经济社会的快速发展与生活理念的转变促使医院不得不提高对内部控制方法与效果 的要求。加强内部控制保障医院各项业务得以顺利开展，是优化调整医院内部组织框架的 基础条件，也是实现医院发展战略目标的重要途径，更是提高了医院对其内外部环境中所 存在潜在风险的识别分析与规避抵御能力。因此，建立和健全基于风险管理的医院内部控 制制度对促进公立医院长期稳定发展具有十分重要的意义。 本文以全面风险管理导向的Z医院内部控制体系优化研究为命题，在查阅国内外相关 文献的前提下，对医院风险管理和内部控制相关理论进行梳理，将风险管理和内部控制相 融合，通过调查问卷形式分析出Z医院内部控制存在的问题，深入剖析医院内部存在的风 险点，并以此为基础建立了基于风险管理的内部控制体系。本文包含五部分内容：第一部 分是理论研究，详细介绍了全面风险管理与内部控制相关的理论知识。第二部分是实践调 查研究，用问卷调查法，从内部控制五要素出发分析Z医院内控体系存在的问题及产生的 原因。第三部分是本论文的核心内容，深入剖析现阶段医院内部存在的风险点和风险应对 策略，针对识别的风险点加强内控体系的建设力度，全面优化医院的内部控制体系。第四 部分为研究中得到的启发，为提高医院风险体系的实效性而提出合理化建议。第五部分是 论文的结论、不足及展望。 内部控制机制是医院自我审查与自我发展的重要手段，也是医院识别和规避各种风险 的主要方式。本文全面分析了医院内部控制机制运行情况，在结合医院风险体系建设现状 的基础上提出加强内部控制建设的方法与措施，为医院进一步调整内部控制方向与目标提 供了更多具有参考价值的信息。 关键词：全面风险管理；内部控制体系；优化策略；Z医院 Ⅴ Abstract Withtherapiddevelopmentofeconomyandsocietyandthechangeoflifeconcept, hospitalshavetoimprovetherequirementsofinternalcontrolmethodsandeffects. Strengtheninginternalcontroltoensurethesmoothdevelopmentofvarious businessesofthehospitalisthebasicconditionforoptimizingandadjusting theinternalorganizationalframeworkofthehospital,isalsoanimportantway toachievethestrategicobjectivesofthehospital'sdevelopment,andalso improvesthehospital'sabilitytoidentify,analyzeandavoidthepotentialrisks initsinternalandexternalenvironment.Therefore,itisofgreatsignificance toestablishandimprovetheinternalcontrolsystembasedonriskmanagementto promotethelong-termstabledevelopmentofpublichospitals. Basedontheresearchontheoptimizationoftheinternalcontrolsystemof ZHospitalGuidedbycomprehensiveriskmanagement,thispaperreviewstherelevant theoriesofhospitalriskmanagementandinternalcontrol,integratesrisk managementandinternalcontrol,analyzestheproblemsexistingintheinternal controlofZhospitalthroughquestionnaire,anddeeplyanalyzestheinternalrisk pointsofthehospitalOnthisbasis,theinternalcontrolsystembasedonrisk managementisestablished.Thispaperconsistsoffiveparts:thefirstpartis thetheoreticalresearch,whichintroducesthetheoreticalknowledgeof comprehensiveriskmanagementandinternalcontrolindetail.Thesecondpartis thepracticalinvestigation,usingthemethodofquestionnaire,fromthefive elementsofinternalcontroltoanalyzetheproblemsandcausesofinternalcontrol systeminZhospital.Thethirdpartisthecorecontentofthispaper,in-depth analysisoftheriskpointsandriskresponsestrategiesexistinginthehospital atthisstage,strengthentheconstructionofinternalcontrolsystemforthe identifiedriskpoints,andcomprehensivelyoptimizetheinternalcontrolsystem ofthehospital.Thefourthpartistheinspirationofthestudy,andputsforward reasonablesuggestionstoimprovetheeffectivenessofhospitalrisksystem.The fifthpartistheconclusion,deficiencyandProspectofthepaper. Internalcontrolmechanismisanimportantmeansofhospitalself-examination andself-development,aswellasthemainwayforhospitaltoidentifyandavoid variousrisks.Thispapercomprehensivelyanalyzestheoperationoftheinternal controlmechanismofthehospital,analyzesthemethodsandmeasurestospeedup theconstructionofinternalcontrolbasedonthecurrentsituationofthe constructionofthehospitalrisksystem,andprovidesmorevaluableinformation Ⅴ forthehospitaltofurtheradjustthedirectionandobjectivesofinternal control. Keywords:comprehensiveriskmanagement;internalcontrolsystem;optimization strategy;Zhospital Ⅴ 目录 摘要.........................................................................................................................................III ABSTRACT.......................................................................................................................................IV 一．绪论.......................................................................................................................................1 （一）研究背景及意义..............................................................................................................1 1.研究背景..............................................................................................................................1 2.研究意义 .............................................................................................................................. 1 （二）文献综述与述评..............................................................................................................1 1.国外研究现状 ...................................................................................................................... 2 2.国内研究现状......................................................................................................................2 3.研究文献综述小结..............................................................................................................2 （三）研究思路及方法、主要内容和创新..............................................................................3 1.研究思路..............................................................................................................................3 2.研究方法..............................................................................................................................3 3.研究的主要内容..................................................................................................................3 4.论文创新点..........................................................................................................................5 二、理论基础.................................................................................................................................6 （一）内部控制理论..................................................................................................................6 （二）全面风险管理理论........................................................................................................................6 1.全面风险管理的内涵.......................................................................................................................6 2.全面风险管理的程序..........................................................................................................7 （三）内控体系与全面风险管理的辩证关系..........................................................................8 （四）分析内部控制与内部控制体系的关系..........................................................................8 三、Z医院内部控制体系运行现状分析......................................................................................9 （一）Z医院简介.......................................................................................................................9 （二）针对Z医院内部控制体系的调查问卷及结果分析......................................................9 1．调查问卷设计....................................................................................................................9 2.Z医院内部控制现状分析...............................................................................................10 3.Z医院内部控制体系的评价...........................................................................................13 （三）Z医院内部控制体系存在的问题.................................................................................17 1.Z医院内部控制环境建设力度较弱.................................................................................17 2.Z医院风险评估水平有待提高.........................................................................................18 3.Z医院控制活动的单调性.................