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class="sm_after_time"></span> <span id="x2vadh25c" class="source"><a target="_blank" href="http://www.msguai.com/lunwen/f/" title="論文范文">論文范文</a></span> <span id="x2vadh25c" class="source"><a target="_blank" href="http://www.msguai.com/usr/login.html" title="我要投稿">我要投稿</a></span> </div> <script type="text/javascript">s("content_top");</script> <div id="x2vadh25c" class="content"> <div id="x2vadh25c" class="excellent_articles_box"> <ul> <li id="x2vadh25c" class="excellent_articles_title">相關(guān)推薦</li> </ul> </div> <p>行政后勤類成本在醫(yī)院成本核算的分?jǐn)傉撐?/p><p>　　<strong>1行政后勤類成本的現(xiàn)狀</strong></p><p style="text-align: center;"><img loading="lazy" src="https://p.9136.com/00/l/c2dbcec44_2.jpg" alt="行政后勤類成本在醫(yī)院成本核算的分?jǐn)傉撐?/></p><p>　　1．1行政后勤類成本的特點(diǎn)</p><p>　　隨著成本核算的發(fā)展，行政后勤成本已經(jīng)逐步轉(zhuǎn)化成臨床科室直接成本，如為臨床科室專項(xiàng)服務(wù)所產(chǎn)生的成本，已經(jīng)設(shè)立明細(xì)科目，直接計(jì)入相應(yīng)科室，如為骨科組織的�？浦R(shí)講座，在本次講座中產(chǎn)生的費(fèi)用，可以通過(guò)財(cái)務(wù)記賬直接計(jì)入科室勞務(wù)成本。但是某些大型活動(dòng)，如全院的義診服務(wù)活動(dòng)產(chǎn)生的成本性支出，則無(wú)法直接計(jì)入臨床科室，需要進(jìn)行分?jǐn)偤娃D(zhuǎn)移處理。除去專項(xiàng)業(yè)務(wù)產(chǎn)生的成本，行政后勤類成本主要有三個(gè)主要部分:一是人力成本，如行政、后勤科室人員的工資、補(bǔ)貼、福利費(fèi)等;二是能源、固定資產(chǎn)折舊、辦公消耗性支出等;三是行政事業(yè)類支出。行政事業(yè)類支出是著力轉(zhuǎn)化為臨床科室直接成本的陣地，但是人力成本、能源、固定資產(chǎn)折舊、辦公消耗無(wú)法直接進(jìn)入臨床科室，現(xiàn)階段只能通過(guò)層級(jí)轉(zhuǎn)移向臨床科室轉(zhuǎn)移。</p><p>　　1．2行政后勤類成本的管理方法</p><p>　　現(xiàn)階段成本核算無(wú)法準(zhǔn)確衡量后勤服務(wù)類科室收益，所以無(wú)法準(zhǔn)確以收益的手段核算行政后勤類科室的工作效率，只能通過(guò)與績(jī)效考核相結(jié)合的辦法來(lái)考量后勤服務(wù)類科室，績(jī)效考核雖然能提高后勤服務(wù)類科室辦事效率，但是無(wú)法準(zhǔn)確界定成本責(zé)任，無(wú)法取得節(jié)能降耗的作用。行政后勤類管理成本在現(xiàn)行全成本核算管理辦法中一般通過(guò)兩種途徑進(jìn)入臨床科室，一種是通過(guò)職工人數(shù)平均法、收入比重法、成本比重法等方法，將部分無(wú)法直接進(jìn)入科室的事業(yè)費(fèi)支出分?jǐn)偟脚R床科室［3］;另一種通過(guò)層級(jí)轉(zhuǎn)移的方法，由行政后勤類科室向醫(yī)療輔助、醫(yī)療技術(shù)、臨床服務(wù)逐級(jí)轉(zhuǎn)移到臨床科室。