[Latest blockbuster] The Ministry of Finance formulated and issued the "Specific Guidelines on Cost Accounting for Public Institutions-Public Hospitals"

In order to establish a government cost accounting guidelines system and strengthen the cost accounting of public hospitals (hereinafter referred to as hospitals), the Ministry of Finance recently issued the "Specific Guidelines on Cost Accounting for Public Institutions-Public Hospitals" (Cai Kuai [2021] No.
26, hereinafter referred to as "Specific Guidelines" ")
.

In order to establish a government cost accounting guidelines system and strengthen the cost accounting of public hospitals (hereinafter referred to as hospitals), the Ministry of Finance recently issued the "Specific Guidelines on Cost Accounting for Public Institutions-Public Hospitals" (Cai Kuai [2021] No.
26, hereinafter referred to as "Specific Guidelines" ")
.

The relevant person in charge of the Accounting Department of the Ministry of Finance answered reporters' questions on the "Specific Guidelines"
.

Question: What is the background of the development of the "Specific Guidelines"?

Question: What is the background of the development of the "Specific Guidelines"?

Answer: The development of the "Specific Guidelines" is mainly based on the following considerations:

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One is the need to further deepen the reform of the budget management system
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In March 2021, the State Council issued the "Opinions on Further Deepening the Reform of the Budget Management System", which clearly stated that budget units should be promoted to deepen government accounting reform, fully and effectively implement the government accounting standard system, and improve the basis of accrual accounting

The second is the need to establish a government cost accounting guidance system
.

In recent years, the Party Central Committee and the State Council have taken the initiative to promote the modernization of the national governance system and governance capabilities in the "Notice on Printing and Distributing the Regulations of Party and Government Organs on Strictly Saving and Opposing Waste", "Several Opinions on Promoting Price Mechanism Reform", and "Regarding Comprehensive Implementation "Opinions on Budget Performance Management" and other documents put forward requirements for strengthening government cost accounting from different angles

The third is to serve the needs of the medical and health system reform
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In recent years, the internal and external environments faced by hospitals are undergoing tremendous changes, such as the reform of medical insurance payment methods and the intensified competition in the medical market

The fourth is the need to standardize and improve hospital cost accounting
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Due to factors such as hospital internal cost management and medical service price supervision, there is a strong demand for hospital cost accounting in practice

Question: What was the process of drafting and publishing the "Specific Guidelines"? How is the feedback from all parties adopted?

Question: What was the process of drafting and publishing the "Specific Guidelines"? How is the feedback from all parties adopted?

Answer: In order to do a good job in the formulation of the "Specific Guidelines", we launched the "Research on Public Hospital Cost Accounting" topic research work in early 2020, comprehensively sorted out relevant policy documents, and carried out in-depth investigation and research on relevant key issues.
The discussion draft was formed at the end of 2020
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In the first half of 2021, after consulting experts from the Government Accounting Standards Committee in hospitals, colleges and universities, etc.

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On June 25, 2021, we issued the “Letter from the General Office of the Ministry of Finance on Soliciting Opinions on the <Specific Guidelines on Cost Accounting of Public Institutions—Public Hospitals (Draft for Comment)> (Caibanhui [2021] No.
14) for Relevant central departments, local finance departments (bureaus) and the public solicit opinions publicly, and at the same time solicit opinions from relevant departments within the ministry
.

All relevant parties gave positive feedback.

Since September 2021, we have sorted out and analyzed all the feedbacks one by one, and communicated with the National Health Commission, the National Medical Insurance Bureau and other relevant units, as well as some consulting experts on key issues.
Review manuscripts
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On November 1, 2021, after review and approval by the Executive Council of the Accounting Department, the internal departmental countersignature and approval procedures will be initiated, and will be issued by the leaders of the department on November 15th

 Question: What are the main principles followed in formulating the "Specific Guidelines"?

 Question: What are the main principles followed in formulating the "Specific Guidelines"?

Answer: The following principles were mainly followed in the formulation of the "Specific Guidelines":

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One is to formulate in accordance with laws and regulations
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The "Specific Guidelines" are formulated in accordance with the "Reform Plan" task of "promoting government cost accounting, stipulating the collection and allocation methods of government operating costs, etc.
", focusing on standardizing the content of cost accounting
.
At the same time, the "Specific Guidelines" follow the provisions of the "Basic Guidelines", maintain a consistent >
.

The second is to take into account practical practices
.
In view of the fact that the hospital has accumulated a certain amount of practical experience in carrying out cost accounting, the "Specific Guidelines" summarized and refined, and fully used and absorbed the contents that did not violate the "Basic Guidelines" to ensure that the hospital's cost accounting practices remained stable, such as cost items The setting, the identification of cost accounting objects related to medical activities, and the classification of hospital departments are all consistent with current practices
.
At the same time, the "Specific Guidelines" have a certain degree of flexibility, so that some of the current practices can meet the requirements, such as including expenses that are difficult to distinguish between the types of activities into medical activities; the cost range corresponds to the full cost of the hospital and the full medical cost in practice; Provide a variety of options for the allocation sequence of unit management expenses and the allocation method of auxiliary department expenses
.

