公立医院食堂财务管理与会计实务探讨

新《医院财务制度》规定非独立法人运营的医院食堂其财务核算需并入医院大账,基于新制度中对食堂的财务管理、成本控制及相关会计实务处理鲜有论述,笔者从浦东新区人民医院的实际情况出发,从食堂的物资流转、收支核算、经济考核等方面探讨建立完善的食堂财务管理体系及有效的会计实务操作。     

收支平衡分析在医院经营管理中的应用

目的　探讨福田区某综合医院 1998～ 2 0 0 3年发展过程中 ,医院经营管理情况、存在问题和今后发展的对策。方法　运用收支平衡分析法 ,计算医院工作量平衡点和业务收入平衡点。结果　通过对该医院 6年内的成本 -业务量 -效益分析 ,发现如果不考虑财政补助 ,医院不能实现收支平衡 ,考虑财政补助 ,医院基本实现收支平衡有结余。讨论　目前政府财政补助对非营利性医院的补偿是必要的 ,多数公立医院在成本控制方面较薄弱 ,对该医院实现收支结余 ,提出几点建议。     

医院预算管理存在的问题与解决方案

医院预算是医院对未来经营活动的资金安排,是根据医院事业发展计划和任务编制的年度财务收支计划;是医院未来各项业务活动的财力保证;是医院财务管理的基本依据。在市场经济条件下,做到有计划地聚财、用财,以收定支,是提高医院资金利用效率必不可少的手段。加强预算管理有利于国家方针、政策的贯彻落实,有利于实现收支平衡,有利于提高医院的财务管理水平,有利于医院经营目标的实现。     

论医院成本控制

医院收支平衡的支撑点将进入第三个发展阶段 ,今后相当长的时期内 ,必须突出成本控制这个支撑点。增强控制成本意识 ,强化经济管理是控制医院成本的重要手段 ;推进卫生改革是实现医院成本控制的根本 ,两手并用 ,缺一不可。     

浅谈医院成本控制

医院成本控制在整个医院经营管理过程中是至关重要的环节。牢固树立医院成本控制理念,组建适合医院发展要求的成本控制保证体系,注重预算编制与执行环节,运用全成本管理方法,完善健全业绩考核和激励机制,使医院成本控制得以有效实施。从而增强医院的财务管理水平和市场竞争能力,实现资源优化配置和效益最大化,使其在市场竞争中处于优势地位。     

浅议如何加强医院基础财务管理

改革开放30年来,医院财务管理逐步从粗放型管理发展到目前的现代化管理,无论是在管理内涵、管理手段,还是在管理效果方面,都有了质的飞跃。但这些管理改革突出体现在为提高职工积极性而进行的内部核算、劳务分配方面,忽视了医院基础财务管理改革,使医院服务成本长期居高不下。要想改变这种状况,只有加强基础财务管理,强化成本控制,建立一套比较完善、严谨、科学、合理的内部控制体系,实现社会效益和经济效益双丰收。     

医院实施全面预算管理的关键环节及控制措施

目的:介绍医院在实施全面预算管理中的关键环节及控制措施。方法:以新《医院财务制度》为依据,以《中华人民共和国预算法》为准绳,结合实际工作,总结全面预算管理中所涉及关键环节并提出控制措施。结果:通过实施全面预算管理逐步降低医院成本,合理配置资源,提高资金使用效率,保证医院战略目标的实现。结论:全面预算管理作为一项重要的经济管理手段,对完善医院内部财务控制、提高财务管理水平发挥着重要作用。     

我国与美国医院财务管理的比较及启示

医院财务管理对医院稳定与健康发展有不可替代的作用,在财务管理工作中有必要学习其他国家先进经验,进一步优化我国医院财务管理。笔者从机构设置、预算管理、成本管理、财务报表四方面对我国与美国的医院财务管理进行比较研究,提出我国应借鉴美国医院财务管理经验创新机构设置、实行全面预算、严格成本管控、完善财务报表,并对未来研究方向进行了展望。     

