随着经济的发展、医疗卫生体制改革的不断深入，公立医院和民营医院的数量不断增加，医院之间的竞争也愈演愈烈，无论是公立医院还是民营医院，都面临巨大生存与发展压力。医院内部控制体系是医院为履行医疗服务职能、实现总体目标而建立的保障系统,也是自我约束和规范的过程，其建立和完善在推进医院治理体系和管理能力现代化的过程中，发挥着极为重要的作用。但是我国医院内部控制体系的研究与实践均处于初级阶段。

本文通过查阅相关文献，展示了国内外医院内部控制体系的研究现状，阐述了内部控制的概念、特征、相关法规等；采取调查问卷的方式，对H医院内部控制体系的现状进行了调查，通过对调查结果的分析以及与业务科室负责人面对面的访谈，提出了H医院内部控制体系建设中存在的问题，针对发现的问题，对H医院内部控制体系进行了优化设计，从医院单位层面、业务层面以及监督层面提出了优化方案。单位层面上应提高内部控制意识、明确规定归口部门、关键岗位权责、增加风险评估次数、扩大风险评估范围、对议事决策建立问责机制；业务层面上，应细化预算管理业务流程、加速更新财务收支管理制度、制定固定资产制度层级、规范自有资金采购流程与相关部门职责；监督层面上，应发挥各监督科室的职能，加强事前预评，进行事中参与，开展专项审计，保证事后审计质量，为内部控制体系的执行和效果保驾护航。

  本文对H医院内部控制体系的优化设计，期望为H医院内部控制体系的完善提供有益的参考；也希望为国内公立、民营医院内部控制体系的建立与完善提供有益借鉴。

With the development of economy and the deepening of medical and health system reform, the number of public and private hospitals has been increasing, and the competition between them has also been increasingly fierce. Both public and private hospitals are facing great pressure for survival and development. Hospital internal control system is a guarantee system established by hospitals to fulfill the functions of medical services and achieve the overall objectives. It is also a process of self-restraint and standardization. Its establishment and improvement play an extremely important role in the process of promoting the modernization of hospital governance system and management capacity. However, the research and practice of hospital internal control system in China are in the primary stage.

By referring to relevant literature, this paper presents the research status of the internal control system of hospitals at home and abroad, and expounds the concept, characteristics and relevant regulations of internal control. Adopt the method of questionnaire, the present situation of the internal control system to H hospital were investigated, through the analysis of the results of the survey and face-to-face interviews with senior business department leaders, puts forward the problems existing in the internal control system construction of H hospital, in view of the problems found, optimized design of H hospital internal control system, from the hospital unit level, business level and supervision level optimization scheme is proposed. At the unit level, we should improve the awareness of internal control, clearly define the authority and responsibility of centralized departments and key posts, increase the number of times of risk assessment, expand the scope of risk assessment, and establish an accountability mechanism for decision-making. At the business level, we should refine the business process of budget management, accelerate the update of financial revenue and expenditure management system, formulate the level of fixed assets system, standardize the internal procurement process and the responsibilities of relevant departments. At the supervision level, we should give play to the functions of each supervision department, strengthen pre-evaluation, participate in the event, carry out special audit, ensure the quality of post-audit, and escort the implementation and effect of the internal control system.

In this paper, the optimal design of the internal control system of H hospital is expected to provide useful reference for the improvement of the internal control system of H hospital. It also hopes to provide useful reference for the establishment and improvement of the internal control system of domestic public and private hospitals.