The third is to closely integrate accounting
.
The "Specific Guidelines" as a component of the system of government accounting standards fully embodies the connection with financial accounting, regulates how cost accounting obtains figures from financial accounting, and ensures data homology and consistency
.
Specific objects include cost accounting, correspondence between the project cost and financial accounts, and financial resources compensation fees, and other details of subjects included in the cost of non-medical activities
.

The fourth is to serve the needs of medical reform
.
In order to serve the needs of the current hospitals for price supervision of medical services and payment method reforms, the "Specific Guidelines" specifically add medical service items, disease types, and disease diagnosis related groups on the basis of traditional departments, consultations, and bed-day cost accounting.
(DRG) Cost accounting and other content
.
Clarify related concepts and provide a variety of accounting methods that are widely used to provide guarantees for hospitals to meet the needs of reforms
.

 Question: What is the main content of the "Specific Guidelines"?

 Question: What is the main content of the "Specific Guidelines"?

Answer: The "Specific Guidelines" has six chapters and 37 articles, and the main contents are as follows:

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The first chapter is the general rules, which mainly stipulate the basis for formulation, the scope of application, the requirements of hospital cost information, the basic steps of cost accounting and other requirements
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The second chapter is the cost accounting object, which mainly stipulates the principles of the hospital to determine the cost accounting object, the main standard cost accounting objects of the guidelines, and the cost accounting objects related to medical activities
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The third chapter is about cost items and scope, which mainly stipulates the setting requirements of hospital cost items, the relationship between cost items and financial accounting information, medical activity cost items, and cost scope
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Chapter 4 is the collection and allocation of business activity costs, including general requirements for the collection and allocation of business activity costs, the collection and allocation of medical activity costs by department, as well as the number of visits, bed days, medical service items, types of diseases, and DRG costs.
Accounting processes and methods
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The fifth chapter is the cost report, which mainly stipulates the concept, classification and content of the hospital cost report, and the preparation requirements of the external cost report
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Chapter 6 is the supplementary provisions, which mainly stipulates that the health administration departments and hospitals can formulate detailed specifications or management methods, cost report formats, and the effective date of the "Specific Guidelines" in accordance with the "Specific Guidelines"
.

Question: What is the scope of implementation of the "Specific Guidelines"?

Question: What is the scope of implementation of the "Specific Guidelines"?

 Answer : The "Specific Guidelines" apply to hospitals at all levels and types that implement government accounting standards and carry out cost accounting work.
There are two main considerations: First, the "Specific Guidelines" set up cost items and account for cost collection.
These clauses all reflect the requirements of the government accounting standards system and need to be used in conjunction with the government accounting standards system; second, after the implementation of the "Specific Guidelines", it is not mandatory for all hospitals to carry out cost accounting work immediately.
Hospitals that carry out or intend to carry out cost accounting work provide a basis for compliance
.

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Question: What types of cost accounting objects are mainly regulated in the "Specific Guidelines"?

Question: What types of cost accounting objects are mainly regulated in the "Specific Guidelines"?

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Answer: According to hospital practice and the cost information requirements of medical reform, the "Specific Guidelines" focus on standardizing a number of cost accounting objects related to medical activities, including departments (including visits and bed days), medical service items, types of diseases, and DRG costs
.
The instructions are as follows:

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Regarding department cost accounting, it is a long-term effective summary of the hospital's practice
.
"Hospital Financial System", "County-level Public Hospital Cost Accounting Operational Measures", etc.
, have stipulated the classification of departments, the collection of department costs, and the allocation of department costs, which are widely used in hospitals
.
According to the total cost of outpatient and emergency treatment and hospitalization in each department, the cost of consultation and the cost of bed day obtained by further calculating the unit cost is also an important cost accounting object of the hospital for a long time
.
In addition, the cost of medical activities collected in the department is also the basis for further calculation of cost accounting objects such as medical service items, disease types, and DRGs
.

Regarding the cost accounting of medical service items, it mainly serves the supervision of medical service prices
.
At present, medical service charges are implemented in accordance with the medical service price items set by the provincial medical service price authorities, and all localities formulate and adjust the prices of related items based on the estimated cost of the project
.
The National Development and Reform Commission, the Health Commission, and the Bureau of Traditional Chinese Medicine issued the "Measures for Cost Allocation of Medical Service Items (Trial)" in 2001 to standardize the cost estimation of hospitals, departments and service items
.
Standardizing the cost accounting of medical service items will help reflect the actual cost of medical service items more accurately, and provide a basis for scientifically and rationally monitoring the price of medical services
.

