医保总额预付制度、按病种付费的结算制度、分级诊疗制度等新医改政策的 不断推出，使得过去那种“以药养医”的医院运营模式受到了前所未有的挑战。 与此同时，国家开放医疗领域，允许民营资本进入更是激化了医院间的市场竞争。 县级公立医院作为基层医疗的领导者面对“以药养医”保护模式的丧失以及民营 资本竞争的双重压力，通过提高成本管理水平，规范科室成本核算就成为医院未 来健康发展的重要途径。 本文以S医院作为研究的对象，以成本核算理论为指导，结合《县级公立医 院成本核算操作办法》，阐述了在S医院实施全成本核算体系的现状，对现运行 的全成本核算体系结果从医院的资产状况、门诊住院情况、收入支出结构三方面 进行分析，总结出S医院在现行的全成本核算体系实施过程中存在成本核算单元 设置不合理、成本未进行三级分摊、成本归集粗糙、实施全成本核算体系的基础 条件不达标、绩效考评未与成本考评挂钩等方面的问题，最后针对S医院现行的 全成本核算体系工作进行完善，并从合理设置成本单元、对成本进行三级分摊、 健全成本核算方法、合理归集成本、推动医院运行全成本核算的基础工作建设、 完善成本绩效考核机制等方面提出了切实可行的整改措施，从而降低医院运营成 本，提升医疗服务水平与质量，使全成本核算体系的运行真正发挥出成本管控的 作用。本文希望通过对S医院成本核算体系的研究，能对目前县级医院的成本核 算状况有所了解，并能为县级医院建立完善全成本核算体系提供一定的帮助和借 鉴。 关键词：新医改；县级公立医院；全成本核算体系 II Abstract Due to the continuous introduction of New Medical Reform policies, such as the system of total medical insurance prepayment, the system of payment by disease, and the system of graded diagnosis and treatment, the hospital operation mode of "cover hospital expenses with medicine revenue" in the past has been confronted with unprecedented challenges. At the same time, the opening up of the medical field by the state and the admission of private capital have intensified the market competition among hospitals. As a leader in primary health care, those County-level Public Hospitals are facing the dual pressures from the loss of the "cover hospital expenses with medicine revenue" protection model and private capital competition. Thus, improving the level of cost management while standardizing department cost accounting is bound to function as an important approach for hospitals to develop healthily in the future. Taking S Hospital as the research object, guided by the cost accounting theory and combining with the "Operating Methods of County-level Public Hospital Cost Accounting", this paper expounds the current situation of implementing the full cost accounting system in S Hospital, and analyzes the results of the current running full cost accounting system from three aspects encompassing: the hospital's asset status, outpatient and inpatient situation and income and expenditure structure. On this foundation, it summarizes the shortplanks existing in the implementation of the current full cost accounting system in S hospital, such as unreasonable cost accounting unit setting, no three-level allocation, rough cost collection, substandard basic conditions for implementing the full cost accounting system, and unrelated performance evaluation to cost evaluation. In the end, the current full-cost accounting system of S hospital is being optimized, and practical rectification measures are put forward from the aspects of setting up cost units reasonably, allocating costs in three levels, perfecting cost accounting methods, reasonably collecting costs, promoting the basic III construction of full-cost accounting of hospital operation, as well as boosting its performance evaluation mechanism, so as to reduce hospital operation costs, upgrade the level and quality of medical services, and enable the operation of the full-cost accounting system to truly play the role of cost control.This paper hopes that through the research on the cost accounting system of S hospital, it can understand the current cost accounting status of county hospitals, and can provide some help and reference for county-level hospitals to establish a complete cost accounting system. Keywords: New Medical Reform； County-level Public Hospitals；full cost accounting system IV 目 录 摘要 ......................................................................................................................I ABSTRACT ........................................................................................................... II 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 .................................................................................................. 3 1.2文献综述 ........................................................................................................ 3 1.2.1国外文献综述 .......................................................................................... 4 1.2.2国内文献综述 .......................................................................................... 5 1.2.3文献评价 .................................................................................................. 6 1.3研究思路方法及内容 ..................................................................................... 7 1.3.1研究思路方法 .......................................................................................... 7 1.3.2研究内容 .................................................................................................. 8 1.4论文创新与不足之处 ..................................................................................... 8 1.4.1研究创新 .................................................................................................. 8 1.4.2不足之处 .................................................................................................. 8 第2章 新医改政策与医院成本核算体系简介 ....................................................... 9 2.1新医改政策解读 ............................................................................................. 9 2.2新医改背景下医院成本核算新变化 ............................................................. 11 2.3医院全成本核算的内容分类及流程 ............................................................. 13 2.4县级医院科室成本核算特点及作用 ............................................................. 16 2.4.1县级医院科室成本核算的特点 .............................................................. 16 2.4.2县级医院实施科室成本管理的作用....................................................... 16 第3章 S医院的科室全成本核算体系运行现状及问题....................................... 18 3.1 S医院简介 ................................................................................................... 18 3.2 S医院的成本核算及成本核算流程 .............................................................. 19 3.2.1 S医院的成本核算.................................................................................. 19 3.2.2 S医院的成本核算流程 .......................................................................... 19 3.3S医院成本核算体系运行结果 ...................................................................... 27 3.3.1从资产状况分析..................................................................................... 27 3.3.2从医院的门诊住院情况分析 .................................................................. 29 3.3.3从收入支出结构分析 ............................................................................. 31 3.4 S医院全成本核算体系存在的问题 .............................................................. 32 3.4.1 S医院全成本核算体系实施的基础条件不完善..................................... 32 3.4.2 S医院实施全成本核算体系在成本核算方面存在的问题...................... 34 3.4.3 S医院实施全成本核算体系在成本控制方面存在的问题...................... 36 第4章 新医改背景下S医院科室全成本核算体系的优化 .............................