即使通過(guò)分?jǐn)�、轉(zhuǎn)移的手段進(jìn)入到臨床科室，但是臨床科室的工作人員對(duì)此類成本也是束手無(wú)策，無(wú)法提高資源的利用效率。</p><p>　　1．3行政后勤類成本在成本核算中的地位</p><p>　　現(xiàn)在醫(yī)院全成本核算分為兩部分，科級(jí)成本核算和院級(jí)成本核算，兩部分互為補(bǔ)充也自成體系�？萍�(jí)成本核算主要使命是明晰成本責(zé)任，合理配置內(nèi)部資源，提高成本利用效率�？萍�(jí)成本核算的中心是臨床服務(wù)科室，行政后勤類科室僅為輔助，受重視程度較差，且無(wú)量化考核辦法，使得行政后勤類科室逐漸在科級(jí)成本核算中扮演起旁觀者的角色。院級(jí)成本核算建立在成本會(huì)計(jì)的基礎(chǔ)上，以資產(chǎn)負(fù)債表為表現(xiàn)形式，主要用于衡量醫(yī)院整體運(yùn)行狀態(tài)，提高醫(yī)院競(jìng)爭(zhēng)力為主要目的，行政后勤類成本融化在各類費(fèi)用中，且占比較小，很難引起決策者重視。</p><p>　　<strong>2行政后勤類成本轉(zhuǎn)移的弊端</strong></p><p>　　2．1成本轉(zhuǎn)移無(wú)法明確成本責(zé)任</p><p>　　隨著成本核算不斷發(fā)展，在成本核算的過(guò)程中明晰成本責(zé)任成為科級(jí)成本核算的首要任務(wù)，準(zhǔn)確的界定成本責(zé)任為進(jìn)一步有效節(jié)能降耗奠定堅(jiān)實(shí)的基礎(chǔ);通過(guò)多年全成本核算實(shí)施，臨床科室每一位工作人員成本意識(shí)普遍提高，每一位工作人員都在力所能及的范圍內(nèi)自覺(jué)控制成本，但是通過(guò)分?jǐn)偦蜣D(zhuǎn)移的形式進(jìn)入臨床科室的成本備受爭(zhēng)議。臨床科室的負(fù)責(zé)人在應(yīng)對(duì)分?jǐn)偟娇剖业某杀緯r(shí)，也只能采取控制科室的有效分?jǐn)倕?shù)的策略，但這并不能在實(shí)質(zhì)上改善分?jǐn)偝杀镜睦眯省Ｔ诿鎸?duì)由層級(jí)轉(zhuǎn)移的方式轉(zhuǎn)移到科室成本明細(xì)表上的行政后勤類成本時(shí)，科室負(fù)責(zé)人束手無(wú)策，甚至有些效益較差的科室對(duì)此類成本比較抵觸。無(wú)法通過(guò)核算找到此類成本的直接責(zé)任人，使得這部分的核算徒勞無(wú)功。</p><p>　　2．2成本轉(zhuǎn)移的方法難以準(zhǔn)確界定</p><p>　　臨床科室無(wú)法控制行政后勤成本，但又必須承擔(dān)行政后勤成本，使得以何種形式分?jǐn)�、轉(zhuǎn)移成本成為爭(zhēng)論的焦點(diǎn)。基本的成本分?jǐn)偡椒ㄓ新毠と藬?shù)平均法、人員費(fèi)用分?jǐn)偡�、收入占比分�(jǐn)偡�、單�?xiàng)成本比重分?jǐn)偡ǖ龋?］。甚至有多參數(shù)結(jié)合的分?jǐn)傓k法，這些分?jǐn)傓k法雖然能夠非常合理的將行政后勤類成本分?jǐn)偟脚R床科室，科室所能找到的降低此類成本的方法也僅僅是從分?jǐn)傓k法入手;如果是以職工人數(shù)平均法進(jìn)入科室的，科室雖然通過(guò)各種手段減少了人員占比，但僅僅是減少了科室分?jǐn)偟降某杀�，并沒(méi)有實(shí)質(zhì)上減少行政后勤成本或提高行政后勤成本的使用效率。面對(duì)不斷增加的行政后勤成本，選取哪種分?jǐn)傓k法并不是主要解決辦法，而應(yīng)是將主要精力集中到行政后勤類科室，合理的讓行政后勤類科室承擔(dān)起成本利弊，進(jìn)而發(fā)揮主觀能動(dòng)性，提高資源效率。</p><p>　　2．3預(yù)算制度存在弊端</p><p>　　廣泛應(yīng)用的行政后勤成本管控辦法為預(yù)算制度。預(yù)算控制模式源于成本管理的標(biāo)準(zhǔn)成本法，事先確定目標(biāo)差異，通過(guò)實(shí)際作業(yè)的控制消除或減少偏差數(shù)額，屬于剛性控制［5］。