基于平衡计分卡的军队中心医院成本控制指标体系的构建及其应用研究.pdf.doc

第三军医大学博士学位论文基于平衡计分卡的军队中心医院成本控制指标体系的构建及其应用研究姓名：刘乐斌申请学位级别：博士专业：社会医学与卫生事业管理指导教师：陈俊国2011-05 第三军医大学博士学位论文效益和经济效益，是新时期军队医院面临的重大课题因此，本研究针对军队中心医院的使命任务和组织特点，综述了当前军队中心医院的成本控制发展概况，分析了军队中心医院的特殊环境和战略目标，对军队中心医院实施基于 BSC的成本管理理论和模式进行了研究，首次建立了军队中心医院成本控制指标体系，并进行了实证观测本课题参考国内外相关文献，选择军队中心医院成本控制作为切入点，基于 BSC基本思想，利用德尔菲法（Delphi）结合层次分析法(Analytic Hierarchy Process，AHP)，将收集的军队中心医院成本控制相关资料进行量化分析，建立了基于 BSC的军队中心医院成本控制指标体系并用综合指数法（ Compositive indexmethod， CIM）对某军队中心医院引用 BSC成本控制体系后一年的成本控制情况与运用该体系前一年的情况进行比较，得出了相关结论为新时期军队中心医院探索成本控制管理提供了新的思路和方法。

论文主要包括以下六个部分：第一部分：对成本、成本控制及医院成本控制相关理论进行概述，总结成本控制理论的形成和实践情况第二部分：分析军队中心医院发展特点，对国内外医院成本控制现状进行归纳和评价，明确了军队中心医院成本控制的重点和方向第三部分：对 BSC运用于医院管理的相关文献进行回顾分析，对 BSC引入军队中心医院成本管理做可行性分析，奠定本研究的理论基础第四部分：分析军队中心医院成本控制与战略管理的关系，对 BSC思想与军队中心医院成本控制体系的融合做理性的思考，归纳二者融合的基本思路第五部分：对军队中心医院成本控制体系构建相关因素进行分析研究，构建了基于 BSC四个维度包括财务、内部流程、发展、客户维度的成本控制指标体系第六部分：在上述研究的基础上，根据 BSC指标体系对某军队中心医院的资料进行筛选，选取了该院基于 BSC的成本控制实施前后两年的与成本管理相关的数据资料进行对比，利用加权综合指数法评价本院自 2009和 2010年的成本控制情况，查找成本控制薄弱环节及其原因，得出了相关结论，并由此提出了军队中心医院有效实施基于 BSC成本控制体系的针对性策略关键词：军队中心医院；成本控制； BSC；指标体系5 第三军医大学博士学位论文The Research on the Establishment and Application ofIndex System of Cost Control Based on BalancedScorecard in Military Central HospitalAbstractFrom 2009, along with the reform in medicine system, basic drug system and medicalinsurance system, hospitals are facing an unprecedented challenge and chance in our country.Health care reform profit mode of hospital challenged.National medical insurance era iscoming. Developing of local voluntary and joint venture hospitals, brought more intenscompetition in the multiple forms of the medical market, not only between the public andvoluntary hospital, but also the local and military hospital.Since 1985, military hospital has supplied paid services outside, it not only eased thecontradiction between supply and demand of national health resources, but also trainedmany military professionals, to make up for inadequate funding, achieved both social andeconomic benefits. But for a long time, military hospital, mainly taking the responsibilitiesof resident military, was disadvantaged in the market competition with local public hospitals.The new situation indicates that health care reform has entered a new medical institutions of"low-profit era". The military centeral hospital must adjust the 26-year- implementation paidmedical services policy, re-examine their own strengths, weaknesses, opportunities andthreats focus on the medical market structure, striving for survival and development in thenew medical market structure.Cost management based on strategic goals is a new idea created and developed in thelast 20 years in West countries. Its core idea is the combination of cost management withstrategic goals, while helping the organization to reducing costs and making correctdecisions to improve competitiveness. This method is still used for business managementmore often, and cost control for hospitals in China are still in the theory exploratory stage.Many specific applications also require further study. The basic tools of hospital cost controlmanagement, are the same as used in business management, including value chain analysis,1 第三军医大学博士学位论文strategic positioning analysis, cost driver analysis, cost-effectiveness evaluation. BSC(Balanced Scorecard, BSC) is an effective tool for a strategic management of cost control. Itis from a strategic perspective, the cost control management to establish a new evaluationsystem for hospitals to provide the scientific basis for decision-making, management sectorthat is currently being practical evaluation tool for cost control.The four dimensions ofBSC-based target identification, we can carry out cost control and make related strategiesaccording to the objectives.Military hospitals, entrusted with the special mission, were surppoted by state financefor a long time, so compared with local public hospitals, their cost accounting systemsdeveloped slowly. Up to now, most military central hospitals still focused economicaccounting on simple method such as “expense substructed from income, surpluses foraward”, and didn’t conduct cost control management. The work for medical technologyimprovement, social and economic benefits is important for military hospital. Balancedscorecard is an efficient tool in manegment. Usage of management tools in hospital costcontrol has become a hot spot. How to improve their level of medical technology at thesame time, create more social and economic benefits, the pursuit 。