医疗是民生之需，更是民生之基。公立医院作为医疗工程的重要主体，始终坚持党的领导，全面落实“全心全意为人民健康服务”的根本宗旨。但随着医疗改革的不断推进，公立医院成本管理粗放，医疗资源配置不均，一味追求规模扩张等问题凸显。为推动公立医院高质量发展，引导公立医院回归定位，进一步增强公立医院综合实力，公立医院需要进一步改革发展模式，高度重视成本管理，把发展方针调整为资源节约型和成本控制型，将成本管理方法落到实处，推进医院提质增效。

本文以RM二级公立医院的成本管理为研究方向，首先，梳理并综述了有关成本管理的最新研究成果，以及公立医院、成本管理及价值链成本管理等相关理论；其次，应用调查问卷、走访调研、数据分析等多种研究方法，对案例医院存在的问题进行了分析，从外部价值链及内部价值链的角度，对医院成本预算、核算、控制及考核方面进行了较为详尽的分析，发现案例医院在成本管理方面存在的主要问题有：事前成本预算流程及制度不健全、成本核算过程粗放、事后的成本控制及考核落实不到位等具体问题，并进一步探究了问题产生的成因；在此基础上，采用价值链成本管理理论的思想，从医院内部、外部价值链各个环节提出了优化方案，具体措施有：优化了预算制度和流程；构建了精细化核算体系，采用作业成本法合理分摊了成本，运用疾病诊断相关病组付费模式核算病组成本；利用病例组合指数强化内部控制，落实考核指标以此激励和提升员工成本管理积极性。

通过对案例医院的成本管理优化研究，旨在为与之有相同问题困扰的公立医院今后在成本管理方面提供一定借鉴，同时对促进医院管理人员思维转变，提升医疗行业实施精细化成本管理，节约成本资源具有一定的参考意义。

Medical care is the need of people's livelihood, but also the basis of people's livelihood. As an important subject of medical engineering, public hospitals always adhere to the leadership of the Party and fully implement the fundamental purpose of "serving the people's health wholeheartedly". However, with the continuous promotion of medical reform, extensive cost management in public hospitals, uneven allocation of medical resources, blindly pursuing scale expansion and other issues. In order to promote the high-quality development of public hospitals, guide the return and positioning of public hospitals, and further enhance the comprehensive strength of public hospitals, public hospitals need to further reform the development model, attach great importance to cost management, adjust the development policy to resource-saving and cost-control, implement cost management methods, and promote the quality and efficiency improvement of hospitals.

This paper takes the cost management of RM secondary public hospitals as the research object. Firstly, it combs and summarizes the latest research results on cost management, as well as the relevant theories on public hospitals, cost management and value chain cost management; secondly, it analyzes the problems existing in the case hospitals by using the questionnaire, visits and surveys, data analysis and other research methods, and makes a detailed analysis on the cost budget, accounting, control and assessment of the hospitals from the perspective of the external value chain and internal value chain, and finds that the main problems existing in the cost management of the case hospitals include: imperfect pre-event cost budget process and system, extensive cost accounting process, inadequate implementation of ex post cost control and assessment and other specific problems, and further explores the causes of the problems; on this basis, it adopts the value chain cost management theory and puts forward an optimization plan from the aspects of the hospital internal and external value chain, and the specific measures include: optimizing the budget system and process; building a detailed accounting system, reasonably apportioning costs by the activity-based cost method, and using the cost accounting group of disease-related diagnosis groups; and strengthening the internal control and assessment by the combination of cases index, so as to motivate the employees to enhance the enthusiasm of cost management.

Through the study of cost management optimization of the case hospital, this paper aims to provide reference for the public hospitals with the same problems in cost management.

[1] Delotte, Touche. Health Care Investment Analysis[J].The sourcebook,1990,3(5):7-9

[2] 胡善联.2l 世纪卫生系统改革对卫生经济学发展的影响 [J].中国卫生资源杂志,1999,2(3):3-4

[3] Larry K, Macdonald, Louis E Reuter IV. A patient-specific approach to hospital cost accounting[J]. Health Services Reasearch,1973,8(2):102-120

[4] Howard J, Berman. The Financial Management of Hospital[J]. Health Administration Press.1982,443

[5] Ellis R ,McGuire T. Optimal payment systems for health services[J]. Journal of health economics,1990,9(4):375-396

[6] Hsiao WC, Dunn DL, Verrilli DK. Assessing the implementation of physician payment reform[J]. New England Journal of Medicine, 1993,(328):928-933

[7] Helmi M A ,Tanju M N . Activity-based costing may reduce costs, aid planning[J]. Healthcare Financial Management Journal of the Healthcare Financial Management Association, 1991, 45(11):95-96.

[8] Udpa, Suneel. Activity-Based Costing for Hospitals[J]. Health Care Management Review, 1996, 21(3):83-96.

[9] Steven B. Analyzing your hospital's labor productivity[J]. Healthcare Financial Management Journal of the Healthcare Financial Management Association, 2005, 59(4):113-114.

[10] Polyzos N.Reforming reimbursement of public hospitals in Greece during the economic crisis:Implementation of DRG system [J]. Health Policy, 2013, 109(1):122

[11] Chan, Yee-Ching Lilian. Improving Hospital Cost Accounting with Activity-Based Costing[J]. Health Care Management Review, Winter1993, 18(1):71-77.

[12] Linda S & M Lorraine. Cost Allocations For Hospital Management [J].Journal of the International Academy for Case Studies.2008,14(8):93-97

[13] Ramsey Iv J. Applying activity-based costing for hospitals. Hospital and Health Services Administration, 1994, 39(3):385-396.

