Medical program costing refers to the calculation of costs by each medical service. The cost of the medical program is divided into two parts: direct costs and indirect costs. The direct costs are charged directly to the cost of the medical program; the indirect costs should be apportioned according to certain criteria and included in the cost of each relevant medical program.
1. Allocation of direct costs
Salaries, wages, employee benefits: according to the measurement period of the actual consumption of labor in each medical project is included in the cost of the project. Amortization method is as follows:
-Salary (hourly cost) = [monthly average salary (yuan)/(monthly working day × daily working hours)] × single working hours
-Subsidized salary (hourly cost) = [monthly average subsidized salary (yuan)/(monthly working day × daily working hours)] × single working hours × number of people working
-Employee benefits (hourly cost) =[Monthly average employee welfare costs / (monthly working days × daily working hours)] × single working hours × number of workers
Operational costs: according to the characteristics of the operational costs incurred, the following method of assessment.
Water: Based on the actual consumption, the proportion of water consumption for each service item is estimated and apportioned proportionally.
Electricity: power and lighting electricity, measured according to the actual consumption of apportionment; unmeasured, according to the proportion of electricity consumption of various services to be apportioned.
Coal: heating coal is apportioned according to the area; operational coal is apportioned according to the proportion of steam consumption or according to the number of people.
Low-value consumables: Low-value consumables and miscellaneous costs used in medical services are apportioned on the basis of the actual expenditures if they can be directly accounted for in the medical program; if they cannot be directly accounted for, they are apportioned on the basis of the ratio of staff members of each medical service to the total number of employees in the hospital.
Sanitary materials (including drugs directly used for diagnosis and treatment, disposal): according to the actual consumption of each medical program. Renewal, maintenance and general repairs of buildings and large instruments and equipments: according to the total value of fixed assets occupied by each medical item, calculated according to the prescribed extraction standard, and included in the cost of each medical item.
2. Indirect cost sharing
Auxiliary department costs: including equipment maintenance room, carpentry room, transformer room, telephone room (switchboard), animal room, bathrooms, laundry, boiler room, sewing group, sewage washing and disinfecting room, supply room, library, driver's class, morgue and other departments of the costs incurred. Consumption of coal, water, electricity, etc. in these auxiliary departments is calculated according to the actual number of occurrences if there is a meter; if there is no meter, it is calculated according to a certain percentage.
Management cost calculation department: including the dean's office, party committee office, labor unions and the expenses incurred by the functional departments.
-Assessable overhead costs for a certain category = the amount of overhead costs during the calculation period × the allocation rate of overhead costs for that category
-Assignment rate of overhead costs = the number of people in a certain category (overhead costs) / the sum of the number of people in the medical, nursing, pharmacy, and preparation departments × 100%
(D) Costing of individual medical items
An individual medical item refers to outpatient clinics, Emergency, hospitalization, surgery and various medical departments of the examination, treatment items of the single cost. The fixed asset cost amortization calculation method is as follows:
-Registration = Fixed Asset Repair Fee × Rate of Accrual / Measurement Period Workload
-Hospitalization = Fixed Asset Repair Fee × Rate of Accrual / Measurement Period Workload
-Surgery = Fixed Asset Repair Fee × Rate of Accrual / Measurement Period Total Approved Work Hours in the Operating Theatre × Individual Surgical Time
-Examination and treatment items (cost per hour) = Fixed Asset Repair Cost x Rate of Provision / Annual Working Day x Daily Working Hours x Individual Working Hours
What are the principles of hospital costing?
Hospital cost accounting should follow the following accounting principles:
Accruals principle
According to the "Hospital Financial System", "Hospital Accounting System" provides that: "hospitals for the accounting process, there is a realization of the system and the accrual system of the two principles of treatment, the income and expenditure of the budgetary funds in accordance with the realization of the system of treatment, the income and expenditure of the business according to the accrual system. The income and expenditure of budgetary funds are treated on a cash basis, while the income and expenditure of operations are treated on an accrual basis..." The cash system is a recognition basis corresponding to the accrual system, in the actual work of the hospital, the cash system does not accurately reflect the hospital's income and expenditure, resulting in the book of assets and liabilities and the actual discrepancy. Credit-based modern settlement methods are varied, the name of the kind of receivable not yet received, payable not yet paid, withholding and amortization of transactions and economic transactions and cash flow of the degree of deviation is quite large. To accurately reflect and account for medical costs, the use of accruals is inevitable, but also for hospitals to carry out cost accounting, income and expenditure matching needs, it helps to correctly account for medical costs. Medical equipment, housing, books, etc., in a certain period of time are a one-time investment, is invested in the first, after the use of these fixed assets through the "accumulated depreciation" accounting account to account for, so as to truly reflect the net value of fixed assets. In addition, the repayment of bank loan interest and wages to be paid and other such liabilities, in the cash system only in the repayment of the books, underestimating the financial risk, but in the accrual system under the monthly books, can fully reflect the hospital's debt situation and medical costs.
