摘 要

在当前医疗卫生体制改革持续深化的背景下，医疗机构面临着日益复杂的发展环境。随着医疗市场竞争加剧和资源约束趋紧，加强内部管理效能建设已成为医院实现可持续发展的关键路径。作为现代医院治理体系的关键环节，科学完善的内部控制机制能够显著提高医疗机构的管理效能，同时有效规避各类运营风险。2020年底国家出台的《公立医院内部控制管理办法》为医疗机构内控建设提供了制度保障和政策指引。本研究以陕西省某二级甲等公立综合医院为案例，针对其因内部控制机制不健全导致的运营效率问题展开深入分析。通过系统研究该院内控体系的优化路径，旨在为同类医疗机构完善治理结构、提升管理效能提供理论参考和实践借鉴。研究成果对于推动公立医院高质量发展、实现精细化运营管理具有重要的现实意义。本文主要研究工作及结论如下：

（1）开展XH医院内部控制体系现状诊断研究。以XH医院为研究对象，综合运用问卷调查法和访谈法等研究方法，系统分析了该院内部控制体系建设现状。研究发现，XH医院在风险识别层面、单位层面与业务层面的内部控制建设、内部控制报告以及评价监督机制等方面均存在不足。

（2）提出XH医院内部控制体系优化方案。基于诊断结果，明确了XH医院内部控制体系优化的目标和原则，并针对各环节提出具体优化措施：在风险评估阶段，XH医院应通过明确风险评估对象、识别特定风险、设置经营风险台账、做出风险应对四个方面进行优化；在单位层面应强化制度执行机制、推进内控信息化深度整合、建立部门协同机制；在业务层面应重点完善内部决策、制度、合同、印章、资金、采购、建设工程、固定资产、存货管理的薄弱环节；在内部控制报告与评价监督层面，应按照内部控制工作编制内部控制报告、开展内外双轨评估模式、构建预防性监督体系。

（3）制定XH医院内部控制优化保障措施。为确保优化方案有效实施，从思想文化、体制机制、组织机构、资金运营以及信息安全五个维度构建了全方位的保障体系。

以上研究内容对XH医院健全内部控制体系具有重要的参考价值，同时也对类似医院优化内部控制体系的搭建有借鉴和指导作用。

ABSTRACT

In the context of the continuous deepening of the current medical and health system reform, medical institutions are facing an increasingly complex development environment. With the intensification of competition in the medical market and the tightening of resource constraints, strengthening the construction of internal management efficiency has become the key path for hospitals to achieve sustainable development. As a key part of the modern hospital governance system, the scientific and perfect internal control mechanism can significantly improve the management efficiency of medical institutions and effectively avoid various operational risks. At the end of 2020, the state promulgated the Measures for the Management of Internal Control of Public Hospitals, which provides institutional guarantees and policy guidelines for the internal control construction of medical institutions. This study takes a second-class public general hospital in Shaanxi Province as a case study to conduct an in-depth analysis of its operational efficiency caused by the imperfect internal control mechanism. By systematically studying the optimization path of the internal control system of the hospital, it aims to provide theoretical reference and practical reference for similar medical institutions to improve the governance structure and improve the management efficiency. The research results are of great practical significance for promoting the high-quality development of public hospitals and realizing refined operation and management. The main research work and conclusions are as follows:

Carry out diagnostic research on the current situation of the internal control system of XH hospital. Taking XH Hospital as the research object, this paper systematically analyzed the current situation of the construction of the internal control system of XH Hospital by comprehensively using questionnaire survey method and interview method. The study found that XH Hospital had deficiencies in the internal control construction, internal control reporting and evaluation and supervision mechanism at the risk identification level, unit level and business level.

Propose the optimization plan of the internal control system of XH Hospital. Based on the diagnostic results, the objectives and principles of the optimization of the internal control system of XH Hospital were clarified, and specific optimization measures were put forward for each link: in the risk assessment stage, XH Hospital should be optimized by clarifying the risk assessment object, identifying specific risks, setting up the business risk account, and making risk responses; At the unit level, the system implementation mechanism should be strengthened, the in-depth integration of internal control informatization should be promoted, and a departmental coordination mechanism should be established. At the business level, we should focus on improving the weak links of internal decision-making, systems, contracts, seals, funds, procurement, construction projects, fixed assets, and inventory management; At the level of internal control reporting and evaluation supervision, internal control reports should be prepared in accordance with internal control work, internal and external dual-track evaluation models should be carried out, and preventive supervision systems should be constructed.

