Medical project cost accounting refers to calculating the cost according to each medical service project. The cost of medical project is divided into direct cost and indirect cost. Direct costs are directly included in the cost of medical projects. Indirect costs should be shared according to certain standards and included in the cost of related medical projects.

1. Direct cost allocation method

Wages, supplementary wages and employee welfare expenses: included in the project cost according to the actual labor consumption of each medical project during the calculation period. The amortization method is as follows:

Wage (hourly wage) = [average monthly wage (yuan)/(monthly working days × daily working hours) ]× single working hours.

Supplementary salary (hourly fee) = [monthly average supplementary salary (yuan)/(monthly working days × daily working hours) ]× single working hours × number of workers.

Employee welfare fee (hourly fee) = [monthly average employee welfare fee/(monthly working days × daily working hours) ]× individual working hours× number of employees.

Business expenses: according to the characteristics of business expenses, they are allocated according to the following methods.

Water: according to the actual consumption, estimate the proportion of water consumption of each service item and share it in proportion.

Electricity: electricity consumption and lighting consumption are measured and shared according to actual consumption; If there is no measurement, it shall be shared according to the proportion of electricity consumption of each service item.

Coal: heating coal is shared by area; Commercial coal is shared according to the proportion of steam consumption or the number of people.

Low-value consumables: low-value consumables and miscellaneous fees used in medical services can be directly included in medical projects and shared according to actual expenditures; Can not be directly included, according to the medical service project personnel accounted for the proportion of the total number of hospital employees.

Expenses of sanitary materials (including drugs directly used for diagnosis, treatment and disposal): included in various medical items according to actual consumption. Purchase expenses for renovation and general repair of houses and large-scale instruments and equipment: according to the prescribed extraction standards, it is calculated according to the total fixed assets occupied by each medical project and included in the cost of each medical project.

2. Indirect cost allocation method

Expenses of auxiliary departments: including expenses of equipment maintenance room, carpentry room, substation room, telephone room (switchboard), animal room, bathroom, laundry room, boiler room, sewing group, decontamination and disinfection room, supply room, library, driver's shift, mortuary and other departments. The consumption of coal, water and electricity in these auxiliary departments should be calculated according to the actual consumption. If there is no meter, it shall be calculated according to a certain proportion.

Management cost calculation department: including the expenses incurred by the President's Office, the Party Committee Office, the trade union and various functional departments.

A certain kind of indirect expenses to be apportioned = the amount of indirect expenses in the calculation period × the distribution rate of this kind of indirect expenses.

Indirect cost sharing rate = sum of the number of departments of a certain type (indirect cost)/number of departments of medical treatment, nursing, pharmacy and establishment × 100%.

(4) Cost calculation of a single medical project

A single medical project refers to the single cost of various inspection and treatment projects in outpatient, emergency, hospitalization, surgery and medical technology departments. The amortization calculation method of fixed assets cost is as follows:

Registration = fixed assets repair purchase fee × accrual ratio/calculation period workload.

Hospitalization = fixed assets repair purchase fee × accrual rate/workload in calculation period.

Operation = fixed assets repair and purchase fee × payable ratio/total hours approved in the operating room during the calculation period × single operation time.

Inspection and treatment items (hourly fee) = fixed assets repair and purchase fee × accrual rate/annual working day × daily working time × single working time.

What are the principles of hospital cost accounting?

Hospital cost accounting should follow the following accounting principles:

I. Accrual principle

According to "Hospital Finance System" and "Hospital Accounting System", "Hospital accounting has two principles, namely cash basis and accrual basis. Budget income and expenditure are treated on the cash basis, and business income and expenditure are treated on the accrual basis. " Cash basis is the basis of recognition corresponding to accrual basis. In the actual work of the hospital, the cash basis cannot accurately reflect the income and expenditure of the hospital. As a result, the assets and liabilities on the books are inconsistent with the actual situation. There are many modern settlement methods based on credit, and transactions such as receivables, payables, prepayments and deferred transactions deviate from economic matters and cash flow to a great extent. To accurately reflect and calculate the medical cost, it is necessary to adopt accrual basis, which is also the need for hospitals to carry out cost accounting and the proportion of income and expenditure, and is helpful to correctly calculate the medical cost, medical equipment, houses, account books and so on. In a certain period of time, it is a one-time investment, and it is put into use first. These fixed assets are accounted by "accumulated depreciation" account, so as to truly reflect the net value of fixed assets. In addition, liabilities such as repayment of bank loan interest and wages to be paid are only recorded at the time of repayment under the cash basis, which underestimates the financial risk, while monthly recording under the accrual basis can fully reflect the hospital's debt situation and medical costs.

