医院是我国医疗服务体系的主体，是维护人民健康的中坚力量。新医改以来， 医院作为市场经济主体的特征愈发显著。为适应外部激烈的市场竞争，不少医院 从提升自身内部管理需求出发，借鉴企业先进的管理理念，逐步推行全面预算管 理。作为大型综合医院的典型代表，H 医院经历了预算管理发展的三个阶段，目 前已初步构建“归口职能部门—预算工作办公室—预算管理委员会”三级管理体 系。 调研表明，H 医院全面预算管理精细化水平不高，原因是预算与业务的融合 不够。具体而言，一是全面预算文化意识淡薄；二是预算组织架构失效；三是预 算管理形式重于实质；四是预算编制范围局限；五是预算管控力度不强；六是预 算考评体系不健全；七是预算信息系统独立。究其原因，主要是源于医院各层级 对全面预算管理理念认识不够、预算组织架构缺乏业务科室支撑、预算与业务管 理互相分离、预算编制基础忽视业务端、预算执行与控制侧重资金角度、预算考 核局限在财务维度、预算系统与业务系统各自为阵等方面。 《国务院办公厅关于建立现代医院管理制度的指导意见》（国办发〔2017〕 67 号）要求“完善医院管理制度，必须建立健全全面预算管理”，实质上从国家 政策层面对医院全面预算管理提出了更高的要求。因此，要提升 H 医院的全面 预算管理水平，应该在业财融合的视角下从以下几个方面入手。首先，更新管理 观念，自上而下通过会议、培训、宣传的形式营造全面预算管理基础环境；二是 优化组织架构，将临床业务科室纳入预算管理团队，夯实全面预算管理基础业务 层；三是破除业财壁垒，组建“业务＋财务”的复合型管理团队，促进全面预算与 业务深度融合；四是强化预算编制，以临床科室的业务预算编制为起点，扩展全 面预算管理数据至业务端；五是再造业务流程，寻找业务与预算的交叉点，促使 预算关键管控嵌入业务；六是吸纳业务指标，对现行预算考核局限财务指标进行 必要的补充；七是借力信息技术，实现全面预算信息与业务信息互通共享。 关键词：业财融合；全面预算管理；医院II Abstract Hospitals are the mainstay of China's medical service system and the backbone of people's health. Since the new medical reform, the characteristics of hospitals as the main body of market economy have become more and more obvious. In order to adapt to the fierce external market competition, many hospitals start from improving their own internal management needs, learn from the advanced management concept of enterprises, and gradually implement comprehensive budget management. As a typical representative of large general hospitals, H hospital has gone through three stages of the development of budget management, and has initially established a three-level management system of "centralized functional depart-budget work office-budget management committee". The investigation shows that the overall budget management level of H hospital is not high, because the budget and business integration is not enough. Specifically speaking, one is the overall budget culture consciousness weak; Second, the budget organizational structure is invalid; Third, the form of budget management is more important than the essence; Fourth, the scope of budget compilation is limited; Fifth, budget control is not strong; Sixth, the budget appraisal system is not sound; Seventh, the budget information system independence. Investigate its reason, mainly comes from the hospitals at all levels of the comprehensive budget management knowledge is not enough, lack of business support department budget organization, budget and separate business management, budgeting based ignore the business side, budget execution, budget assessment and control on capital Angle limitations in the financial dimension, as budget system and business system, etc. The guiding opinions of the general office of the state council on the establishment of a modern hospital management system (guo ban fa [2017] no. 67) requires that "to improve the hospital management system, comprehensive budget management must be established and improved", which in essence puts forward higher requirements for comprehensive hospital budget management from theIII national policy level. Therefore, in order to improve the overall budget management level of H hospital, we should start from the following aspects from the perspective of financial integration. Firstly, the management concept should be updated to create a comprehensive budget management basic environment through meetings, training and publicity from top to bottom. Second, optimize the organizational structure, bring clinical business departments into the budget management team, and consolidate the basic business layer of comprehensive budget management. Third, to break down the financial barriers, the establishment of "business + finance" compound management team, to promote the comprehensive budget and business integration; Fourth, we