I 摘要 近两年来，国家为进一步推行医疗行业改革，从控制药品费用到医保相关政策贯彻 实施等方面，都不断强调着医院成本核算与控制的重要性。2017年国务院计划全面推行 按病种付费为主的多元复合式医保支付方式（即DRGs点数付费办法），并于2020年 在浙江省率先实施。新医保支付方式改革，明确对精神病、安宁疗护、医疗康复等需要 长期住院且日均费用稳定的疾病，折算成DRGs点数按照床日进行支付。医保局根据确 定费用支付给医院，其中所支付的费用如果有盈余可纳入医院收入，若超标则需医院补 齐差额，与住院个人再无关系。 CK医院是位于浙江省的民营医院，一方面医院具有企业性质，盈利是医院发展的 重要目标，另一方面医院设有定点医保，伴随医改取消药品加成、医保支付方式改革等 政策的推行，医院未来的收入主要根据病种计算出确定费用，替代目前依据项目类型定 价收费的模式。因此，医疗成本将成为CK医院盈亏的关键因素。CK医院目前迫切需 要转变内部成本管理模式，降低各病种的医疗服务成本，才能在新的改革形势下保持盈 利发展的势头。本文尝试将作业成本法应用于CK医院的医技检查类科室，帮助CK医 院改善成本管理的现状，为医院成本管理改革提供借鉴。 本文采用理论和案例结合的方法，围绕CK医院应用作业成本法对成本管理的影响 展开分析与研究。首先，在相关理论方面主要介绍了成本管理五大理论、医院成本管理 以及作业成本法的相关概念，并分析了作业成本法在成本管理中的优势与局限性。接着 以CK医院为研究案例，对CK医院成本管理现状以及存在问题进行分析与总结。最后 将作业成本法的核算流程应用于CK医院的医技检查类科室，得出了医疗项目总成本以 及单例成本等成本核算结果。 通过对作业成本法核算结果的分析，发现CK医院如果实行作业成本法，能够取得 如下预期成效：一是作业成本法能反映企业的资源耗用情况，使得来年的成本预算更加 合理、实用；二是作业成本法核算结果可以作为成本控制的基础数据，帮助成本控制策 略更加精准，使得成本控制效果更加明显；三是作业成本法能将间接成本进行分摊，使 得成本的核算结果更加真实；四是在作业成本法的实行过程中，可强化全员的成本管理 意识，帮助医院管理层区分增值作业与非增值作业，使得考核制度趋于完善。 CK医院要保障作业成本法顺利、高效地实施，就需要：一是提高全院成本管理意 识，调动各科室员工参与成本管理的积极性；二是在医院内形成成本管理信息反馈协调 机制，实现成本精细化管控；三是加强医院信息一体化建设，实现信息互通互联。 关键词：医院成本管理；作业成本法；作业动因 Abstract II Abstract Intherecenttwoyears,tofurthercarryoutthemedicalindustry'sreform,the governmenthascontinuouslystressedtheimportanceofhospitalcostaccountingandcontrol fromcontrollingdrugexpensestoimplementingtherelevantpoliciesofmedicalinsurance.In 2017,theStateCouncilplannedtocomprehensivelyimplementthemulti-componentpayment methodofmedicalcoveragemainlybasedonthetypesofdiseases(DRGspointpayment method),andtaketheleadinZhejiangProvincein2020.Thenewpaymentmethodof medicalinsuranceexplicitlypointsoutthatfordiseasesrequiringlong-termhospitalization andgeneratingstabledailyaveragecosts,suchasmentalillness,hospicecare,andmedical rehabilitation,thepaymentisconvertedthroughDRGspointsandcombinedwiththenumber ofbeddays.Themedicalinsurancebureaupaysthehospitalaccordingtothedetermined expenses.Ifthereisanysurplus,itcanbeincludedinthehospitalincome.Ifitexceedsthe standard,thehospitalneedstomakeupthedifference,whichhasnothingtodowiththe inpatient. CKhospitalisprivatelyheld,locatedinZhejiangProvince.Ontheonehand,thehospital hasthenatureofanenterprise,profitasanessentialgoalofhospitaldevelopment;onthe otherhand,itisamedicalinsurancedesignatedhospital.Withtheimplementationofpolicies suchascancelingdrugmark-upandthereformofmedicalinsurancepaymentmode,the hospital'sfutureincomeismainlycomputedbydiseasetypes,replacingthecurrentpricing modelpricedaccordingtoprojecttypes.Therefore,themedicalcostwillbecomethecritical factordeterminingCKhospital'sprofitability.Atpresent,CKhospitalurgentlyneedsto changetheinternalcostmanagementandreducethemedicalservicecostforvariousdiseases tomaintainprofitanddevelopmentinthenewreform.Thispaperattemptstoapply activity-basedcostingtoCKhospital'smedicaltechnologyexaminationdepartment,helpCK hospitalimprovethecurrentsituationofcostmanagement,andprovideareferencefor hospitalcostmanagementreform. Thispaperusesacombinationoftheoryandcasetoanalyzeandstudytheinfluenceof activity-basedcostingoncostmanagementinCKhospital.Firstofall,itintroducesthefive theoriesofcostmanagement,hospitalcostmanagement,andrelatedconceptsof activity-basedcosting.Itanalyzestheadvantagesandlimitationsofactivity-basedcostingin costmanagement.Then,takeCKhospitalasacasestudytoanalyzeandsummarizethe currentsituationandexistingproblemsinthecostmanagementinCKhospital.Finally,apply