How to effectively prevent economic operation risks, block the "road to wealth" of medical corruption from the source, protect the safety of state-owned assets, improve the efficiency of medical resource utilization, reduce the burden of patients' medical expenses, better escort the health of the people, strengthen the internal control of the hospital, and talk about how to strengthen internal control in practice.
The "Opinions on Further Strengthening Financial and Accounting Supervision" issued by the General Office and the General Office of the People's Republic of China clearly state that the internal supervision of the unit will be further strengthened. All units should strengthen their daily supervision over their economic operations, financial management, and accounting activities. Establish an internal financial supervision mechanism and internal control system with clear rights and responsibilities and strong constraints based on their own actual conditions, clarify the subject, scope, procedures, rights and responsibilities of internal supervision, and implement the main responsibility of internal financial and accounting supervision of the unit. The main person in charge of each unit is the first person responsible for the financial and accounting supervision of the unit, and is responsible for the authenticity and integrity of the financial and accounting work and financial information of the unit. The organization or personnel responsible for financial and accounting supervision should be clearly defined within the unit, and be responsible for the daily supervision and inspection of the unit's economic business, financial and accounting behavior and accounting data. Financial and accounting personnel should strengthen self-restraint, abide by professional ethics, refuse to handle or correct financial and accounting matters in violation of laws and regulations in accordance with their authority, and have the right to report violations of laws and regulations by units or individuals.
1. Problems existing in the internal control of the hospital
The main problems of hospital internal control are highlighted in the following aspects:
First, the understanding of the internal control of the hospital is not in place, and the attention is not high
In the stage of rapid expansion and development of hospitals, many hidden dangers and risks are covered, and hospital leaders do not have a good understanding of internal control and do not attach much importance to it, resulting in the hospital as a whole not paying enough attention to internal control and taking many "running and dripping" for granted.
Second, there is a lack of organizational mechanisms for internal control
The traditional internal control stays in the scope of financial accounting, and due to the lag of financial information, the risk control in the business process is not in place, and the internal control risk is greater. The main reason is that the internal control of the hospital lacks organizational leadership, the rights and responsibilities are not clear, and the leading department lacks effective coordination and rights, which leads to the form of internal control basin.
Third, the construction of the internal control system is lagging behind
The hospital lacks a proper internal control system, the system construction is seriously lagging behind, and there is a lack of effective internal control and restraint mechanism for key positions and key personnel.
Fourth, the examination and approval control is not strict
Key matters such as projects, procurement, and expenditures are not strictly checked for feedforward project approval, resulting in a large number of hidden risks. For example, in the process of purchasing drugs, consumables and equipment, some hospitals have a certain degree of irregularities in the procurement process, and cannot operate in strict accordance with the bidding procedures, which leads to economic losses such as quality problems and procurement inflations.
Fifth, there is a lack of internal control evaluation and supervision mechanisms
The lack of evaluation mechanism for the effect of hospital internal control construction, the lack of understanding of the changes in the internal and external environment of the hospital, the lack of sufficient analysis of the changes in the internal environment to adapt to the external changes, and the failure to hold special internal control meetings, the internal audit can not be carried out effectively, which makes it difficult for the hospital to fully understand its effectiveness and deficiencies in the process of implementing internal control.
Sixth, the construction of informatization is lagging behind
In the informatization construction of hospitals, there are a large number of "information islands", data cannot be shared and shared, interconnected and interconnected, and they work independently, leaving a large number of hidden dangers in internal control.
2. Strengthen the internal control of the hospital
The notice on carrying out the activities of the "Economic Management Year of Public Medical Institutions" (Guowei Financial Letter 2020 No. 262) clearly emphasizes that the internal control system and regulatory measures for the economic behavior of various business activities should be refined, and the daily supervision mechanism of joint inspection and joint inspection of medical and financial management departments should be established, and standardized management and inspection of medical services should be carried out regularly and irregularly to avoid violations of laws and regulations. Strengthen internal audit oversight. Give full play to the role of internal audit and improve the long-term supervision mechanism. Strengthen regulatory means. Actively use information technology to explore and carry out intelligent supervision, standardize diagnosis and treatment and charging and other behaviors, and ensure the economic safety of units.
The Notice on Printing and Distributing the Measures for the Management of Internal Control of Public Hospitals (Guowei Finance Fa 2020 No. 31) clearly states that the internal control of hospitals mainly includes: risk assessment, internal control construction, internal control report, and internal control evaluation. The objectives of the hospital's internal control mainly include: ensuring that the hospital's economic activities are legal and compliant, the safety and use of assets are effective, the financial information is true and complete, the fraud and corruption are effectively prevented, and the resource allocation and use efficiency are improved.
The Internal Control Regulations for Administrative Institutions (Trial) (Cai Kuai 2012 No. 21) clearly points out that the unit shall establish an internal control system suitable for the actual situation of the unit in accordance with this specification and organize its implementation. The specific work includes sorting out the business process of various economic activities of the unit, clarifying the business links, systematically analyzing the risks of economic activities, determining the risk points, selecting risk response strategies, and on this basis, establishing and improving the internal management system of the unit in accordance with the relevant state regulations and urging the relevant staff to implement it conscientiously.
