公立医院全成本核算的特点································································ 21
4.4.1 全过程成本核算············································································ 21
4.4.2 全方位成本核算············································································ 22
4.4.3 全员成本核算··············································································· 22
4.5 公立医院全成本核算流程···································································· 22
4.5.1 成本汇总····················································································· 22
4.5.2 成本划分····················································································· 22
4.5.3 成本分摊····················································································· 23
4.5.4 成本分析和控制············································································ 24
4.5.5 成本考核····················································································· 24
4.5.6 公立医院全成本核算流程图····························································· 25
4.6 我国公立医院全成本核算的基础条件和措施········································ 25
小结········································································································ 26
第5 章 济南市中医医院全成本核算案例分析··················································· 27

IV

目 录

5.1 济南市中医医院成本核算改革的背景·················································· 27
5.2 济南市中医医院全成本核算的概况····················································· 28
5.2.1 济南市中医医院全成本核算成本结构················································· 28
5.2.2 济南市中医医院全成本核算组织结构················································· 28
5.2.3 济南市中医医院全成本核算具体步骤················································· 29
5.3 济南市中医医院全成本核算的成效······················································ 34
5.4 济南市中医医院全成本核算中面临的问题············································ 35
5.4.1 核算体系不完整············································································ 35
5.4.2 监控监督机制缺失········································································· 35
5.4.3 信息网络化管理滞后······································································ 36
5.4.4 人为因素····················································································· 36
5.5 济南市中医医院全成本核算问题解决对策············································ 36
5.5.1 推动核算体系对接········································································· 36
5.5.2 建立监控监督机制········································································· 37
5.5.3 加强信息化建设············································································ 37
5.5.4 减少人为因素影响········································································· 37
小结········································································································ 38
结 论·············································································································· 39
参考文献··························································································40
致 谢············································································································· 43

V

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