但是隨著市場(chǎng)發(fā)展，為了加快醫(yī)院對(duì)市場(chǎng)動(dòng)態(tài)變化的反應(yīng)，使組織的應(yīng)變能力變的柔性化，反應(yīng)更加靈敏。隨著管理柔性化的進(jìn)程，預(yù)算控制逐漸失去優(yōu)勢(shì)，發(fā)展趨勢(shì)的不確定性和隨時(shí)調(diào)整的發(fā)展思路，使得預(yù)算極易被打破進(jìn)而失去效力，即使是零基預(yù)算也無(wú)法達(dá)到有效控制成本的作用。預(yù)算制度有時(shí)候還會(huì)形成各機(jī)關(guān)后勤部門間的隔膜和沖突，如果不能妥善的協(xié)調(diào)和劃分業(yè)務(wù)范圍，在資源配置問(wèn)題上將會(huì)引起互相推諉，即便能節(jié)省一定的成本，但是會(huì)影響具體決策、決議的推進(jìn)，進(jìn)而影響整體經(jīng)濟(jì)發(fā)展。</p><p>　　<strong>3解決方法</strong></p><p>　　由于行政后勤部門工作量無(wú)法量化考核，導(dǎo)致在成本核算無(wú)法考核科室的績(jī)效，更無(wú)法實(shí)現(xiàn)收支的有機(jī)結(jié)合，所以行政后勤成本的管理不能拘泥于一般的考核思路，應(yīng)拓寬思路從以下角度入手。</p><p>　　3．1推進(jìn)行政后勤類成本向醫(yī)療直接成本轉(zhuǎn)變行</p><p>　　政后勤類科室主要是為臨床科室服務(wù)，所有的活動(dòng)都與臨床科室息息相關(guān)，所以在行政后勤科室成本記賬時(shí)盡量將成本計(jì)入受益科室。這樣就形成受益科室對(duì)機(jī)關(guān)后勤類科室的監(jiān)督，有利于督促行政后勤類科室提高效率，實(shí)現(xiàn)監(jiān)督性的成本責(zé)任推進(jìn)措施。有些醫(yī)院為了更準(zhǔn)確地量化考核部分行政后勤科室，采取內(nèi)部定價(jià)制度，通過(guò)模擬的內(nèi)部交易形式，實(shí)現(xiàn)了部分行政后勤類科室的量化考核，但是此方法局限性較大，不適合某些行政部門的管理，但是最終目的均是由臨床科室監(jiān)督行政后勤類科室的成本管控策略。</p><p>　　3．2按核算周期設(shè)定預(yù)算額度</p><p>　　按照財(cái)務(wù)管理，一般按照年度或季度為各部門設(shè)立預(yù)算額度。但是隨著社會(huì)經(jīng)濟(jì)節(jié)奏的加快，經(jīng)濟(jì)環(huán)境的不可預(yù)測(cè)性不斷加強(qiáng)，為了制定更有效的行政后勤成本管理限額，建議按月度測(cè)算成本，根據(jù)上一周期的實(shí)際發(fā)生情況和本周期將實(shí)施的工作計(jì)劃，由核算部門設(shè)定成本限額，指導(dǎo)行政后勤類科室合理安排和控制自身成本，結(jié)合有效的考評(píng)手段，調(diào)動(dòng)行政后勤類科室成本管理責(zé)任意識(shí)，主動(dòng)發(fā)揮資源效率，提高醫(yī)院管理水平。通過(guò)推進(jìn)行政后勤類成本向醫(yī)療直接成本轉(zhuǎn)變和及時(shí)的預(yù)算限額制度相結(jié)合的手段，既加強(qiáng)臨床科室對(duì)機(jī)關(guān)科室的有效監(jiān)督力度，解決臨床科室對(duì)分?jǐn)偝杀臼譄o(wú)策的局面，又提高行政后勤類科室的成本責(zé)任意識(shí)。更重要的是通過(guò)合理政策，可以加強(qiáng)行政后勤類科室工作積極性，提高機(jī)關(guān)工作辦事效率。</p><script>s("content_relate");</script><p>【行政后勤類成本在醫(yī)院成本核算的分?jǐn)傉撐摹肯嚓P(guān)文章：</p><p><a 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