Key problem: the control benefit of hospital economic management cost
Introduction to 0
At present, under the condition of socialist market economy, the new medical and health system reform has been started. In the new plan, we will establish a basic security system, establish a national essential drug system, improve the primary medical and health service system, promote the pilot reform of public hospitals, and promote the equalization of basic public health services. The reform of public hospitals is not only the difficulty of the whole medical and health system reform, but also the key to the success or failure of the reform. The goal of public hospital reform is to "adhere to public welfare and cancel drug use." Increase government investment and promote the reform of compensation mechanism in public hospitals; Improve the management level of public hospitals and establish a service model with high quality, high efficiency, low consumption and low price. "Strengthening the economic management of public hospitals is an important aspect of promoting the reform of public hospitals and improving the management level.
1 Problems existing in the current economic management of public hospitals
1. 1 paid insufficient attention to the study and implementation of relevant financial laws and regulations, while hospitals paid more attention to the study and implementation of medical and other related laws and regulations, and paid insufficient attention to the study and implementation of relevant financial laws and regulations. Due to the hospital's ineffective implementation of financial laws and regulations, in addition to compensation, it will also be fined, causing great economic losses to the hospital.
Hospitals are more likely to violate economic laws and regulations, including: ① centralized bidding and procurement by the government. ② Incorrect calculation of individual income tax sources, and omission or underpayment of taxes. (3) Super-scale and over-estimated infrastructure investment. (4) Violation of the charging policy, such as overcharging and arbitrary charges.
1.2 The income realization mode is unreasonable, and there are overtreatment and overthecking behaviors. The income of hospitals consists of three parts: government investment, medical service income and drug income, with government investment accounting for only a small part. In order to maintain the normal operation of the hospital and ensure the reasonable labor remuneration of medical staff, most of them rely on medical service income and drug income, while drug income and health materials income account for a large proportion.
When the hospital distribution system is directly or indirectly linked to the business income of departments or doctors, it will lead to excessive medical behavior of doctors; At the same time, it will also lead to the charging behavior of hospitals in violation of the price policy, which can be summarized as: comparative charging, independent item charging, decomposition charging, repeated charging, citrus payment charging, compulsory charging, setting prices beyond the floating ratio of government-guided prices, and increasing service frequency charging.
1.3 There is no effective cost management system, and the utilization efficiency of health resources is low. Hospital administrators and employees have insufficient understanding of the importance and significance of cost management, and there are phenomena such as blind expansion of scale, personnel expansion, personnel expansion and increased personnel expenses. Capital construction and equipment procurement do not consider cost-effectiveness, but unilaterally pursue high, refined and sophisticated. Various sanitary materials and materials used by various departments are not strictly controlled and are seriously wasted. Even though hospitals have implemented cost management and accounting, due to the lack of clear policy guidance and scientific methods, the cost accounting carried out by most hospitals is also incomplete, and it still stays in the stage of calculating the balance of income MINUS expenditure to calculate bonuses. The ultimate goal of cost management and accounting is unclear, which leads to the inefficient use of various health resources.
1.4 The management level of fixed assets and various materials is not high. At present, the inventory, registration and use records of reserve assets in some hospitals are incomplete; Purchasing, accepting donations and scrapping equipment do not perform accounting procedures, resulting in inconsistent accounts; Some equipment and facilities have been idle for a long time, which has affected the efficiency of asset use. Some scrapped and disposed fixed assets do not comply with relevant procedures.
There are some problems in hospital material management, such as emphasizing procurement and neglecting management. When purchasing materials, the property and material management department often replaces inventory cost management with experience management. When replenishing property and materials, experience management is often used instead of inventory cost management; When replenishing property and materials, we don't purchase according to the purchase plan and proceed from the actual situation of the hospital, which leads to the purchase of some materials that are not urgent, unnecessary and unusable, resulting in a large backlog of inventory materials and occupying a large amount of working capital.
1.5 the internal control ability and means to deal with various economic matters and businesses need to be improved. The internal control ability and means of hospitals in organizing income, purchasing medical materials, accounting expenses, purchasing equipment, contract management, bill accounting, business dealings, payment and settlement and other economic matters and business handling are relatively low. For example, the main problems existing in hospital contract management at present are as follows: ① formulating contract terms that emphasize the amount, while ignoring the amount. (2) Pay more attention to contract signing than contract performance. ③ unscientific contract text management process and unclear responsibilities; For another example, although computer network technology is also used, the establishment of the whole system is imperfect and lacks comprehensive control, summary, management and analysis capabilities.