theactivity-basedcostingaccountingprocesstothemedicaltechnologyinspection departmentinCKhospitalandobtainthecosts,includingthetotalcostofmedicalprojects,a singlecasecost. Thefollowingexpectedoutcomeswillbeachievedifimplementingtheactivity-based costinginCKhospitalthroughtheanalysisoftheresults.First,activity-basedcostingcan Abstract III reflecttheresourceconsumptionoftheenterprise,makingthecostbudgetofthenextyear morereasonableandpractical.Second,thecalculationresultfromtheactivity-basedcosting canbeusedasthebasicdataforcostcontrol,helpingthecostcontrolstrategybecomemore accurateandincreasingtheeffectivenessofcostcontrol.Third,activity-basedcostingcan apportiontheindirectcost,makingtheresultsofcostaccountingmorereal.Fourth,duringthe implementation,activity-basedcostingwillstrengthenstaff'scostmanagementawareness, helpthehospitalmanagementtodistinguishvalue-addedandnon-value-addedactivities,and maketheassessmentsystemtendtobeimproved. Toensurethesmoothandefficientimplementationofactivity-basedcosting,CKhospital needsto:first,improvetheawarenessofthehospitalcostmanagement,motivatethestaffsin everydepartmenttoparticipateincostmanagement;second,formacostmanagement informationfeedbackandcoordinationmechanisminthehospital,andrealizetherefinedcost control;third,enhancethehospital'sinformationintegrationtoachievetheinformation interconnection. KeyWords:hospitalcostmanagement;activity-basedcosting;activitymotivation 目录 IV 目录 第1章绪论........................................................................................................................1 1.1研究背景及意义....................................................................................................1 1.1.1研究背景......................................................................................................1 1.1.2研究意义......................................................................................................2 1.2文献综述................................................................................................................2 1.2.1国外研究现状..............................................................................................2 1.2.2国内研究现状..............................................................................................5 1.2.3文献评述......................................................................................................7 1.3研究内容与结构....................................................................................................8 1.3.1研究内容......................................................................................................8 1.3.2研究结构......................................................................................................9 1.4研究方法..............................................................................................................10 第2章成本管理理论与作业成本法概述......................................................................11 2.1成本管理理论......................................................................................................11 2.2医院成本管理概述..............................................................................................12 2.2.1医院成本管理的内涵................................................................................12 2.2.2医院成本管理内容....................................................................................12 2.2.3医院成本管理遵循原则............................................................................13 2.3作业成本法简介..........................