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1、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2010306 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
2、，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，
3、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，对医院的计摘要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
4、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。AbstractIAbstractWith the constant deepening of national new medical reform, hospitals take part in market competition with its particular status. Then it requires the hospitals to increase revenue and re
5、duce expenditure, keep improving the operating conditions of the hospitals and seek the sustainable development under the premise of insisting on public welfare. In order to implement the objective requirements of the spirit related to the medical reform, deepen the structural reform of financial ma
6、nagement, realize the scientific and elaborate management, improve the accounting information quality and promote the scientific development of the hospitals, the treasury department and health department unite to revise and issue the Financial Regulations for Hospitals on the basis of repeated rese
7、arch according to the medical reform plan and the actual demand of the financial management of the medical institutions.(Financial Agency. Number 2010306)The financial system reform for the hospitals improves the status of financial management in the hospitals and enhances the requirements of the ho
8、spital budget management and the cost accounting level. It requires the hospitals to find out the family, strengthen internal control, formulate the medical service price and reduce the fee of medicine and large-scale medical examination and treatment on the basis of cost accounting to improve the h
9、ospitals operating efficiency and realize the coordinate and sustainable development of social benefit and economic benefit for the hospitals.In this text, it first analyzes the domestic scholars research status for the hospitals cost accounting, at the same time illustrates the cost accounting syst
10、em construction under the Financial System for the Hospitals implemented in all the hospitals in our country on January1st, 2012 and makes a concrete introduction about the cost accounting method for the departments, the medical service project, per visit, bed day and disease entities respectively.
11、Taking the XX Traditional Chinese Medicine Hospital as an example, it studies and analyzes the current situation of the AbstractIIcost accounting system and accounting method, points out the problems existing in the cost accounting system of the hospitals and conducts a deep analysis of the source.
12、After that, it puts forward the cost-volume-profit method for the cost accounting of the hospital medical project. On this basis, it comes up with some suggestions such as the cost management for the XX Traditional Chinese Medicine Hospital, the upgrade of the personnel financial quality, the reinfo
13、rce of the hospitals budget control, the establishment of incentive mechanism for the cost control, the increase of data accuracy for the cost accounting and the improvement of the cost accounting method for the hospital. Therefore, the established cost accounting system for the hospital guarantees
14、that everyone has responsibility and target inside the hospital. It mobilizes the participation of all the staff in cost control and saving by combining with reasonable rewards and penalties system so as to develop the hospital cost accounting systems role of maximizing medical cost control and redu
15、cing the medical cost.On the basis of the newly issued financial system for the hospital, this text proposes the recommendations for improvement in the hospital cost management from various aspects including personnel quality, equipment configuration, system construction and accounting method. As to
16、 personnel, it requires the managers to change their thoughts and get rid of the management concept during the planning economy era, emphasize financial management as well as strengthen the cost for social responsibility, control the cost and set up the cost-effectiveness concept for all staff; as to personnel, it comes up with the propositions of the design and application in various section of the computer management system in order to increase the data accuracy