Second, the distinction between revenue expenditure and capital expenditure principles
Revenue expenditure is different from capital expenditure, the former is fully compensated by the current year's operating income, the latter is first recorded as an asset, through depreciation or amortization of the cost of amortization into the cost of each year. Distinguish between revenue and capital expenditures, in order to correctly calculate the profit and loss for each year and reflect the value of assets. If the revenue expenditure as a capital expenditure, the result is undercounting the current cost, more than the value of the asset, an inflated profit; on the contrary, more than the current cost, less than the value of the asset, an inflated profit. Distinguish between revenue expenditure and capital expenditure principle requires accounting should be reasonable distinction between revenue expenditure and capital expenditure. Where the benefits of the expenditure is only relevant to the current accounting period, should be treated as revenue expenditure, the cost of the current accounting period; Where the benefits of the expenditure is relevant to several accounting periods, should be treated as capital expenditure, and amortized in a balanced manner over several accounting periods to generate benefits, respectively, the cost of several accounting periods. Based on the criteria for classifying revenue and capital expenditures, it can be determined that medical expenditures are revenue expenditures and capital expenditures are capital expenditures. Subsidies to subsidiaries and contributions to parent organizations cannot be included in the cost of health care according to the principle of matching. The important significance of the division of revenue expenditure and capital expenditure is to correctly determine which expenditures should be included in the current cost, which expenditures can not be included in the current cost, so that the accounting statements reflect the true and reliable data.
Three, the principle of matching income and expenditure
The principle of matching income and expenditure requires that costs and their related income match, that is, the costs of a certain accounting period or the costs of certain objects and the costs of the related income or output to match. The principle of matching income and expenditure as a recognition requirement for accounting elements, used in profit determination. The economic activity of the accounting entity brings a certain amount of income, but also necessarily have to incur corresponding costs. Profit must have cost, the cost is for the income, the two are the unity of opposites, profit is the result of the income than the cost. The principle of income-expenditure matching is based on the principle of beneficence, i.e., who benefits, who pays for the costs. The principle of beneficence recognizes the existence of a causal relationship between gains and losses, and a distinction must be made in accordance with the principle between direct costs, which are causally linked, and indirect costs, which are not directly linked. Direct costs are directly proportional to income to determine the current period's profit and loss; indirect costs are determined by judgment using appropriate and reasonable criteria. In practice, the principle of matching revenues and expenses has two meanings: one is the cause and effect of matching revenues or outputs with their corresponding costs; and the other is the time matching, matching revenues or outputs for a certain period of time with the costs and expenses for the same period of time.
The use of this accounting principle in accounting for medical costs, can accurately analyze the relationship between inputs and outputs, accurately calculated for a period of time or a case of cost. Measurement of medical costs must be reasonable and accurate application of the principle of matching income and expenditure after determining the cost object, matching medical expenses with revenues, matching research expenses with the output of new knowledge or technological improvements.
Four, the principle of earmarking
The principle of earmarking is a unique criterion of institutional accounting, which exists only in institutional accounting. For the national designated purposes of the various types of special funds and special funds, should be used in accordance with the designated purpose, can not be diverted to other uses. Hospitals must use the funds according to the different purposes specified at the time of acquisition of funds, earmarked and special accounts; accounting statements should be separately reflected in the acquisition, use, so as to ensure the effectiveness of the use of earmarked funds. The principle of earmarking is a unique accounting principle of budgetary accounting, fully embodies the idea that non-profit organizations use funds according to the wishes of the contributors. Hospitals in the process of medical cost accounting must follow this principle to ensure the smooth realization of national interests.
The principle of accrual, the principle of distinction between revenue expenditure and capital expenditure, the principle of proportionate income and expenditure and the principle of earmarking are closely related, they are from different aspects of regulating the main body of accounting, correctly accounting for revenues and costs, is the process of hospitals must follow the four basic principles of accounting for health care costs.