Formulate internal control optimization safeguard measures for XH Hospital. In order to ensure the effective implementation of the optimization plan, a comprehensive guarantee system has been built from five dimensions: ideology and culture, institutional mechanism, organizational structure, capital operation and information security.

The above research content has important reference value for the improvement of the internal control system of XH Hospital, and also has a reference and guiding role for the construction of the optimized internal control system of similar hospitals.

[1]Krishnan. Audit committee quality and internal:an empirical analysis[J].Accounting Review,2005.

[2]Mockwill. Simmon. COSO Based Auditing[J].Auditing Research,2007(10):185-190.

[3] COSO. Enterprise Risk Management Internal Framework. Executive Summary[S].2013.

[4]Nebbel Motubatse, Karin Barac, Elza Odendaal. Accruals Quality and Internal Control Over Financial Reporting[J].Accounting Review, 2015, 82(5): 1141-1170.

[5]Ahmed Atef Oussii, Neila Boulila Taktak. The Impact of Internal Audit Function Characteristics on Internal Control Quality[J].Managerial Auditing Journal,2018,33(5):13-17.

[6]GOH B W, LI D. Internal controls and conditional conservatism[J].The Accounting Review,2011,86(3):975-1005.

[7]M Goldberg Danny.Focus on High-risk CoNrols.[J]The INernal Auditor. 2015.(1):12-16

[8]Leudis Orlando Vega de la Cruz, Yosvani Orlando Lao Leóny, Any Flor Nieves Julbe. Proposal of a coefficient to evaluate the management of the internal control[J].Contaduría y Administración, 2017(2): 699-714

[9]MARY A I. Impact of Effective Internal Control in the Management of Mother an-d Child Hospital Akure, Ondo State[J].Journal of Finance and Accounting,2017(5):61-73.

[10]Lucia, Georgeta, Daina, et al. Improving performance of a pharmacy in a Romanian hospital through implemeNation of an iNernal managemeN coNrol system.[J]. Science of the Total EnvironmeN, 2019.

[11]Sultan, Zaheer, Waheed . Internal quality control of blood products: An experience from a tertiary care hospital blood bank from Southern Pakistan[J]. Journal of Laboratory Physicians,2018,10 (1):64-67.

[12]HOAI T T, HUNG B Q, NGUYEN N P. The impact of internal control systems on the intensity of innovation and organizational performance of public sector organizations in Vietnam: the moderating role of transformational leadership[J].Heliyon,2022,8(2):e08954.

[13]Krishnan J. Audit committee quality and internal control: An empirical analysis[J]. The Accounting Review,2005,80(2): 649-675.

[14]Barbara T, Frederik Guido Sebastiaan Vos,Esmee Peters,Vincent Delke. A Kraljic and Competitive Rivalry Perspective on Hospital Procurement During a Pandemic (COVID-19): a Dutch Case Study[J]. Journal of Public Procurement,2021,22(1).

[15]杨有红,胡燕.试论企业治理与内部控制的对接[J].会计研究,2004(10):14-18.

[16]汪建.浅析医院内部控制的现状及对策[J].会计师,2011(12):105-106.

[17]国家审计署课题组控.政府部门内部制失效溯源[J].财经,2007(5):22-23.

[18]刘永泽,况玉书.关于政府内部控制的几个问题[J].会计与控制评论,2014(1):14.

[19]陈亚楠,付桂彦.内部控制视角下行政事业单位资产管理优化分析[J].财会通讯,2016(07):120-121.

[20]韩颖.新形势下行政事业单位内部控制现状及完善途径[J].财会学习,2017(20):251.

[21]陈春蕾.行政事业单位内部控制实施现状研究[J].财会学习,2020(07):233-235.

