为解决百姓“看病难、看病贵”，我国自 2015 年启动综合医改。习近平总书 记在党的十九大报告中提出“健康中国”战略。党和政府不断加大综合医改力度、 深度和广度。本论文是在综合医改进入了攻坚期和深水区的大背景下，结合 2014 年 1 月财政部实施《行政事业单位内部控制规范（试行）》要求，研究医院面对政 府由直接投入医院转向增加投入医保、取消药品耗材加成、鼓励社会资本进入健康 产业等综合医改举措，医疗行业市场竞争加剧，对医院建设发展带来冲击、形成压 力。自负盈亏是本轮医院卫生体制改革的出发点。医院面对综合医改的机遇和挑战。 要想生存和发展就必须走精细化管理之路。高值耗材费用在患者就医总费用中占有 很大比例,是医院加强成本管理，缓解看病难、看病贵问题的重要内容，通过加强 高值耗材内部控制，进一步规范管理、降低成本、防范风险，才能实现社会责任和 经济效益双赢。 论文揭示了综合医改对医院带来的挑战，介绍了内部控制基本理论以全面风险 管理、全面质量管理等相关理论内容，结合《行政事业单位内部控制规范（试行）》 要求，以 B 医院高值耗材内部控制管理实践为案例，立足 B 医院高值耗材内部控制 现状，总结存在的问题并深入分析问题成因，结合综合医改要求，提出以全面风险 管理为导向、提升质量和降低成本为目标的高值耗材内部控制优化方案，最后通过 从单位层面制定保障措施，以期优化方案能够落到实处，为践行医改政策、提升医 院效益、减轻患者负担提供一条有效途径，对全国高值耗材内部控制推广具有较强 的借鉴意义。 关键词：高值耗材；内部控制；改善1 ABSTRACT In order to solve the "difficult and expensive medical treatment" of the common people, China launched comprehensive medical reform since 2015. General secretary Xi Jinping put forward the strategy of "" healthy China" "in the 19th party report. The party and the government have continuously strengthened, deepened and expanded the comprehensive medical reform. This paper is the comprehensive reform has entered a GongJianQi and the background of deep water area, in January 2014, the ministry of finance of the administrative institutions internal control standard (try out) "requirements, research hospital in the face of the government to increase investment by directly into hospital medical care, cancel the drug consumables addition, encourage social capital to comprehensive reform measures such as health industry, medical industry market competition intensifies, the hospital construction development impact, formation pressure. Self - financing is the starting point of health system reform. Hospitals face the opportunity and challenge of comprehensive medical reform. If we want to survive and develop, we must take the road of fine management. High value consumables account for a large proportion of patients' total medical expenses, which is an important part of the hospital to strengthen the cost management and alleviate the problem of difficult and expensive medical services. Only by strengthening the internal control of high-value consumables, further standardizing the management, reducing costs and preventing risks can we achieve win-win social responsibility and economic benefits. Paper reveals the challenges brought about by the comprehensive reform of the hospital, this paper introduces the basic theory of internal control to comprehensive risk management, total quality management, and other related theory, combined with the administrative institutions internal control standard (try out) "requirements, high-value consumables with B hospital internal control management practice as a case, based on the hospital B high-value consumables internal control present situation, summarizes the existing problems and causes in-depth analysis problem, combining comprehensive health care reform, puts forward to comprehensive risk management as the guidance, improve quality and reduce the cost as the goal of high value material internal control optimization scheme, finally, from the unit level, formulate measures, It is expected that the optimization plan can be implemented, providing an effective way to implement the medical reform policy, improve hospital benefits and reduce patients' burden, which has2 a strong reference significance for the promotion of internal control of high-value consumables nationwide. KEYWORDS: High-value medical consumables；Internal control；Improvement1 目 录 第一章 绪论..............................................................................................1 第一节 研究背景及意义......................................................................................1 一、研究背景................................................................................................1 二、理论意义及现实意义............................................................................2 第二节 文献综述..................................................................................................3 一、国外研究现状........................................................................................3 二、国内研究现状........................................................................................4 三、国内外研究述评....................................................................................4 第三节 研究内容与思路......................................................................................5 一、研究内容................................................................................................5 二、研究思路................................................................................................5 三、研究方法................................................................................................6 第二章 概念界定与相关理论..................................................................8 第一节 内部控制基本理论..................................................................................8 一、内部控制的含义....................................................................................8 二、内部控制的目标....................................................................................8 三、内部控制的作用....................................................................................9 四、内部控制的方法....................................................................................9 第二节 全面风险管理相关理论........................................................................10 一、风险与风险管理定义..........................................................................10 二、全面风险管理程序与步骤..................................................................10 三、全面风险管理与内部控制的联系......................................................10 四、全面风险管理导向的内部控制体系..........................................10 第三节 全面质量管理相关理论........................................................................ 11 一、全面质量管理概念.............................................................................. 11 二、全面质量管理的方法.......................................................................... 11 三、全面质量管理与内部控制关系..........................................................122 第三章 B 医院高值耗材内部控制现状分析........................................13 第一节 B 医院简介.............................................................................................13 第二节 B 医院高值耗材内部控制现状.............................................................13 一、 医院高值耗材定义及特点.................................................................13 二、B 医院高值耗材使用基本情况...........................................................14 三、B 医院高值耗材内部控制现状概述...................................................15 第三节 B 医院高值耗材内部控制主要问题.....................................................17 一、内控制度落实不到位，高值耗材内控专项制度缺失.......................17 二、采、用、管职能过于集中...................................................................18 三、业务活动缺乏全程管控.......................................................................18 第四节 B 医院高值耗材内部控制问题成因分析.............................................20 一、内部控制自身受限...............................................................................20 二、内部控制全员意识薄弱.......................................................................20 三、内部控制风险评估能力差...................................................................20 四、内部控制缺乏绩效评估和激励机制...................................................21 五、审计监督作用发挥有限.......................................................................21 第四章 B 医院高值耗材内部控制优化建议........................................22 第一节 B 医院高值耗材内部控制基本原则.....................................................22 一、合法性原则...........................................................................................22 二、全面性原则...........................................................................................22 三、重要性原则...........................................................................................22 四、适应性原则...........................................................................................22 五、成本效益原则.......................................................................................22 第二节 B 医院高值耗材内部控制优化目标.....................................................22 一、提升医疗服务的效率和质量...............................................................22 二、保障高值耗材购用程序合规合法.......................................................23 三、确保医院高值耗材资产安全...............................................................23 四、提高医院高值耗材业务活动的效率和效果.......................................23 五、会计和管理信息的真实有用...............................................................23 第三节 B 医院高值耗材内部控制优化举措.....................................................233 一、提升高值耗材风险防控能力..............................................................23 二、加强高值耗材全面预算管理..............................................................24 三、引进先进科技手段，实现闭环管理..................................................24 四、开展高值耗材内部控制专项自评......................................................27 五、强化高值耗材内部控制审计监督......................................................28 第四节 B 医院高值耗材内部控制保障措施 ....................................................28 一、强化宣传培训，提升高值耗材内部控制意识..................................28 二、完善高值耗材内部控制组织机构......................................................29 三、完善高值耗材内部控制管理制度体系..............................................29 第五章 研究结论与展望........................................................................31 第一节 研究结论................................................................................................32 一、结论....................................................................................................32 二、本文创新之处....................................................................................33 三、本文的不足........................................................................................33 第二节 展望........................................................................................................33