医院财务管理的改革与实践

随着市场经济的进一步发展，医院规模的不断扩大，办院形式的多种多样，以及电子计算机在财务管理中的普遍运用，医院财务管理的目标、内容、形式都发生了深刻变化：知识经济时代要求医院财务管理目标创新，医院财务管理目标要从“收支平衡，略有结余”向管理要效益，向知识人才要效益的目标发展。市场经济的发展，要求医院财务管理内     

我国城镇职工基本医疗保险费用结算办法现状及对策研究

医保基金收支平衡是基本医保制度建立成功与否的标志,此目标实现的基础是要通过制定科学合理的结算办法,并与医院以签署协议的方式来做为保证,以此形成医院以及参保人员的自我约束和监督机制。在分析我国目前各地医保管理机构现行结算办法利弊的基础上,提出了通过制定完善的结算办法来实现基金收支平衡的一些对策和措施,探讨通过对医院分类管理,有效的信息化支持,完善具体结算办法以及其他配套政策等方面来实现“医、保、患”三赢的对策研究。     

Measuring the cost impact of hospital information systems: 1987–1994

This study measures the impact of information technology (IT) use on hospital operating costs during the late 1980s and early 1990s. Using a proprietary eight-year panel dataset (1987–1994) that catalogues application-level automation for the complete census of the 3000 U.S. hospitals with more than 100 beds, this study finds that both financial/administrative and clinical IT systems at the most thoroughly automated hospitals are associated with declining costs three and five years after adoption. At the application level, declining costs are associated with the adoption of some of the newest technologies, including systems designed for cost management, the administration of managed care contracts, and for both financial and clinical decision support. The association of cost declines with lagged IT as well as the cost patterns at the less automated hospitals both provide some evidence of learning effects.     

财务管理人员在医院发展中作用的思考

医院的财务管理在医院全面协调可持续发展中的作用不容忽视。财务管理在医院筹集发展资金、合理配置医疗资源、保持收支盈余、提高偿债能力、参与预测与决策以及对医院经济活动进行财务控制和监督等活动中,发挥着不可替代的作用。财务管理人员要努力成为医院管理的"斗士、谋士、贴士、医士、博士"。     

Drivers of cost system development in hospitals: results of a survey

While many hospitals are under pressure to become more cost efficient, new costing systems such as activity-based costing (ABC) may form a solution. However, the factors that may facilitate (or inhibit) cost system changes towards ABC have not yet been disentangled in a specific hospital context. Via a survey study of hospitals, we discovered that cost system development in hospitals could largely be explained by hospital specific factors. Issues such as the support of the medical parties towards cost system use, the awareness of problems with the existing legal cost system, the type of contract for the physician's internal financial agreement, should be considered if hospitals refine their cost system. Conversely, ABC-adoption issues that were found to be crucial in other industries are less important. Apparently, installing a cost system requires a different approach in hospital settings. Especially, results suggest that hospital management should not underestimate the interest of the physician in the process of redesigning cost systems.     

Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia

Growing evidence has demonstrated that informal fees for health services comprise a large proportion of total health spending in some countries. In 1999, individual out-of-pocket payments for health in Cambodia were estimated at 27 US dollars per person, with a proportion paid as under-the-table fees at public facilities. By formalizing such payments and implementing resource management systems within a comprehensive health financing scheme, Takeo Referral Hospital controlled out-of-pocket patient expenditures, ensured patients of fixed prices, protected patients from the unpredictability of hospital fees and promoted financial sustainability. Utilization levels increased by more than 50% for inpatient and surgical services, and cost recovery from user fees averaged 33%. Furthermore, the hospital phased out external donor support gradually over 4 years and achieved financial sustainability.     

上海市级医院财务管理数字化转型的探索与实践

目的 从办医主体视角,提出促进公立医院财务管理数字化转型的路径和建议。方法 梳理公立医院财务管理面临问题及原因,以上海市级医院为例,从财务数字化转型切入,总结提升公立医院运营管理效能的举措。结果 集中统一建立会计核算、成本核算和智能分析平台,从而规范医院会计基础核算、规范成本核算路径、强化运营分析评价和加强数据质量控制,强化预算管理、提升成本效率、增强业财融合。结论 办医主体推动公立医院财务管理转型中,需要兼顾不同管理层级和医院业务特点选择系统建设模式,还需从持续加强数据质量控制,构建具有实效的指标评价体系等方面继续努力。     

