近三年的实践证明,成本核算改革不仅是一项经济运行机制的改革,而且是社会主义现代化医院的重要管理手段,它可以促进医院改革的不断深入,建立科学化、规范化的管理体制和有活力的运行机制,促使医院管理不断走向科学化和现代化,适应社会主义市场经济的变革和医保改革的形势和要求。 一、实施成本核算改革的必要性 长期以来,医院外延扩张、粗放经营的方式使医院经济管理缺乏严格的内部核算,普遍存在高投入、低效率,医疗资源利用不足,人浮于事的现象,导致医疗成本居高不下,这种状部已不能适应社会主义市场经济形势和广大人民群众对医疗服务的需求。医院曾进行过科室收入核算、单项提成、经济承包以及综合目标管理等经济改革,对调动职工积极性,增加医院收入起到了积极作用,但这些改革主要以分配为中心进行,目前显露的弊端越来越多,最主要是没有成本观念,资源利用效率不高,无法从根本上解决医院生存和发展的问 The practice in the past three years has proved that the cost accounting reform is not only an economic operation mechanism reform, but also an important management tool for modern socialist hospitals. It can promote the continuous deepening of hospital reform, establish a scientific and standardized management system and have The vigor of the operating mechanism has prompted hospital management to continue to be scientific and modernized, adapting to changes in the socialist market economy and the situation and requirements for medical insurance reform. First, the need to implement cost accounting reforms For a long time, the expansion of hospitals in an out-of-scale manner has resulted in the lack of strict internal accounting for the economic management of hospitals. This has led to high investment, low efficiency, insufficient utilization of medical resources, and overstaffing, resulting in medical costs. At a high level, this kind of situation has been unable to adapt to the socialist market economic situation and the needs of the general public for medical services. The hospital has carried out economic reforms such as departmental income accounting, individual commissioning, economic contracting, and comprehensive target management. It has played a positive role in mobilizing the enthusiasm of employees and increasing hospital revenues. However, these reforms are mainly centered on distribution, and the drawbacks that have emerged at present are increasing. The more, the most important is that there is no concept of cost, and the resource utilization efficiency is not high enough to fundamentally solve the problem of hospital survival and development.