随着新一轮医疗改革的持续推进，A公立医院成本管理的弊端逐渐显现，无 法满足现代医院管理的要求。研究A公立医院成本管理优化问题将有助于降低 成本风险，提高成本管理效益；有助于提高医疗资源使用效率，促进医院可持续 发展；有助于营造精细化成本管理的文化氛围，提高全院员工的参与度。本文通 过研究成本管理优化、精益六西格玛管理、标杆管理、正反馈闭环管理系统等相 关理论，结合A公立医院成本管理实际情况，采用文献研究法、案例分析法、 六何分析法、定量与定性结合分析法、PEST分析法，对A公立医院成本管理存 在的问题和原因进行深入浅出地分析，探索构建A公立医院“一核两翼”的成 本管理优化策略体系，即以精细化管理理念为核心，以优化成本结构和成本管理 活动为左右两翼。在A公立医院成本管理工作中深化精细化管理理念，培养全 院职工精细化成本管理的意识；采用标杆瞄准评估法对医院三项主要业务成本， 即药品成本、卫生材料成本和人力成本的结构进行优化；采用联合确定基数法关 联成本考核和成本预算；引入作业成本法进行成本核算；充分利用本量利分析工 具进行成本分析与控制；最终使得A公立医院各成本管理活动之间形成良性的、 可持续的循环。同时，本文提出整合医院现有的信息资源，健全成本管理的组织 结构，更新成本管理相关的制度规范这三项保障措施，来确保A公立医院成本 管理优化策略方案的顺利实施。本文提出的“一核两翼”成本管理优化策略体系， 将帮助A公立医院系统地改善其成本管理，从而提升医院成本管控水平，提高 医疗资源使用效率，同时也为同行医院提供借鉴参考。 关键词：公立医院，医院成本，成本管理，成本管理优化 II Abstract With the sustained progress of the new round of medical reform, the drawbacks of cost management of A public hospital are gradually emerging, which can not meet the requirements of modern hospital management. Studying the cost management optimization problem of A public hospital will help reduce cost risks and improve cost management benefits; help improve the efficiency of medical resources use and promote the sustainable development of hospital; help create a culture for refined cost management and improve the participation of overall staff. By studying the cost management optimization, lean six sigma administration, benchmark management, positive feedback closed-loop management system and other related theories, combined with the actual situation of A public hospital cost management, using literature research method, case analysis method, six analysis method, quantitative and qualitative combination analysis method and PEST analysis method, this paper analyzes the problems and causes of the cost management of A public hospital in an in-depth analysis, and explores the construction of the cost management optimization strategy system of “one core and two wings” of A public hospital, which is to fine management concept as the core, to optimize the cost structure and cost management activities for the left and right wings. Deepen the concept of refined management in the cost management of A public hospital, and cultivate the consciousness of the refined cost management of the whole hospital staff; adopt the benchmarking assessment method to carry out the three main business costs structure optimization of the hospital, namely the cost of medicines, the cost of sanitary materials and the cost of labor; use the jointly set target method to correlate cost assessment and cost budget; introduce the activity-based costing method for cost accounting; make full use of the cost-volume-profit analysis tool for cost analysis and control; and finally a virtuous and sustainable cycle is formed among the cost management activities of A public hospital. At the same time, this paper proposes to integrate the existing information resources of the hospital, improve the organizational structure of cost management, and update related system regulation to ensure the smooth implementation of A public hospital cost management optimization strategy. The "one core and two wings" cost management optimization strategy system proposed in this paper will help A public hospital systematically improve its cost management, thereby improving the hospital III cost control level and improving the efficiency of medical resources use, and also providing reference for peer hospitals. Key words: Public hospital, Hospital cost, Cost management, Cost management optimization 1 目录 摘要 .................................................................................................................................... I Abstract ............................................................................................................................... II 第1章 绪论 ....................................................................................................................... 1 1.1 研究背景和研究意义 ............................................................................................. 1 1.1.1 研究背景 ....................................................................................................... 1 1.1.2 研究意义 ....................................................................................................... 3 1.2 研究目的和研究内容 ............................................................................................. 4 1.2.1 研究目的 ....................................................................................................... 4 1.2.2 研究内容 ....................................................................................................... 4 1.3 研究方法和技术路线 ............................................................................................. 5 1.3.1 研究方法 ....................................................................................................... 5 1.3.2 技术路线 ....................................................................................................... 6 1.4 主要创新之处 ......................................................................................................... 7 第2章 文献综述和相关理论基础 ..................................................................................... 9 2.1 国内外文献综述 ..................................................................................................... 9 2.1.1 国内外关于成本管理的研究 ....................................................................... 9 2.1.2 国内外关于成本管理优化的研究 ............................................................. 10 2.1.3 国内外关于公立医院成本管理优化的研究 ............................................. 12 2.1.4 国内外研究成果评析 ................................................................................. 14 2.2相关理论基础 ........................................................................................................ 15 2.2.1 精益六西格玛管理理论 ............................................................................. 15 2.2.2 标杆管理理论 ............................................................................................. 15 2.2.3 正反馈闭环管理系统理论 ......................................................................... 16 第3章 A公立医院成本管理的现状分析 ....................................................................... 17 3.1 A公立医院概况 .................................................................................................... 17 3.2 A公立医院成本管理的现状 ................................................................................ 17 3.2.1 A公立医院成本管理概况 .......................................................................... 17 3.2.2 A公立医院的成本运行现状 ...................................................................... 21 3.3 A公立医院成本管理存在的问题 ........................................................................ 22 3.3.1 医院运营成本居高不下 ............................................................................. 23 3.3.2 医院成本支出缺乏预算约束 ..................................................................... 24 2 3.3.3 成本核算数据的精细化程度不高 ............................................................. 24 3.3.4 成本分析、控制和考核没有发挥作用 ..................................................... 25 3.4 A公立医院成本管理问题的原因分析 ...