[14] Lisa Ridderstolpe. Clinical Process Analysis and Activity-Based Costing at a Heart Center [J]. Journal of Medical Systems, August 2002, 4(26): 309–322 .

[15] RobertS.Kalpan, StevenR.Anderson.Time-driven activity-based costing[J]. Harvard business review, 2004(11):90

[16] MAX R,WENDY P,ELMER B. Public procurement of innovations discussion and

endogenous institutions[J].International,2011,24(5):452-468.

[17] Gunasekaran A. Stratic Cost Management Accounting: An Exploratory Study[J].

January.2015.

[18] 赵加喜.新医改背景下医院成本核算和精细化管理初探[J].中外企业家杂志,2015,6(10):265

[19] 赵丽.基于价值链的企业成本管理模式构建[J].合作经济与科技,2018(24):122-124

[20] 陈伟烽,钟燕珊.新医改背景下公立医院科室的战略与财务分析——以A医院检验科为例[J].会计之友,2017(13):69-72.

[21] 医院诊断和治疗仪器使用规范及成本测算课题组.医院部分诊断设备测算调查研究概述[J].中国医院管理,1997,17(4):13-14

[22] 马骏.医疗项目及病种成本核算[J].中国医院管理,1997,17(1):60-61

[23] 韩玉珍,周胜利.国内外医院成本核算进展[J].中国医院管理,2003,(12):32-35

[24] 卞鹰,孟庆跃.生产函数在医院成本分析中的应用[J].中国卫生事业管理, 1998(12):641-644.

[25] 魏颖.中国卫生经济培训与研究网络论文集[J].北京:北京医科大学出版 社,1999,735-739

[26] 杜乐勋,高广颖. 理解与把握医疗收费价格由社会必要劳动时间决定的理论[J].中国卫生经济, 1998(12):14-15.

[27] 程薇,房耘耘.中医医疗服务项目成本核算方法研究 [J].中国中医药信息杂志,2002,9(12):72-74.

[28] 朱士俊.作业成本法在医院成本管理中的应用研究[J].中华医院管理杂志, 2005,21(2):95-97.

[29] 张君亦,周健泽, 谢晓芬. 医院实行作业成本法的可行性分析[J].卫生经济研究, 2009(6):45-45.

[30] 法元升,李鹏 .作业成本法在医院成本管理中的应用[J].科技信息,2009(18):317-318.

[31] 寇建功. 初探医院作业成本管理的模式[J]. 经营管理者,2009(20):67-67.

[32] 侯常敏, 吴倩.基于作业成本法的医疗项目成本管理[J].中国医院, 2010,14(7):46-49

[33] 王琨, 张清芝, 王紫巍. 作业成本法应用于64层螺旋CT成本管理的尝试[J].中国卫生经济, 2011,30(9):90-92.

[34] 周绿林,孙寅秋.医院实施作业成本法的流程设计[J].会计之友,2011(33):30-32.

[35] 徐力新,梁允萍,娄兴汉.医疗项目成本核算的现状研究[J].现代医院, 2014,14(5):6-8.

[36] 惠全红.基于作业成本法的B医院成本管理研究——以 CT室为例[J].卫生职业教育,2017,35(24):142-144.

[37] 郑琳莎.时间驱动作业成本法在医疗服务项目成本核算中的应用研究[J].中国注册会计师,2018(09):84-87.

[38] 王小红《政府会计准则——基本准则》对预算会计理论教学与实践影响透视[J]会计之友,2017(10)10:53- 58.

[39] 张希. 政府会计制度下医院固定资产的核算管理[J]. 会计之友,2018(20):136-139.

[40] 陈慧媛.医改背景下公立医院成本管理的思考[J].会计之友,2019,06:140-143.

[41] 何然,左艺梦,李嘉仪.医疗服务项目精细化成本管理探究[J].卫生经济研究,2019,3607:67-69.

[42] 苏波.DRGs模式下公立医院成本管理研究[J].财会月刊,2019,13:107-111.

[43] 潘俊,孙国岩,谢华王.《政府会计制度》实施下医院成本管理模式探析[J].中国卫生经济,2019,3807:82-85.

[44] 马媛媛.实例分析公立医院成本管理中作业成本法的应用[J].财会学习,2017,(05):69-72.

[45] 张胜,于广军.公立医院成本管理目标确立与适宜路线探讨[J].中国医院,2021,2505:68-70.

[46] 王玉廷,周小兰,沈毅,张荣贵.DRG支付下医院住院医疗成本管理及控制[J].卫生经济研究,2021,3809:58-61.

[47] 薛林南,线春艳,郭宛丽,谈娜,李春.基于平衡计分卡的公立医院战略成本管理研究[J].中国卫生经济,2017,3601:82-84.

[48] 任毅,李风芹,于蔚,田立启.DRG支付方式下医院成本管理特征､路径选择与策略[J].中国卫生经济,2020,3909:84-87.

[49] 何昱. 时间驱动作业成本法在公立医院成本管理中的应用[J].中国集体经济,2019,(13):154-155.

[50] 吴强,韩芸,马佳琪,唐盛军.价值链视角下公立医院成本管理案例分析[J].中国卫生经济,2020,39(01):85-87.

[51] 程明.价值链视角下的医院成本管理策略——基于上海XH医院的实践案例[J].会计之友,2020(24):2-7.

[52] 许坦,操乐勤,操礼庆.新形势下城市公立医院战略成本管理体系构建[J].中国卫生经济,2021,40(01):81-83.