should strengthen the budgeting, starting from the business budgeting of clinical departments, and expand the comprehensive budget management data to the business end. Fifth, reengineering the business process, finding the intersection between the business and the budget, and making the budget key control embedded in the business; Sixth, absorb the business index, carry on the necessary supplement to the current budget appraisal limited financial index; Seventh, make use of information technology to realize the comprehensive budget information and business information sharing. Key words: financial integration; Comprehensive budget management; The hospitalIV 目录 摘要......................I Abstract...................II 一、绪论.................1 （一）研究背景............................1 （二） 研究意义..........................1 1.理论意义.............................1 2.现实意义.............................1 （三）国内外研究现状综述........2 1.国外文献综述.....................2 2.国内文献综述.....................2 3.综述小结.............................4 （四）研究内容、研究框架、研究方法.................. 4 1.研究内容.............................4 2.研究框架.............................5 3.研究方法.............................5 二、业财融合与全面预算管理的理论概述.......................7 （一）业财融合的涵义与特征....7 1.业财融合的涵义.................7 2.业财融合的特征.................7 3.业财融合的作用.................7 （二）全面预算管理的理论概述8 1.全面预算管理的涵义.........8 2.全面预算管理的内容.........8 3.全面预算管理的原则.........9 4.全面预算管理的流程.........9 5.全面预算管理的方法.........9 6.全面预算管理的作用.......10 （三）业财融合视角下的全面预算管理特点.........11 1.业务与预算管理团队协作紧密......................11 2.业务与预算管理信息交互顺畅......................11 3.业务与预算管理提升组织价值......................12 三、H 医院全面预算管理现状..........13 （一）H 医院背景......................13 1.行业背景...........................13 2.H 医院概况.......................13 （二）H 医院全面预算管理状况.............................15 1.全面预算管理的发展历程..............................15 2.全面预算管理的组织与沟通..........................15 3.全面预算管理的编制与审批..........................16 4.全面预算编制的内容与方法..........................18 5.全面预算管理的执行与控制..........................19 6.全面预算管理的分析与考评..........................19V 7.全面预算管理的信息化状况..........................20 四、H 医院全面预算管理存在问题与原因分析.............22 （一）H 医院全面预算管理存在的问题.................22 1.全面预算管理文化意识淡薄..........................22 2.全面预算管理组织架构失效..........................22 3.全面预算管理形式重于实质..........................23 4.全面预算管理编制范围局限..........................23 5.全面预算管理的管控力度不足......................26 6.全面预算管理考评体系不健全......................27 7.全面预算管理信息系统独立..........................28 （二）H 医院预算管理问题的原因分析.................28 1.各层级对全面预算管理认识不够................. 28 2.全面预算组织架构缺乏业务支撑................. 29 3.全面预算与业务管理互相分离......................30 4.全面预算编制基础忽视业务端......................30 5.预算执行与控制侧重资金角度......................31 6.预算考核评价局限在财务维度......................32 7.预算系统与业务系统各自为阵......................34 五、业财融合视角下 H 医院全面预算管理优化建议... 36 （一）更新管理观念，营造 H 医院全面预算管理的基础环境..........36 1.提升全院全员全面预算管理意识................. 36 2.培养复合型的全面预算管理人才................. 36 （二）优化组织架构，夯实 H 医院全面预算管理的业务基础..........37 1.将临床业务科室纳入预算管理组织............. 37 2.界定四级预算管理架构各层级分工............. 38 （三）破除业财壁垒，促进 H 医院全面预算与业务深度融合..........39 1.组建业财融合的预算管理团队......................39 2.建立业财联动紧密型工作机制......................39 （四）强化预算编制，扩展 H 医院全面预算管理的数据内涵..........40 1.细化全面预算管理的编制..............................40 2.强化全面预算管理的控制..............................40 （五）再造业务流程，促使 H 医院全面预算关键管控嵌入业务......41 1.业务流程与预算管理流程相互串联............. 41 2.预算管控的关键时点嵌入业务流程............. 42 （六）吸纳业务指标，完善 H 医院全面预算考核评价指标体系......42 1.将业务指标纳入全面预算考评体系............. 42 2.加强全面预算考评结果的分析应用............. 43 （七）借力信息技术，实现 H 医院全面预算信息与业务信息共享..43 1.预算管理流程的梳理与再造..........................43 2.预算管理相关信息系统整合..........................44 六、总结与展望...46 （一）全文总结..........................46 （二）未来展望..........................46