[22]曹文英.行政事业单位内控管理制度的建立与完善分析[J].中国市场,2019(20):2.

[23]许新霞,何开刚.内部控制要素的缺失与完善:基于内部控制和风险管理整合的视角[J].会计研究,2021(11):149-159.

[24]白潇.基于区块链技术的行政事业单位内部控制体系构建研究[J].财政科学,2021(03):94-102.

[25]关于印发公立医院内部控制管理办法的通知[J].中华人民共和国国家卫生健康委员会公报,2020,(12):208-217.

[26]郑大喜.基于COSO框架的公立医院价格内部控制研究[J].中国卫生经济,2020,39(03):46-50

[27]龚谦.新会计制度下医院做好内控管理的对策及内控制度的构建策略[J].财会学习,2020,(34):189-190.

[28]孟珂羽,李天庆,姜晨等.公立医院内部控制评价体系建立与实施[J].中国医院,2021,25(01):85-86.

[29]邓睿淇.基于内部控制精细化的公立医院智慧财务体系建设[J].卫生经济研究,2022,39(01):90-93.

[30]张玥婷.A医院内部控制体系优化方案设计研究[D].西南交通大学,2022.

[31]陶爱林,蔡蒙蒙.加强内控建设促进医院高质量发展[J].经济师,2021(11):272-274.

[32]罗纪富,李俊忠,王丽.公立医院内控体系中的风险评估标准化建设探讨[J].财会学习,2021(35):189-190.

[33]陈韶樟.新常态下公立医院内控管理现状分析[J].质量与市场,2022(10):85-87.

[34]刘腾.公立医院内部控制建设探究[D].山东农业大学,2023.

[35]张晓宾.风险防控视角下公立医院内控的措施[J].中国产经,2022(18):79-81.

[36]袁晚秀.财务风险管理视角下A医院内部控制评价与改进研究[D].南京林业大学,2023.

[37]刘翔宇.大数据背景下行政事业单位内部控制审计研究[D].山东财经大学,2023.

[38]贺茗茗.成都市S公立医院内部控制制度执行中存在的问题及对策研究[D].四川大学,2023.

[39]屈少婷.公立医院内部控制深化发展问题及对策研究[D].成都大学,2024.

[40]黄锌.内控视角下公立医院预算业务的风险与控制探究[J].财会学习,2021(23):48-50.

[41]王瑶.基于COSO框架的公立医院全面预算管理内控建设研究[J].经济研究导刊,2021(27):76-78.

[42]李力昌.全面预算管理在医院财务内控中的应用分析[J].财会学习,2021(31):71-72.

[43]白雨微.医院财务内控提升成本管理绩效的路径探索[J].纳税,2021,15(23):59-60.

[44]吉敦亮.基于内控视角的医院成本控制分析[J].行政事业资产与财务,2021(17):117-118.

[45]仇媛媛.内控视角下医院合同管理信息化应用研究[J].行政事业资产与财务,2021(21):32-33.

[46]纪丽华.医院内控视角下的票据管理探究[J].会计师,2021(22):88-89.

[47]龙翔凌.内控视角下的公立医院修缮工程审计模式研究[J].中国总会计师,2022(01):122-125.

[48]毕晓霞.探究医院财务管理工作中财务内控的运用[J].环渤海经济瞭望,2022(01):93-95.

[49]冯国栋.医院财务内控中全面预算管理的应用研究[J].财会学习,2022(04):55-57.

[50]吴雪晖,任馨.HRP环境下医院内控审计方法研究[J].中国管理信息化,2022,25(07):81-83.

[51]王文平.医院财务内控的常见问题及对策探讨[J].投资与创业,2022,33(07):110-112.

[52]黄亮.关于加强医院财务内控管理的措施思考[J].财经界,2022(29):102-104.

[53]王艳.陕西省ZY医院内部控制体系优化研究[D].西安科技大学,2021.

[54]齐悦.公立医院内部控制研究[D].对外经济贸易大学,2022.

[55]王静宇.公立医院预算业务内部控制研究[D].河南财经政法大学,2023.

[56]陈爽.A公立医院医疗业务内部控制建设现状及整体优化对策研究[D].成都大学,2023.