重庆市公立医院成本核算实践的问题与对策

Problems and countermeasures of cost accounting practice in public hospitals in Chongqing city

采用政策研究法、文献研究法、问卷调查法和结构化访谈法,剖析重庆市公立医院成本核算实践过程存在的问题:医院成本核算整体处于不完全科室成本核算阶段;医院成本核算实践基础薄弱,多因素制约成本核算工作开展;医院科室归类、编码与三级分摊参数选择等核心技术缺乏标准化体系;医院成本核算外生压力和内生动力不足;医院成本核算结果运用广度和深度不足。因此建议:强化顶层设计,完善公立医院成本核算的体制机制;健全公立医院标准化成本核算体系,制定具体的行业操作指导规范;夯实公立医院成本核算基础,分步分类推进成本核算实践;细化成本核算功能内涵与外延,拓宽成本核算结果运用范围。

Using the methods of policy research, literature review, questionnaire survey and structured interview, this paper analyzed the problems during the process of cost accounting practice in public hospitals in Chongqing city. These main problems included the whole hospital cost accounting is in the stage of incomplete cost accounting stage, the practice foundation of hospital cost accounting is weak,many factors restrict the development of cost accounting work, hospital departments are classified, the core technologies such as classification, coding and selection of hospital departments lack standardization system, the exogenous pressure and endogenous power of hospital cost accounting is insufficient, and the application of hospital cost accounting results is inadequate in breadth and depth. Therefore, it is suggested to strengthen the top-level design to perfect the institutional mechanism of public hospital cost accounting, improve the standardized cost accounting system of public hospitals, formulate specific industry operation guidelines, consolidate the basis of public hospital cost accounting, advance the practice of cost accounting step by step, refine the connotation and extension of cost accounting function, and to widen the scope of application of cost accounting results.