1.6 lacks a systematic and effective evaluation index of economic and social benefits. Although some hospitals have also established some evaluation indexes such as management rate, asset-liability ratio, current ratio and per capita medical expenses, they are not comprehensive and have not been well implemented, and have played their due role.
2. Strengthen the economic management of public hospitals
2. 1 Strengthening the study of financial laws and regulations In order to implement national financial laws and policies, safeguard the safety and integrity of state-owned assets, and plug management loopholes, hospital management and staff should seriously study: accounting law, budget law, personal income tax law, provisional regulations on business tax, provisional regulations on value-added tax, contract law, bidding law, price law, Bill Law, financial rules of public institutions, measures for the management of state-owned assets of public institutions, and hospital financial system.
2.2 Reasonable organization of hospital income Although the new medical reform plan will gradually increase the financial investment in public hospitals, it is still a major test for the hospital's financial system and economic management level to cancel the drug price increase rate of 15% after the pilot and establish a universal medical insurance system to control the per capita medical expenses, and hospitals must improve their economic management level. Medical staff must uphold the legitimate rights and interests of patients and make reasonable diagnosis and treatment; Don't participate in high fees and excessive medical treatment that harms the interests of patients. Hospitals should adjust the overall income structure, try to reduce the proportion of medicine bottle income and sanitary materials income in the overall income, and increase the proportion of medical technology service income. This can not only reduce the burden of patients' expenses, but also increase the gold content of the whole hospital income, and organize various incomes reasonably and legally.
2.3 the establishment of a full process cost control system. Hospital cost objects are divided into medical expenses, drug expenses and management expenses according to economic content and use; At the level of cost accounting, it can be divided into ditch-level cost accounting, department cost accounting, project cost accounting and single disease cost accounting. The medical service is uncertain, and the medical service cost of each medical technology and service provider is different due to the different demand time, mode selection and application degree of patients. Even for the same disease, different patients will change the medical cost because of their different diagnosis and treatment methods and the degree of illness, so the accounting and management of medical service cost has its own characteristics and complexity.
The cost accounting center is mainly set at the hospital level, and departments and teams are equipped with part-time accountants, forming a cost accounting control system from top to bottom, from leaders to employees, from office logistics to clinical medical technology, which is the premise for hospitals to implement full cost accounting. Only by strengthening cost accounting and control, accurate prediction in advance, control in the process and accounting afterwards can the cost of medical services be effectively reduced. Hospitals should strictly control personnel expenses and department consumption, and set a reasonable quota. Mobilize the enthusiasm of employees according to the principle of "more work, more pay, distribution according to ability"; Make cost consumption quota, such as allocating materials according to consumption ratio, and controlling the amount of office expenses, travel expenses, entertainment expenses, etc. , and establish the corresponding assessment and reward and punishment system. Hospitals should establish an incentive evaluation system focusing on assessing social benefits, and change from paying attention to the economic benefits of departments in the past to paying equal attention to business indicators and medical quality, so as to decouple the personal income of employees from the income of departments, so that the majority of medical workers can consciously control controllable costs, reduce waste of resources, reduce costs and improve quality and efficiency.
2.4 Do a good job in comprehensive budget management. The comprehensive budget of the hospital includes the following contents: business income budget, cost budget, scientific research budget, project investment budget, financial budget, etc. The hospital's medical income and expenditure behavior is not for profit, and the financial budget must adhere to the principles of fixed income and expenditure, balance of income and expenditure, overall consideration and emphasis. The budget of hospital revenue and expenditure is compiled according to the items of medical charges and costs stipulated by the Ministry of Health, according to the relevant business volume, with the benefit as the main line and the pursuit of science, rationality and truth. The dean is responsible for the overall budget of the hospital, the directors of all subjects are responsible for the budget of the undergraduate course room, and the finance department is fully responsible for the hospital budget preparation, the balance of the preliminary budget plan, the budget release, the budget adjustment and the assessment.