The Internal Control Report Management System of Administrative Institutions (Trial) (Cai Hui 2017 No. 1) emphasizes that the preparation and reporting of internal control reports shall be uniformly deployed by the Ministry of Finance in accordance with the method of "unified deployment, hierarchical responsibility, step-by-step summary and one-way submission", and the hierarchical organization and implementation of various regions and vertical management departments shall be summarized in a bottom-up manner, and the non-vertical management departments shall report to the financial departments at the same level, and the administrative institutions shall submit one-way reports to the administrative departments at the higher levels in accordance with the administrative management relationship. The administrative departments (hereinafter referred to as the departments) shall, in accordance with the requirements of the financial sector, responsible for organizing the implementation of the internal control report of the administrative institutions of the department, and the authenticity and completeness of the internal control summary report of the department.
The Guiding Opinions on Further Strengthening the Construction of Internal Control in Public Hospitals (Cai Kuai 2023 No. 31) clearly requires that for the key businesses and high-risk areas where problems frequently occur in public hospitals, find out hidden risks, form a risk list, strengthen the implementation of responsibilities, strengthen the rectification of problems, promote the internalization of relevant laws, regulations and relevant policies and systems into internal control systems, standards and processes, establish a long-term mechanism, highlight key points, emphasize practical results, and effectively improve the pertinence and effectiveness of internal control work.
The Guiding Opinions on Strengthening the Operation and Management of Public Hospitals (Guowei Finance Fa 2020 No. 27) clearly requires that operational risk prevention and control be strengthened. Strengthen the supervision and management of internal audit, risk management and internal control, and establish and improve risk research, assessment, prevention and control mechanisms; Strengthen the construction of internal control at the unit level, financial level and business level, and realize the whole-process control of hospital economic matters; Establish a daily supervision mechanism for joint inspection and joint inspection of medical, financial and other management departments, and carry out standardized management inspections of medical services on a regular and irregular basis to avoid violations of laws and disciplines in pursuit of economic interests; Strengthen debt risk management and strictly prohibit borrowing for construction.
The Regulations on the Internal Audit of the Health and Family Planning System (Decree No. 16 of the former Health and Family Planning Commission) proposes to review and evaluate the appropriateness and effectiveness of business activities, internal control and risk management through the use of systematic and standardized methods, so as to promote the improvement of governance and improve the management level and service ability of the unit.
Several Opinions on Further Strengthening the Internal Audit Work of the Health Industry (Guowei Finance Fa 2022 No. 9) emphasizes that all units should provide conditions for internal audit institutions to access relevant computer systems and electronic data such as finance, assets, procurement, medical care, logistics, etc., explore the construction of an integrated internal audit information system, and interconnect with other information systems. It is necessary to adhere to the use-oriented data analysis, promote the transformation of audit work from on-site audit to background data analysis and on-site audit, and focus on discovering emerging and tendentious problems through data comparison and analysis, and strengthen risk perception and early warning. It is necessary to establish and improve the internal audit data management system to ensure data security.
Notice on Printing and Distributing 7 Work Guidelines including Basic Guidelines for Internal Audit in the Health Industry (for Trial Implementation) (Guo Wei Ban Financial Letter 2023 No. 416) is divided into basic guidelines and 6 special audit guidelines, including large-scale medical equipment performance, high-value medical consumables, procurement management, construction projects, contract management, internal control evaluation, etc. The guidelines for internal control evaluation (for trial implementation) point out that the internal control evaluation of a unit is divided into an evaluation of the effectiveness of internal control design and an evaluation of the effectiveness of internal control operation. The internal audit institution shall carry out the internal control evaluation of the unit from the unit level and the business level in light of the actual situation of the unit.
3. How to strengthen the construction of internal control in hospitals
With the full implementation of the reform of DRG DIP's medical insurance payment system, especially the impact and impact of the three-year epidemic, the pressure on hospital operation and management is "huge", and "living a tight life" has become a major trend. Strengthen internal control and build hospitals.
First, raise awareness of internal controls. The hospital should fully understand the construction of internal control and the importance of high-quality development of the hospital, and the leaders should attach great importance to it, incorporate it into the hospital's development strategy and daily work, establish an internal control management organization, clarify the division of responsibilities, and ensure the smooth progress of internal control.
Second, improve the internal control system. The hospital should formulate a targeted internal control system according to the actual situation, and update the internal control system in a timely manner to adapt to the development of the hospital and changes in the external environment. Ensure that all business activities are carried out in compliance and efficiently.
Third, pay attention to the key links with high risks. In view of the high risk of economic losses of medical corruption, such as budget, income, expenditure, drug consumables and equipment procurement, economic contracts, etc., carefully analyze and study, and integrate internal control into the whole process of daily business management.
Fourth, establish and improve the internal supervision mechanism. Hospitals should strengthen internal supervision, establish and improve internal supervision systems such as auditing, discipline inspection and supervision, and ensure that the internal control system is effectively implemented.
Fifth, it is necessary to strengthen the construction of informatization. Hospitals should increase investment in informatization construction, optimize the internal control process, embed the internal control information system into various business management systems, monitor risks through intelligent big data analysis, and provide timely alarm reminders to provide strong support for internal control work.
Sixth, strengthen the cultivation of internal control talents. Hospitals should pay attention to the cultivation of internal control talents, strengthen the construction of internal control teams, improve the professional quality and practical ability of the team, pay attention to changes in the internal and external environment, analyze the impact of environmental changes on hospital internal control, continuously improve the level of internal control, and improve risk prevention capabilities.
In short, with the increasing complexity of hospital economic and business activities, the challenges to the construction of internal control of hospitals are increasing, and hospitals must strengthen internal control, effectively prevent risks, and seek benefits from refined management in order to achieve high-quality development.
Author |Qin Yongfang.
* |Qin Yongfang: Medical and health financial accounting, economic research.
Edit |Yang Zixuan, Zhang Wenqing.
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