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论文编号：	15412
作者编号：	2320213874
上传时间：	2025/6/10 19:22:28
中文题目：	基于时间驱动作业成本法的ZY中医医院成本核算优化研究
英文题目：	Research on Cost Optimization of ZY Traditional Chinese Medicine Hospital Based on Time-Driven Activity-Based Costing (TDABC)
指导老师：	边泓副教授 孙慧强正高级会计师
中文关键字：	时间驱动作业成本法；医院成本核算；医疗服务项目成本核算
英文关键字：	Time-driven activity-based costing; Hospital cost accounting; Medical service project cost accounting
中文摘要：	在深化医改政策背景下，公立医院收入结构发生根本性变革。随着药品耗材加成全面取消、大型设备检查价格下调、医保支付模式系统性改革，公立医院传统补偿渠道大幅缩减，运营压力持续加剧。2021年6月，《关于推动公立医院高质量发展的意见》明确提出实施精细化成本管理的要求；2024年12月，国家多部门联合发布《公立医院成本核算指导手册》，重点强调医疗服务项目成本、病种成本及DRG成本的核算需求。然而，受限于信息化水平不足、间接费用分摊机制僵化等问题，多数医院仍采用粗放的科室成本核算模式，难以精准追踪医疗服务项目的真实资源消耗，导致成本控制与决策支持效能低下，这一矛盾在兼具标准化政策导向与个体化诊疗特征的中医医院中尤为突出。 本文聚焦DRG支付改革下公立中医医院的成本管理困境。根据临床治疗相近、医疗资源消耗相近的分组原则，DRG付费要求医院精确核算病组内各医疗服务的真实成本。将时间驱动加入公立中医医院医疗服务项目成本核算中，旨在完善医院成本核算体系。运用文献研究法、案例分析法、实地访谈法，立足成本管理、成本控制、成本动因等相关理论，深入探讨采用时间驱动作业成本法进行项目成本核算的必要性与可行性。研究路径遵循“理论构建-问题诊断-方案设计-实施保障”的逻辑框架。首先，界定成本管理相关概念；其次，通过实地调研ZY公立中医医院，发现该院项目成本核算体系不完善和核算方法范围不准确等问题；再次，结合医院自身成本现状、管理目标和资源状况，遵守重要性原则，将时间驱动作业成本法与科室成本核算方法相结合，提供优化方案；最后实施保障措施，医院通过健全医院项目成本核算体系、完善数据收集和信息化管理平台、宣传培训逐步引导医院管理层和工作者接受新方法，保证方法顺利开展。 通过研究可知，应用时间驱动作业成本法进行中医特色医疗服务项目成本核算，有利于提高成本核算精度和灵活性，提高工作效率；有利于完善公立医院成本管理体系，为合理定价及立项决策提供数据支撑；有利于优化服务流程，降低医疗服务成本；有利于提高患者满意度，助推医院高质量健康发展，更好地满足人民不断增长的医疗卫生服务需求。
英文摘要：	Under the backdrop of deepening healthcare reform policies, the revenue structure of public hospitals has undergone fundamental transformations. With the complete elimination of drug and consumable markups, price reductions for large-scale medical equipment examinations, and systematic reforms to medical insurance payment models, traditional compensation channels for public hospitals have significantly diminished, leading to intensifying operational pressures. In June 2021, the Opinions on Promoting High-Quality Development of Public Hospitals explicitly mandated the implementation of refined cost management. By December 2024, multiple national departments jointly issued the Guidance Manual for Cost Accounting in Public Hospitals, emphasizing the critical need for cost accounting of medical service items, disease categories, and DRG (Diagnosis-Related Groups). However, constrained by inadequate digitalization capabilities and rigid indirect cost allocation mechanisms, most hospitals still rely on crude department-level cost accounting models. This approach fails to accurately track the actual resource consumption of medical services, resulting in inefficient cost control and decision-making support. Such contradictions are particularly pronounced in traditional Chinese medicine (TCM) hospitals, which must reconcile standardized policy directives with individualized diagnostic and therapeutic characteristics. This thesis focuses on the cost management challenges of public Traditional Chinese Medicine (TCM) hospitals under the Diagnosis-Related Groups (DRG) payment reform. Guided by the grouping principles of clinical treatment similarity and comparable medical resource consumption, the DRG payment mechanism necessitates hospitals to precisely calculate the true costs of medical services within each disease group. By incorporating time-driven elements into the cost accounting of medical service projects in public TCM hospitals, this research aims to refine the hospital's cost accounting system. Grounded in theoretical frameworks of cost management, cost control, and cost drivers, the study employs literature review, case analysis, and field interviews to comprehensively investigate the necessity and feasibility of applying Time-Driven Activity-Based Costing (TDABC) for project cost accounting. The research follows a logical framework of "theoretical construction – problem diagnosis – solution design – implementation safeguards".Firstly, key concepts in cost management are defined to establish theoretical boundaries. Secondly, through on-site investigations at ZY Public Traditional Chinese Medicine Hospital, systemic issues such as deficiencies in the project cost accounting framework and inaccuracies in method application are identified. Thirdly, adhering to materiality principles and integrating the hospital's current cost status, management objectives, and resource allocation, an optimized solution is proposed that combines TDABC with departmental cost accounting methods. Finally, implementation safeguards are enacted: The hospital refines its project cost accounting system through enhanced data collection and digitalized management platforms, while conducting targeted awareness campaigns and training programs to facilitate the adoption of the new methodology among administrators and staff, thereby ensuring its smooth implementation.This structured approach addresses both technical and organizational barriers, offering a replicable pathway for advancing precision cost management in TCM hospitals navigating the dual challenges of DRG standardization and individualized clinical practices. Through research, it is evident that applying TDABC to the cost accounting of medical service projects in various departments of ZY Public Traditional Chinese Medicine Hospital is beneficial for enhancing the accuracy and flexibility of cost accounting and improving work efficiency. It is conducive to perfecting the cost management system of public hospitals, providing data support for rational pricing and project decision-making. It helps optimize service processes and reduce medical service costs. It also improves patient satisfaction, promotes the high-quality development of hospitals, and better meets the people's growing demand for healthcare services.
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