I 摘要 公立医院的资金补偿渠道通常有三种主要途径：1.药品加成收入；2.医疗服务收 入；3.政府财政补助。其中药品加成收入和医疗服务收入是公立医院的主要补偿渠道， 二者合计共占医院总收入的95%左右；政府的财政补助收入最少，约占5%左右。随着 我国医疗事业改革的不断深入，为了解决“看病难，看病贵”这一社会现象，使我国 医疗事业回归公益性的初心，国家从2009年开始推行药品“0加成”政策，时至今日， 这一政策基本已经在全国大部分县级公立医院中实施。药品“0加成”这一政策的实施， 导致公立医院的补偿途径由原来的三条途径变为以医疗服务收费为主，财政补贴为辅 的两条途径。虽然国家有相应的配套财政补助措施，但补助金额十分有限，失去占总 收入40%的补偿渠道，无疑对公立医院的补偿机制造成了非常重大的影响。同时，随着 国家给予公立医院的财政补助逐年减少，加之大量民营医疗机构不断蚕食市场，不论 是公立医院的生存还是发展都受到了较大的威胁。在此背景下，公立医院亟需寻求一 种高质量的经营管理办法，提高资金使用效率，降低运营成本，增加医院内部结余， 从而适应新的生存环境和竞争环境。如何选择一种更加科学的成本核算体系，帮助公 立医院加强成本的管控，实现改善经营的目标，是我国公立医院不得不面对的现实。 县级公立医院是我国医疗体系的主要构成部分，数量上占我国公立医院总数的一 半以上，医疗服务所覆盖的人数占全国总人数的70%，是城乡医疗中起桥梁作用的纽带， 更是区域医疗服务的重要组成部分。相比更高级别的公立医院，它们在设施、设备方 面虽然没有较大的差距，但是在医疗服务水准和运营管理水平上，依然存在着较大的 差距。譬如在成本核算、控制方面，优秀的三级甲等医院不论是在信息化管理能力， 还是人员的工作能力和经验上都更胜一筹，其工作效果和效率自然会更加出色，以此 来对冲不论是来自医疗事业改革或是外部竞争加强对医院经营上带来的负面影响。县 级公立医院与之相比，因为各方面都有一定的差距，所以面临的问题也更加严峻。 本文主要通过文献研究法、调查研究法和比较研究法三种方法，在学习国内外文 献中关于医院成本核算相关的研究成果的基础上，研究全成本核算在县级公立医院中 相比传统医院成本核算的优势，并在研究过程中去发现研究对象在全成本核算方面存 在的不足，针对不足提出优化方案。本文期望在以G市人民医院为对象的研究中能对 全成本核算在县级公立医院成本核算中的应用有比较深入的了解，能够为我国县级公 立医疗机构在建设成本核算方面提供一定的借鉴。 关 键 词：G市人民医院；全成本核算；成本控制 论文类型：应用研究 ABSTRACT II ABSTRACT Public hospitals usually have three main ways of compensation: 1. 2. Income from medical services; 3. Government financial subsidies. Among them, drug markups and medical services are the main compensation channels for public hospitals, accounting for about 95% of the total revenue of the hospital. The government's financial subsidy income is the least, accounting for about 5%. With the continuous deepening of China's medical reform, in order to solve the social phenomenon of "difficult and expensive medical services" and make China's medical services return to public welfare, the country began to implement the "0 plus" drug policy in 2009. Up to now, this policy has been basically implemented in most county-level public hospitals in China. The implementation of the policy of "0 markup" on drugs leads to the change of the compensation channels of public hospitals from the original three ways of medicine markup income, medical service income and government financial subsidies to two ways of compensation, which are dominated by medical service fees and supplemented by financial subsidies. Although the state has corresponding supporting financial subsidy measures, the amount of subsidy is very limited, and the loss of compensation channels accounting for 40% of the total revenue undoubtedly has a very significant impact on the compensation mechanism of public hospitals. At the same time, with the decrease of financial subsidies to public hospitals year by year and the encroachment of a large number of private medical institutions on the market, both the survival and development of public hospitals are threatened. In this context, public hospitals are in urgent need of seeking a high-quality operation and management method to improve the efficiency of fund use, reduce operating costs and increase hospital internal balance, so as to adapt to the new living environment and competitive environment. How to choose a more scientific cost accounting system to help public hospitals to strengthen cost control and achieve the goal of improving operation is a reality that public hospitals in China have to face. County-level