Research On Internal Control Construction And Overall Optimization Of Medical Business In A Public Hospital

The Guiding Opinions on Strengthening the Operation and Management of Public Hospitals(No.27 Document of Finance Department of National Health Commission in 2020)proposed that Public hospitals should focus on the economic behavior of various business activities,establish and improve internal control management and risk monitoring systems and measures,so as to meet both the requirements of business management standardization and the needs of risk prevention and control accuracy.As an indispensable part of Public hospital management activities,the effectiveness of internal control design and operation is closely related to the prevention and control of internal risks,the improvement of operating efficiency and the realization of management objectives.In particular,since the issuance of the Administrative Measures for Internal Control in Public Hospitals(No.31 Document of Finance Department of National Health Commission in 2020),internal control in the business level of public hospitals has added six business areas of medical,scientific research,teaching,Internet medical,medical consortium and information construction on the basis of the original six business areas of budget,revenue and expenditure,procurement,assets,capital construction and contracts.As one of the new areas,the construction of internal control of medical business is in the exploration stage.The medical business involves many important aspects,such as the management of implementation of diagnosis and treatment standards,medical quality and safety,the control of reasonable inspection,reasonable drug use,introduction and use of drugs,medical consumables and medical equipment,the management of diagnosis and treatment projects and activities,operation of medical related committees,construction of hospital conduct,medical dispute settlement,etc,Establishing a sound and reasonable internal control mechanism has become an urgent problem to be solved.Based on this,this paper,on the basis of sufficient theoretical research,adopts the literature research method,case study method,field research method,analytic hierarchy process and fuzzy comprehensive evaluation method,taking Public hospital A as an example,references and expands the five elements of COSO internal control,and describes and analyzes the status quo of Public hospital A’s internal control of medical business from five aspects: control environment,risk assessment,control activities,information and communication,supervision and results application.The analysis found that Public hospital A mainly exist the following problems in the five aspects: The control mechanism was not comprehensive,and the phenomenon of "focusing on business rather than management" was rampant;The risk of the management of implementation of diagnosis and treatment standards,medical quality and safety,the risk of reasonable inspection and rational drug use control,and the potential risk of the use of drugs,medical supplies and medical equipment are large;The system design is defective and not updated in time,the management responsibilities are not clear,the boundary is not clear,and the control process is not perfect;The internal information and communication are not smooth,information construction is difficult,and external information and communication enthusiasm are not high;The effectiveness of internal supervision is insufficient,the external supervision is weak,the supervision mechanism is not perfect,and the application of supervision results is not significant.Further analysis shows that the causes of the problem are weak control consciousness and insufficient endogenous power;Poor implementation of internal control and weak control effect;Imperfect incentive and restraint mechanism and limited external driving force;Inadequate human resources,poor personnel quality and difficult work;Tight budget funds and low quality of third-party construction.Therefore,according to the actual situation of Public hospital A’s organizational structure design and medical business development,this paper combines relevant theories to put forward suggestions from the following five aspects: Optimize the internal control environment;Strengthen risk prevention and control awareness and improve risk assessment mechanism;Implement internal control activities and strengthen implementation;Unblock information and communication channels and promote information construction;Specific suggestions are put forward in five aspects of strengthening supervision and application of results.It is hoped to provide reference for the internal control construction of medical business of Public hospital A and other medical institutions.