Application Of Xining City And County Hospital Department Costing Implementation

Objective:there are lots of researches about hospital cost accounting, such as department cost accounting, project cost accounting, DRGs accounting and so on. However, any kind of the costing rules has not been introduced yet, and the horizontal contrast of cost of different hospitals cannot be achieved. As a breakthrough the county-level hospitals service70%population of our country. We need to find out their detail costs with the department cost accounting which is the most basic way. This study surveys Xining county-level hospitals with the basic cost accounting condition, and try to establish a department cost accounting system in hospital; calculate the true costs of medical services and find out management problems that exist in hospital process of operation; have comparative analysis in different counties; urge them to increase economic efficiency; and provide some reference for government to introduce compensation policies and promote accounting rules for county-level hospitals in western region.Contents:(1) Survey of Xining county hospitals’ cost accounting condition. With the investigation, we can know of the current cost accounting status, and summarize the favorable conditions and unfavorable conditions which help to provide information for designing scientific and rational accounting methods.(2) Implementation of department cost accounting in county-level hospitals. The implementation includes three parts:construction of department cost accounting system; detail implementation steps; and difficulties and solutions during the implementation.(3) Analysis and Application. Calculate the department full cost through cost accounting software which is suitable for county-level hospital, and make comparative analysis of the average county medical services social cost, the cost structure, dynamic condition and cost variance. At last, discussion and recommendations would be made to strengthen hospital economic management, to promote cost accounting rules and to establish hospital scientific compensation mechanisms under the Drug Zero Plus policy.Methods:Cost accounting is a process of combination of theory and practice. It overall combines qualitative methods and quantitative methods. Include:(1) Literature. Access to a large number of domestic and international literature and policy provisions with key words like " hospital "," county-level hospital "," cost accounting "etc.. Learn the latest research progress and draw a clear direction and focus for this study;(2) typical sampling. Relying on the Ministry of Health Development Research Center project "pilot and monitor of county-level hospital cost accounting", which applies typical sampling way to select24county-level pilot hospitals subordinated to12counties from national public hospital reform pilot cities and provincial pilot cities. They are Jiaxing City(Zhejiang Province), Wuhu City(Anhui Province) and Xining City(Qinghai Province). Each of them represents separately East, Mid and West of China. This study just focus on hospitals subordinated to Xining in west of China.(3) Expert advice. In order to unify accounting caliber and determine cost allocation, expert advices are regularly consulted.(4) Informant interviews. Collect information of each county hospital about department settings, information system interface, drug&material consumption, personnel, area, workload and other basic conditions.(5) Empirical research. Through the ways of training, observation and guidance, find the difficulties happened in hospital implementing process, and summarize solutions to promote the accounting.Results:(1) There are three hospitals having been carried out department cost accounting. All of them are County People’s Hospital. But the financial data they can only provide are relatively coarse, which is not the full cost accounting. Although there are some management issues, every hospital has basically met accounting criteria from the basic costing conditions perspective.(2) It includes13steps in carrying out cost accounting. For example, mobilization, accounting unit division, department staff salary check, department area measurement, fixed assets approved, large users stripping, internal workload statistics, confirmation of workload and revenue data for clinical and medical-technology departments, other income statistics that need to be manually confirmed, data of drug and material consumption, daily expenditure data, data processing, report and analysis.(3) Problems and solutions encountered in the implementation process are summarized into five parts: organization and coordination, accounting programs, implementation process, data processing and data consistency.(4) Xining county-level hospitals mainly rely on medical income and fiscal transfer payment, and their science project revenue is zero. Balance of medical service is23,952,900Yuan loss; the loss rate of outpatient is greater than the inpatient s’. The cost structure suggests that, proportion of drugs fee is highest with45.16%and followed by personnel expenses and other costs, whose ratio are32.87%and9.45%. However, the material cost is far below that of large top hospitals. Dynamic analysis finds that workload and weather conditions would have impact on hospital cost and revenue. The average cost of outpatient attendance is145.03Yuan, with a loss of13.58Yuan on average attendance. The outpatient departments like rehabilitation medicine, pediatrics and Chinese traditional medicine loss greatly. Among the inpatient departments, the average bed day cost is617.17Yuan, with an average loss of46.34Yuan per bed day. And departments of rehabilitation medicine, surgery and emergency get loss bigger. Some of the losses departments can make a breakeven point of balance by expanding patient sources and improving internal efficiency.Conclusion:The essential element for hospital sustainable development involves two aspects. One is high-quality medical service and the other one is a good economy condition.(1) Xining county hospitals should strengthen cost control, build up a concept of full cost management, pay more attention on controlling drug costs, labor costs and management costs as well as improve work efficiency.(2) The keys of county hospital department costing promotion include many things. For example, sort out department dictionary settings from different information system; define cost accounting units; build up a regional cost accounting platform and unify accounting caliber; train system maintenance professionals, etc.(3) Follow principles of the primary and secondary order and different local conditions when establish a science compensation mechanism for county-level hospitals in western region. Besides increase government investment, reasonably adjust medical service price and salary structure. In the meantime, implement centralized bidding of medicines, consumables, equipment. Last but not least, carry out department full cost accounting, and gradually transit to project cost accounting.