public hospitals are the main component of China's medical system, accounting for more than half of the total number of public hospitals in China. The number of people covered by medical services accounts for 70% of the total number of people in China. They are the bridge between urban and rural medical care, and an important part of regional medical services. Compared with higher level public hospitals, there is no big gap in facilities and equipment, but there is still a big gap in medical service level and operation ABSTRACT III and management level. Such as in cost accounting and control, excellent level of first-class hospital both in information management, and personnel's work ability and experience on, their work efficiency and effectiveness will naturally better, in order to hedge both from health care reform and strengthen the external competition of the negative effects on hospital management. Compared with county-level public hospitals, they are faced with more serious problems because of the gap in all aspects. This paper mainly through literature research, investigation, study and comparative research, three methods in studying literature at home and abroad about the hospital cost accounting, on the basis of relevant research results, the full cost accounting in the public hospitals at the county level compared with the traditional the advantage of hospital cost accounting, and in the process of research to find out the deficiency existing in the object of study in terms of total cost accounting, in view of the lack of optimization scheme is put forward. This paper hopes to have a deeper understanding of the application of total cost accounting in the cost accounting of county-level public hospitals in the study of people's hospital of G city, and provide some references for the construction cost accounting of county-level public medical institutions in China. KEY WORDS： G people's Hospital ； Total cost accounting ；Cost control TYPE OF THESIS: Application research 目录 IV 目 录 摘要 ... I 1 导论 .. 1 1.1 研究背景与意义 . 1 1.1.1 研究背景 ... 1 1.1.2 研究意义 ... 3 1.2 文献综述 ............. 4 1.2.1 国外文献综述 .......................... 4 1.2.2 国内文献综述 .......................... 5 1.3 研究方法及内容 .. 7 1.3.1 研究方法 ... 7 1.3.2 研究内容 ... 7 1.4 论文创新与不足之处 ......................... 9 1.4.1 论文创新 ... 9 1.4.2 不足之处 . 10 2 医院成本核算的相关理论分析 .................. 11 2.1 医院成本核算的理论基础 .............. 11 2.1.1 委托代理理论 ...................... 11 2.1.2 成本收益理论 ...................... 11 2.1.3 战略成本管理理论 .............. 12 2.2 全成本核算概述 12 2.2.1 全成本核算的概念 .............. 12 2.2.2 全成本核算的范围 .............. 13 2.2.3 全成本核算的分类 .............. 13 2.2.4 全成本核算的原则 .............. 14 2.2.5 全成本核算的组织体系 ...... 15 3 我国公立医院成本核算现状分析 .............. 16 3.1 医院会计制度关于成本核算的规定 ............................. 16 3.2 医院成本核算总体状况 .................. 16 3.3 医院间接成本分摊现状分析 .......... 17 3.4 医院管理费用的处理 ...................... 18 3.5 医院管理者和员工的成本核算意识淡化 ..................... 18 4 G市人民医院成本核算存在的问题及原因分析 ...................... 20 4.1 G市人民医院简介 ............................ 20 目录 V 4.2 G市人民医院成本核算现状 ............ 20 4.3 G市人民医院成本核算存在的问题 21 4.3.1《制度》缺乏指导、分摊方式比较单一 ............. 24 4.3.2信息技术的共享程度较低 ..... 25 4.3.3部门间协调程度不高 ............. 25 4.3.4医院管理者和员工的成本核算意识淡薄 ............ 25 4.4 G市人民医院成本核算问题的成因分析 ....................... 26 4.