Regarding disease types and DRG cost accounting, it mainly serves to formulate medical insurance payment standards
.
The "Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Basic Medical Insurance Payment Methods" stated that "from 2017, the budget management of the medical insurance fund will be further strengthened, and the comprehensive implementation of a diversified compound medical insurance payment method based on disease-based payment
.
All localities must choose A certain number of disease types are paid according to the type of disease.
The state selects some regions to carry out a trial of payment by disease diagnosis-related groupings (DRGs), and encourages localities to improve various payment methods such as per capita and bed-day
.
" Standardize disease types and DRG cost accounting It helps to accurately reflect the actual cost of the disease and DRG, provides a basis for determining the charging and payment standards including the medical insurance fund and personal payment, and promotes the hospital to control the medical cost
.

Question: How does the "Specific Guidelines" stipulate the cost items of medical activities?

Question: How does the "Specific Guidelines" stipulate the cost items of medical activities?

Answer: According to the regulations on medical expenditure in the "Hospital Financial System", the current hospital practice divides the cost of medical activities into personnel expenses, sanitary material expenses, drug expenses, fixed asset depreciation expenses, intangible asset amortization expenses, and withdrawal of medical risk funds.
The seven categories of other expenses are consistent with the first-level detailed subjects under the "Medical Business Costs" subject of the original "Hospital Accounting System"
.
The "Government Accounting System-Accounting Subjects and Reports of Administrative Institutions" (hereinafter referred to as "Government Accounting System") has undergone major changes in the setting of accounting subjects, and the expenses incurred by the unit are mainly through "business activity expenses" and "unit management expenses" Subject accounting, the "Supplementary Provisions Regarding the Implementation of the "Government Accounting System-Accounting Subjects and Reports of Administrative Institutions" by Hospitals" (hereinafter referred to as "Supplementary Provisions for Hospitals") stipulates how to pass the subjects of "Business Activity Expenses" and "Unit Management Expenses" Under the detailed subjects, obtain the information of seven categories of cost items
.

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The hospital cost items specified in the "Specific Guidelines" basically maintained the current practice, only changing "other expenses" to "other medical expenses" to distinguish it from the "other expenses" of the first-level account item in the "Government Accounting System"
.
The main considerations for keeping cost items basically unchanged are as follows: First, the current seven types of cost items can basically meet the needs of hospital cost accounting; second, hospital cost accounting, especially the cost accounting of county-level hospitals, has just made progress in recent years.
Major changes in the project; third, although the "health material costs" and "drug costs" have changed from the primary detailed subjects of the original "Hospital Accounting System" to the three detailed subjects of "Hospital Supplementary Regulations", they are still hospital costs The focus of management and control can continue to be a primary cost item in accordance with the principle of importance
.

 Question: What is the relationship between the "Specific Guidelines" and the cost accounting specifications formulated by the health administrative departments at all levels?

 Question: What is the relationship between the "Specific Guidelines" and the cost accounting specifications formulated by the health administrative departments at all levels?

Answer: The "Specific Guidelines" and the cost accounting specifications formulated by the health and health administrative departments at all levels have their own focus and are closely related to each other in terms of positioning and functions
.
The "Specific Guidelines" belong to the "formulation and interpretation" link of the system of government accounting standards.
It is a component of the national unified accounting system and is formulated and interpreted by the financial department of the State Council
.
According to the basic principles and basic methods of the Basic Guidelines, the "Specific Guidelines" carry out a top-level design of hospital cost accounting from the level of government accounting standards, focusing on industry-wide cost accounting objects, cost items, cost ranges, cost collection and distribution, Uniform provisions are made for cost reports, so as to provide basic compliance and guidance for the health administrative department to formulate specific cost accounting standards based on the actual needs of the hospital's administrative management, and the hospital to formulate specific cost accounting management methods based on the actual needs of the unit
.
The cost accounting specifications and other documents formulated by the health administrative departments at all levels belong to the "implementation" link of the government accounting standards system.
They are the normative documents for the administrative departments to specifically implement the Basic Guidelines and Specific Guidelines.
They can be combined with hospitals.
Practice makes detailed regulations
.

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 Question: Regarding the "Specific Guidelines", what work remains to be done in the next step?

 Question: Regarding the "Specific Guidelines", what work remains to be done in the next step?

Answer: In order to promote the implementation of the "Specific Guidelines" in hospitals, we will carry out the following work in the next step: First, organize relevant publicity and training, promote hospitals to increase their awareness of cost accounting, master cost accounting requirements, and improve cost accounting; second, organize and compile related work.
Application cases, detailed specific operations, and guide the actual application of the hospital; the third is to promote the relevant parties to make full use of the cost accounting results to strengthen cost management and cost information application
.

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