I 摘要 随着时间的推移和医疗改革的不断深入，全成本核算模式在医院成本控制 中所体现出的作用越发明显，公立医院全成本核算工作的开展效果，直接影响 其成本控制质量。公立医院应从战略角度出发，强化成本核算意识，制定具有 可实施性的合理措施，在医院内部管理中切实形成成本分析、成本控制、成本 降低氛围，以不断提升医院核心竞争力。现阶段我国不少公立医院已选用全成 本核算法进行成本核算，同时学术界对“全成本核算”在我国商业界的运用也 较为关注，所开展的研究课题较多，但大多数课题的研究层面较为宏观，且理 论层面探索较多，实践层面探索较少，对公立医院在新医改背景下运用全成本 核算模式的课题分析非常少。本课题以 H 公立医院为研究对象，对其现阶段的 成本管理工作进行研究，从成本预算管理、成本核算管理和成本绩效考核等方 面着手，探索在新时代背景下 H 公立医院的成本管理质量，并找寻当前工作中 所暴露的不足之处。 最后对 H 公立医院全成本核算的不足提出了自己的优化建议。希望能够对 H 公立医新制度的正确执行，自身全成本核算工作的规范性起到帮助，也对同类 同规模的公立医院具有启发和借鉴意义，进而达到规范公立医院全成本核算工 作的目的，为国家宏观调控医院成本管理工作提供统一、可比的数据基础。 关键词：公立医院；成本管理；成本控制Abstract II ABSTRACT With the continuous reform of hospital management system and the smooth implementation of new system，the application of total cost accounting method plays an important role in hospital cost management. Whether public hospitals can do a good job of total cost accounting is directly related to the effectiveness of cost management. Only by paying more attention to hospital cost accounting can public hospitals make cost management feasible， effectively control costs， reduce costs and achieve the goal of maximizing hospital cost-effectiveness. At present， many public hospitals in China have gradually adopted the method of total cost accounting to calculate the cost of hospitals， and the total cost accounting of hospitals has become the focus of many experts and scholars， but its research mainly focuses on the macro-theory of total cost accounting of hospitals， and the total cost accounting of public hospitals in the new system. There is not much research on implementation. Therefore， through in-depth study of the current situation of H public hospital cost control under the new system， this paper analyzes the implementation of H public hospital total cost accounting under the new system， analyzes the cost budget， cost accounting， cost performance and other content， summarizes the problems of H public hospital cost control. Finally， we put forward our own optimization suggestions for the total cost accounting of H public hospitals. Hope to help H public hospitals properly implement the new system， standardize their own total cost accounting work， but also the same size of the same type of public hospitals have a certain inspiration and reference significance， so as to standardize the work of total cost control in public hospitals， for the national macro-control of hospital cost management to provide a unified. Comparable data base. Key Words: Public hospitals; Cost management; Cost control目录 III 目 录 第 1 章 绪论.................................................................................................................1 1.1 选题的背景和意义 .........................................................................................1 1.1.1 选题背景 ...............................................................................................1 1.1.2 选题意义 ...............................................................................................1 1.2 国内外研究现状 .............................................................................................2 1.2.1 国外研究现状 .......................................................................................2 1.2.2 国内研究现状 .......................................................................................3 1.2.3 研究评述 ...............................................................................................5 1.3 研究思路和方法 .............................................................................................6 1.3.1 基本思路 ...............................................................................................6 1.3.2 研究方法 ...............................................................................................6 1.4 创新点 .............................................................................................................6 第 2 章 公立医院成本控制研究的基础.....................................................................7 2.1 公立医院概述 .................................................................................................7 2.1.1 公立医院界定 .......................................................................................7 2.1.2 对公立医院非营利性的认识 ...............................................................7 2.2 公立医院成本控制概述 .................................................................................8 2.2.1 公立医院成本控制的含义 ...................................................................8 2.2.2 公立医院成本控制的特点 ...................................................................8 2.3 公立医院成本控制的主要内容及意义 .......................................................10 2.3.1 公立医院成本控制的主要内容 .........................................................10 2.3.2 公立医院成本控制的原则 .................................................................11 2.3.3 公立医院成本控制的意义 .................................................................12 第 3 章 H 公立医院成本控制现状及存在的问题分析 ...........................................14 3.1 H 公立医院基本概况 ....................................................................................14 3.2 H 公立医院成本控制的现状 ........................................................................14 3.2.1 H 公立医院成本核算的组织体系 ......................................................14 3.2.2 H 公立医院成本核算的费用要素和成本项目 ..................................15目录 IV 3.2.3 H 公立医院成本核算对象与核算单元 ..............................................17 3.2.4 H 公立医院全成本核算的流程 ..........................................................17 3.3 H 公立医院全成本核算数据分析及问题 ....................................................20 3.3.1 H 公立医院主要指标数据分析 ..........................................................20 3.3.2 H 公立医院成本构成分析 ..................................................................21 3.3.3 H 公立医院医疗成本收益分析 ..........................................................22 3.3.4 H 公立医院医疗项目成本分析 ..........................................................23 3.3.5 H 医院成本控制存在的问题 ..............................................................23 3.4 H 公立医院成本控制存在问题的原因分析 ................................................25 3.4.1 成本预算缺乏刚性约束 ......................................................................25 3.4.2 成本核算不全面 ..................................................................................27 3.4.3 缺乏内部考核和监督 ..........................................................................28 3.4.4 医院工作人员素质存在缺陷 ..............................................................29 第 4 章 H 公立医院成本控制的优化措施 ...............................................................30 4.1 加强预算刚性约束 ........................................................................................30 4.1.1 预算的执行 ..........................................................................................30 4.1.2 预算的调整 ..........................................................................................30 4.1.3 预算的分析 ..........................................................................................30 4.2 完善成本核算体系 ........................................................................................31 4.2.1 成本核算的流程 ...............................................