Second, the principle of distinguishing income expenditure from capital expenditure.

Income expenditure is different from capital expenditure. The former is fully compensated by the current year's operating income, while the latter is recorded as an asset first, and the annual cost is amortized through depreciation or amortization. The purpose of distinguishing income expenditure from capital expenditure is to correctly calculate the annual profit and loss and reflect the value of assets. If revenue expenditure is regarded as capital expenditure, the result is that the current expenses are underestimated, the value of assets is overestimated and profits are inflated. On the other hand, the current expenses are overvalued, the value of assets is underestimated and the profits are artificially reduced. The principle of distinguishing income expenditure from capital expenditure requires that accounting should reasonably distinguish income expenditure from capital expenditure. If the income of expenditure is only related to this accounting period, it shall be regarded as income expenditure and included in the cost of this accounting period. If the benefit of expenditure involves several accounting periods, it should be regarded as capital expenditure, amortized evenly in several accounting periods and included in the cost of several accounting periods respectively. According to the division standard of income expenditure and capital expenditure, it can be determined that medical expenditure belongs to income expenditure. Capital expenditure belongs to capital expenditure. However, according to the matching principle, subsidies to subordinate units and expenditures turned over to superior units cannot be included in medical expenses. The important significance of distinguishing revenue expenditure from capital expenditure lies in correctly determining which expenditure should be included in the current cost and which expenditure cannot be included in the current cost, so as to make the data reflected in accounting statements true and reliable.

Third, the principle of revenue and expenditure ratio.

The principle of matching revenue and expenditure requires that expenses should match their related income, that is, expenses in an accounting period or fees charged on some objects should match related income or output. As the confirmation requirement of accounting elements, the principle of matching revenue and expenditure is adopted to determine profits. The economic activities of accounting subjects bring certain income, and corresponding expenses will inevitably occur. If there is an advantage, there must be expenditure, and expenditure is for income. The two are the unity of opposites. Profit is the result of the ratio of income to expenses. The principle of matching revenue and expenditure is based on the principle of benefit, that is, whoever benefits will bear the cost. The benefit principle recognizes that there is a causal relationship between income and loss, and it is necessary to distinguish between direct costs with causal relationship and indirect costs without direct relationship according to the principle. Direct cost and income are directly matched to determine the current profit and loss; Indirect costs are judged by appropriate and reasonable standards. In practical work, the principle of income and expenditure ratio has two meanings: one is causal coordination, which matches income or output with its corresponding cost; The second is time coordination, which matches the income or output in a certain period with the cost in the same period.

Using this accounting principle in medical cost accounting can accurately analyze the relationship between input and output and accurately calculate the cost of a period or a case. The measurement of medical cost must use the principle of revenue and expenditure ratio reasonably and accurately after determining the cost object, so as to coordinate medical expenses with income and scientific research expenses with new knowledge output or technological improvement.

Fourth, the principle of earmarking.

The principle of earmarking funds is a unique criterion of public institution accounting, which only exists in public institution accounting. All kinds of special funds and special funds designated by the state should be used according to the specified purposes and cannot be used for other purposes. The hospital must use the funds according to the different purposes specified when obtaining the funds, with special funds for special purposes and special accounts for accounting; Accounting statements should reflect their acquisition and use respectively to ensure the use effect of special funds. The principle of special funds is a unique accounting principle of budget accounting, which fully embodies the idea that non-profit organizations use funds according to the wishes of investors. Hospitals must follow this principle in the process of medical cost accounting to ensure the smooth realization of national interests.

The principle of accrual basis, the principle of distinguishing income and expenditure from capital expenditure, the principle of proportion of income and expenditure and the principle of earmarking are closely related. They standardize accounting subjects from different aspects and correctly calculate income and cost, which are the four basic principles that hospitals must follow in the process of medical cost accounting.