2.5 Improve the management level of property and materials. Hospital materials are divided into three categories: medical equipment, hospital facilities and logistics support materials. The management of these materials is collectively referred to as hospital material management. Hospitals should be good at using modern logistics and distribution means to minimize storage rooms. Hospitals should try not to store any materials that suppliers can distribute profitably, and try to achieve zero inventory. In the use of materials, it is necessary to change the phenomenon of paying more attention to purchase than management, only distributing materials, without follow-up assessment after receiving them, and the serious loss of materials, so that every department can know the income and expenditure of the month, and link the accounting results with the labor remuneration distribution of individuals and departments to reduce unreasonable consumption and waste in the use process.
2.6 Strictly follow the expenditure approval procedures under internal control. Hospitals need to formulate and introduce the financial revenue and expenditure approval and audit system to employees. Clear all kinds of capital expenditure approval authority. For all important matters, the approver shall "countersign" the expenditure according to his responsibilities and authority and corresponding procedures. Financial personnel should strictly control receipts and payments according to the approved budget and relevant regulations. Any department or individual must submit a written payment voucher when using the money, and indicate the purpose, amount and payment method of the money. For a large amount of payment, a valid economic contract or relevant supporting documents must be attached at the same time before the fund payment procedures can be handled.
Provisions on Internal Control of Financial Accounting in Medical Institutions (Trial) stipulates the internal control of public hospitals from the perspective of post setting. Hospital internal control management should solve two problems: qualification identification and reasonable authorization of personnel engaged in this business activity. Hospital managers should have different degrees of authorization for managers in different positions, different links and parts, and different levels. When the hospital handles various economic businesses, it must be authorized and approved according to the prescribed procedures.
2.7 Strengthening the management of foreign economic contracts Hospital contracts can be roughly divided into seven categories: capital construction contracts, procurement contracts, lease contracts, loan contracts, social paid service contracts, advertising contracts, insurance warranty contracts, etc. We should strengthen contract management from the following aspects: ① The hospital should organize regular or irregular professional training for contract managers involved in contract establishment, negotiation, drafting, countersigning, auditing, signing and performance. On this basis, clear responsibilities, strengthen the assessment mechanism, and improve the sense of responsibility of contract managers. ② Give full play to the role of legal adviser and carefully scrutinize the terms of the contract. For different types of contracts, hospitals should scrutinize the wording of relevant clauses from the perspective of legal understanding and implementation, and form hospital standard contracts or standard clauses. (3) Strengthen financial monitoring and audit supervision of contract performance, and realize active contract management.
2.8 In order to ensure the preservation and appreciation of the inherent assets, the hospital should establish and improve the fixed assets management system with unified leadership and graded responsibility. In accordance with the principle of combining value management with physical management, make inventory on a regular basis to ensure the consistency of accounts and accounts, and ensure the safety and integrity of assets.
The financial feasibility analysis of major medical projects in hospitals must be scientific and reasonable, so as to improve the utilization rate of medical equipment and make idle equipment be used as soon as possible. We should do a good job in the cost-benefit analysis of the use of medical equipment, adhere to economic accounting, and realize the unity of economic and social benefits.
2.9 Establish effective evaluation indicators of economic and social benefits, and establish unified evaluation indicators of economic and social benefits, such as per capita business income, per capita income, return on assets, value-added rate of state-owned assets, cost income rate, medical income and sanitary materials cost rate, management rate, per capita expenses of patients, etc. The higher the per capita business income, per capita income, rate of return on assets and rate of appreciation of state-owned assets, the better the economic benefits and the higher the level of utilization and appreciation of assets. The lower the cost-income ratio, the lower the ratio of medical income to the cost of sanitary materials, the lower the management rate and the per capita cost of patients, the lower the cost of realizing business income, the lower the cost of realizing business income, and the lower the burden of patients' expenses; This reflects the hospital's better economic and social benefits.
In short, strengthening the economic management of public hospitals is an inevitable choice for hospitals to consciously follow the law of value, pay attention to economic benefits, strengthen scientific management, tap their internal potential and improve the efficiency of health resources under the socialist market economy environment; It is the only way for hospitals to put social benefits first, adhere to the unity of economic benefits and social benefits, make rational diagnosis and treatment, solve the problems of difficult and expensive medical treatment for the masses, and take the road of sustainable development of public hospitals with "high quality, high efficiency, low consumption and low price".
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