The variance of length of stay and the optimal DRG outlier payments

Prospective payment schemes in health care often include supply-side insurance for cost outliers. In hospital reimbursement, prospective payments for patient discharges, based on their classification into diagnosis related group (DRGs), are complemented by outlier payments for long stay patients. The outlier scheme fixes the length of stay (LOS) threshold, constraining the profit risk of the hospitals. In most DRG systems, this threshold increases with the standard deviation of the LOS distribution. The present paper addresses the adequacy of this DRG outlier threshold rule for risk-averse hospitals with preferences depending on the expected value and the variance of profits. It first shows that the optimal threshold solves the hospital’s tradeoff between higher profit risk and lower premium loading payments. It then demonstrates for normally distributed truncated LOS that the optimal outlier threshold indeed decreases with an increase in the standard deviation.      

Use of business planning methods to monitor global health budgets in Turkmenistan

After undergoing many changes, the financing of health care in countries of the former Soviet Union is now showing signs of maturing. Soon after the political transition in these countries, the development of insurance systems and fee-for-service payment systems dominated the discussions on health reform. At present there is increasing emphasis on case mix adjusted payments in larger hospitals and on global budgets in smaller district hospitals. The problem is that such systems are often mistrusted for not providing sufficient financial control. At the same time, unless further planned restructuring is introduced, payment systems cannot on their own induce the fundamental change required in the health care system. As described in this article, in Tejen etrap (district), Turkmenistan, prospective business plans, which link planned objectives and activities with financial allocations, provide a framework for setting and monitoring budget expenditure. Plans can be linked to the overall objectives of the restructuring system and can be used to ensure sound financial management. The process of business planning, which calls for a major change in the way health facilities examine their activities, can be used as a vehicle to increase awareness of management issues. It also provides a way of satisfying the requirement for a rigorous, bottom-up planning of financial resources.     

Impact of Critical Access Hospital Conversion on Beneficiary Liability

ABSTRACT: Context: While the Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, the program puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare part B benefit. Purpose: This paper examines the impact of hospital conversion to CAH status on beneficiary out‐of‐pocket coinsurance payments for hospital outpatient services. Methods: The study is based on a retrospective observational design using administrative data from Medicare hospital cost reports and fee‐for‐service beneficiary claims from 1999 to 2003. The study compares changes in beneficiary co‐payments before versus after CAH conversion with payment trends among small rural non‐converting hospitals over the same period. Findings: Conversion to CAH status is associated with an increase in beneficiary coinsurance payments per outpatient visit of $17.19, equivalent to 34% of the sample average. However, CAH designation had no significant effect on the share of outpatient costs paid by the beneficiary. Most of the increase in beneficiary liability associated with conversion is attributable to the provision of more services per outpatient visit. Conclusions: While this and other studies show that conversion to CAH status results in more intensive outpatient care, CAH conversion does not appear to inadvertently create financial barriers to accessing ambulatory services in remote rural communities by forcing beneficiaries to pay a higher share of their Medicare part B costs.     

DRG改革背景下医院卫生技术评估的功能与推行策略

医院卫生技术评估(HB-HTA)是专门针对医院实际情况进行评估的方法学工具,可辅助医院进行卫生技术管理与决策。HB-HTA与DRG均是医院管理的工具,二者价值理念相同、现实作用相近,可推动医院向精细化管理和高质量服务提供的发展方向迈进。在DRG改革中,HB-HTA可通过对卫生技术安全性、有效性和经济性评估,对同一病种的不同诊疗过程、技术和相应的配套措施进行分析和比较,帮助医院进行成本核算,优化"服务包"的安全有效性和成本效益,促进医院对DRG改革进行战略性回应。此外,HB-HTA还可覆盖到DRG短时间无法覆盖和不适宜以DRG支付的医疗服务,辅助医院对多元复合式医保支付方式进行整体性探索。未来,应在医院内部重点打造"HB-HTA+DRG"式医院精细化管理模式,同时要理顺组织体制、注重大数据开发和使用、加快HB-HTA试点工作并建立动态监管机制。