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摘要1摘要随着国家新医改的不断深化，医院以其特殊的身份参与市场竞争，这就要求医院在坚持公益性的前提下，增收节支，不断改善医院的经营状况，谋求可持续发展。为落实医改有关精神的客观要求、深化财政财务管理体制改革、实现科学化精细化管理、提高会计信息质量、促进医院科学发展，根据医改方案的要求和医疗机构财务管理的实际需要，财政部、卫生部在反复调研基础上联合修订印发了新《医院财务制度》（财社[2010]306号）。这次的医院财务制度改革，提升了财务管理在医院的地位，对医院预算管理和成本核算水平的要求提高，要求医院要摸清家底，强化内部控制，在成本核算的基础上，合理制定医疗服务价格，降低药品和大型医技检查治疗费用，提高医院运行效率，实现医院的社会效益与经济效益的协调持续发展。本文首先综合分析了国内学者对医院的成本核算研究现状，同时就2012年1月1日在全国医院实施的新《医院财务制度》下医院的成本核算体系建设进行了阐述，并分别对科室成本核算方法、医疗服务项目成本核算方法、床日与诊次成本核算方法和病种成本核算方法做了详细的介绍。以XX中医医院为研究对象，对其成本核算体系与核算方法现状进行研究分析，指出其医院成本核算体系中存在的问题，并深入分析其根源，提出了以量本利法进行医院服务项目成本核算，并在此基础上，对XX中医医院的成本管理提出提升人员财务素质，加强医院预算控制，建立成本控制的激励机制，提高成本核算数据精度，改善医院成本核算方法等建议。由此建立的医院全成本核算体系，确保了医院内部人人有责任，个个有指标，结合适当的奖惩制度调动全体员工参与成本控制，节约成本，从而使医院成本核算能够发挥最大的控制医疗成本、降低医疗费用的作用。本文在最新颁布的医院财务制度基础上，对医院成本管理从人员素质、设备配置、体系建设与核算方法各方面提出改进建议。在人员上，要求管理者转变思想，摆脱计划经济时代的经营观念，在强化社会责任成本的同时重视财务管理，进行成本控制，树立全院职工的成本效益思想；在设备上，对医院的计算机管理系统各板块设计与应用提出意见，以提高成本核算数据的精准度，有效开展医院成本核算；在体系建立上，结合预算管理与绩效管理对医院的管理与制度进行规摘要范，完善成本管理体系；在核算方法上，引入量本利分析法对医院服务项目成本进行核算分析，通过盈亏平衡对医院经营项目的开展决策提供参考依据。AbstractIAbstractWiththeconstantdeepeningofnationalnewmedicalreform,hospitalstakepartinmarketcompetitionwithitsparticularstatus.Thenitrequiresthehospitalstoincreaserevenueandreduceexpenditure,keepimprovingtheoperatingconditionsofthehospitalsandseekthesustainabledevelopmentunderthepremiseofinsistingonpublicwelfare.Inordertoimplementtheobjectiverequirementsofthespiritrelatedtothemedicalreform,deepenthestructuralreformoffinancialmanagement,realizethescientificandelaboratemanagement,improvetheaccountinginformationqualityandpromotethescientificdevelopmentofthehospitals,thetreasurydepartmentandhealthdepartmentunitetoreviseandissuetheFinancialRegulationsforHospitalsonthebasisofrepeatedresearchaccordingtothemedicalreformplanandtheactualdemandofthefinancialmanagementofthemedicalinstitutions.(FinancialAgency.Number[2010]306)Thefinancialsystemreformforthehospitalsimprovesthestatusoffinancialmanagementinthehospitalsandenhancestherequirementsofthehospitalbudgetmanagementandthecostaccountinglevel.Itrequiresthehospitalstofindoutthefamily,strengtheninternalcontrol,formulatethemedicalservicepriceandreducethefeeofmedicineandlarge-scalemedicalexaminationandtreatmentonthebasisofcostaccountingtoimprovethehospitals’operatingefficiencyandrealizethecoordinateandsustainabledevelopmentofsocialbenefitandeconomicbenefitforthehospitals.Inthistext,itfirstanalyzesthedomesticscholars’researchstatusforthehospitals’costaccounting,atthesametimeillustratesthecostaccountingsystemconstructionundertheFinancialSystemfortheHospitalsimplementedinallthehospitalsinourcountryonJanuary1st,2012andmakesaconcreteintroductionaboutthecostaccountingmethodforthedepartments,themedicalserviceproject,pervisit,beddayanddiseaseentitiesrespectively.TakingtheXXTraditionalChineseMedicineHospitalasanexample,itstudiesandanalyzesthecurrentsituationofthecostaccountingsystemandaccountingmethod,pointsouttheproblemsexistinginAbstractIIthecostaccountingsystemofthehospitalsandconductsadeepanalysisofthesource.Afterthat,itputsforwardthecost-volume-profitmethodforthecostaccountingofthehospitalmedicalproject.Onthisbasis,itcomesupwithsomesuggestionssuchasthecostmanagementfortheXXTraditionalChineseMedicineHospital,theupgradeofthepersonnelfinancialquality,thereinforceofthehospital’sbudgetcontrol,theestablishmentofincentivemechanismforthecostcontrol,theincreaseofdataaccuracyforthecostaccountingandtheimprovementofthecostaccountingmethodforthehospital.Therefore,theestablishedcostaccountingsystemforthehospitalguaranteesthateveryonehasresponsibilityandtargetinsidethehospital.Itmobilizestheparticipationofallthestaffincostcontrolandsavingbycombiningwithreasonablerewardsandpenaltiessystemsoastodevelopthehospitalcostaccountingsystem’sroleofmaximizingmedicalcostcontrolandreducingthemedicalcost.Onthebasisofthenewlyissuedfinancialsystemforthehospital,thistextproposestherecommendationsforimprovementinthehospitalcostmanagementfromvariousaspectsincludingpersonnelquality,equipmentconfiguration,systemconstructionandaccountingmethod.Astopersonnel,itrequiresthemanagerstochangetheirthoughtsandgetridofthemanagementconceptduringtheplanningeconomyera,emphasizefinancialmanagementaswellasstrengthenthecostforsocialresponsibility,controlthecostandsetupthecost-effectivenessconceptforallstaff;astopersonnel,itcomesupwiththepropositionsofthedesignandapplicationinvarioussectionofthecomputermanagementsysteminordertoincreasethedataaccuracyofthecostaccountingandcarryoutthehospitalcostaccountingeffectively;astosystemconstruction,itconductsthespecificationsaboutthemanagementandsysteminthehospitalandtheperfectionofthecostmanagementsystembycombiningbudgetandperformancemanagement;astoaccountingmethod,itproceedstheaccountinganalysisforthecostofthehospitalserviceprojectbyintroducingcost-volume-profitanalyticalmethodandprovidesthereferenceframeforthedecisionofthehospital’soperatingprojectdevelopmentthroughprofitandlossbalance.目录目录绪论.................................................1第一章新医院财务制度下的医院成本核算体系................5第一节新制度对医院成本核算提出的新要求.................