【作者】 李岩；

【导师】 江其玟；

【作者基本信息】 东南大学 ， 会计（专业学位）， 2021， 硕士

【摘要】 2020年7月,国新办在布置深化医药卫生体制改革下半年重点工作任务中提出,近十年公立医院改革已取得重大阶段性成效,应继续强化供给侧结构性改革,其中重点指出公立医院在发展的内涵上、管理上走内涵式的、集约性的、高效的管理方式,使公立医院的发展走向高质量发展的道路。对于目前医改政策中“取消药品加成”、“取消耗材加成”、财政补偿机制不完善等影响公立医院取得医疗收入的政策,医院根据“以收定支”的基本原则,需要对目前成本进行精细化管理。本文以A医院为例,结合其发展现状,对其成本进行精细化管理。论文对于公立医院成本管理体系构建具有一定的理论意义和现实意义。论文结合医改深化背景环境,深度分析近十年医疗改革的各项举措,根据成本精细化管理理论,通过回顾国内外相关文献,总结目前国内公立医院在成本精细化管理上的一些不足。以A医院为主要研究对象,通过在全院范围内开展的成本调查问卷,横向从成本预算、成本核算、成本控制,纵向从人力成本、药品成本、耗材成本和设备折旧等四个方面概括总结A医院目前成本管理现状。根据成本精细化管理理念,从必要性三个角度指出A医院需实施成本精细化管理。接着根据A医院目前成本现状,从横向、纵向两个维度,横向包括成本预算、成本核算、成本控制,纵向包括人力成本、药品成本、耗材成本和设备折旧等四个方面构建成本精细化管理体系。最后将成本精细化体系从横向、纵向两个方面将其运用到A医院的经营业务过程中,体现出成本精细化管理对A医院是有效果的,是利于A医院经济可持续发展的。论文研究对公立医院成本管理水平提升具有一定的借鉴和参考价值。论文研究表明:(1)A医院实现成本精细化管理是现阶段在医院运营管理方面较为重要的一项工作,通过成本精细化管理,能够提高医院的运营效率。A医院的成本管理工作,没有将每一项成本管理工作分解、细化并落实,精细化程度远远不够。因此A医院必须开展成本精细化管理工作;(2)本文从A医院成本管理的横向和纵向两个维度为A医院构建成本精细化管理体系,横向管理中主要是对成本预算、成本核算和成本控制方面的精细化,纵向管理中主要是对成本内容中的人力成本、药品成本、耗材成本和设备折旧等四个方面的精细化,论证成本精细化管理体系能够为A医院达到减少成本、提高运营效率目的;(3)成本精细化管理是公立医院实现医疗效益、提高医疗效率、达到精细化成果的必然途径,推动公立医院高质量发展,提高医院经济运营质量,通过对成本的精细化管理,努力实现公立医院的发展方式从规模扩张向质量效益转型,管理模式上从粗放管理向精细管理跃进,促使公立医院走向内涵化、高效化、精细化的高质量发展道路,从而实现经济效益和社会效益有机统一;更多还原

【Abstract】 In July 2020,in laying out the key tasks for deepening the reform of the medical and health system in the second half of the year,the State Information Office proposed that the reform of public hospitals in the past decade has achieved significant stage results,and should continue to strengthen the supply-side structural reform,so that the development of public hospitals will move towards the road of high-quality development.It is pointed out that the connotation of development and management of public hospitals are connotes,intensive and efficient.For the current medical reform policies,such as "canceling drug markups","canceling consumables markups" and imperfect financial compensation mechanism,which affect public hospitals’ access to medical income,hospitals need to carry out fine management of current costs according to the basic principle of "determining expenditure according to income".This paper takes Hospital A as an example,combines its development status,and carries out fine management on its cost.This paper has certain theoretical and practical significance for the construction of public hospital cost management system.Combined with the background environment of deepening medical reform,this paper makes an in-depth analysis of various measures of medical reform in the past ten years.According to the theory of cost refinement management,by reviewing relevant domestic and foreign literature,this paper summarizes some deficiencies of the current domestic public hospitals in cost refinement management.In A hospital as the main research object,through the floor on the cost within the scope of questionnaire,lateral from cost budget,cost accounting,cost control,longitudinal cost from four aspects of content summarized A hospital cost management present situation at present,according to the cost of the elaborating management idea,from the perspective of the necessity of three points out that A hospital to implement the elaborating management costs.Then according to the current cost status of Hospital A,the cost fine management system is constructed from horizontal and vertical dimensions,including cost budgeting,cost accounting and cost control,and manpower cost,drug cost,consumable cost and equipment depreciation.Finally,the cost refinement system is applied to the business process of A hospital from the horizontal and vertical aspects,which shows that the cost refinement management is effective for A hospital and conducive to the sustainable economic development of A hospital.The research of this paper has certain reference value for the improvement of the cost management level of public hospitals.The research shows that :(1)The realization of cost refinement management in hospital A is an important work in hospital operation management at the present stage.Through cost refinement management,the operation efficiency of the hospital can be improved.In the cost management of Hospital A,every cost management work is not decomposed,refined and implemented,and the degree of refinement is far from enough.Therefore,Hospital A must carry out fine cost management;(2)in this paper,from A hospital cost management of vertical and horizontal two dimensions the elaborating management system to build A hospital cost,horizontal management is mainly to the cost budget,cost accounting and cost control aspects of refinement,mainly in vertical management to the cost of content of the human cost,drug cost,cost of consumables and equipment depreciation and so on four aspects of refinement,It is demonstrated that the cost fine management system can reduce costs and improve operational efficiency for A Hospital.(3)is public hospital medical costs of fine management efficiency,improve the efficiency of medical treatment,the surest way to achieve fine results,promote the development of public hospital quality,improve the quality of hospital economic operation,through the refinement of cost management,and strive to achieve the development of public hospital way transformation from scale expansion to quality benefit,In terms of management mode,it makes a leap from extensive management to fine management,and makes public hospitals move towards the development path of connotation,high efficiency and refinement,so as to realize the organic unity of economic benefits and social benefits.更多还原