Current Status of Cost Management Accounting from the Perspective of Social Responsibility in Hospitals

CHAPTER 3. CURRENT STATE OF COST MANAGEMENT ACCOUNTING FROM THE PERSPECTIVE OF SOCIAL RESPONSIBILITY IN HOSPITALS

BINH DUONG PROVINCE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

3.1. Formation and development process

Binh Duong Obstetrics and Pediatrics Hospital (Hospital) belongs to Y Tam Giao Company Limited, located at 455 CMT8, Phu Cuong Ward, Thu Dau Mot City, Binh Duong Province, website: https://benhvienpsnbd.com.vn/ , phone: 0274.3836.042 | Fax: (0274)3859580

Email: bvpsbinhduong@yahoo.com

The predecessor of the Hospital is Binh Duong Semi-Public Obstetrics and Gynecology Hospital, established and operated by the People's Committee of Binh Duong Province since June 30, 2001. After 11 years, the semi-public hospital has been steadily progressing with a stable organization including clinical, paraclinical departments and functional departments to serve patients, creating a convenient and secure medical facility for customers to come for examination and treatment thanks to good basic techniques, advanced technology development, and nursing care that focuses on customers and patients. In addition, the hospital has also gradually improved the favorable working environment for medical staff so that they can develop their professional expertise and have a long-term commitment to the hospital.

From January 1, 2012, due to the state policy of abolishing semi-public, the People's Committee of Binh Duong Province decided to convert the hospital model from semi-public to Y Tam Giao Company Limited and from then on the hospital changed its name to Binh Duong Maternity and Pediatrics Hospital, with the financial accounting method according to the enterprise but the organizational structure is similar to before, the only difference is that it develops more and faster in terms of bed size, high technical stature and service attitude.

Currently, the hospital has nearly 200 beds with 6 clinical departments, 4 paraclinical departments and 4 functional rooms. The team of enthusiastic and experienced doctors, clean, comfortable and luxurious facilities and rooms, along with modern equipment will make customers satisfied when coming to see a doctor or receive treatment here. Thanks to the good quality of treatment, safety, attentive nursing care, and hospital fees suitable for all economic sectors, Binh Duong Obstetrics and Pediatrics Hospital has attracted

With a stable customer base, not only in the province but also attracting customers from neighboring provinces such as Binh Phuoc, Tay Ninh, Dong Nai, it is a reasonable choice for customers who need examination and treatment of obstetrics and gynecology and pediatrics in the area.

Some achievements in recent times:

From 2013 to 2017, medical examination admission increased by 30% after 5 years, an average increase of 6%/year; the rate of women giving birth at the Hospital increased by 31% after 5 years, an average increase of 6.2%/year; to ensure service quality, the rate of medical staff at the Hospital also increased by 18% after 5 years.

The Hospital's key specialized fields have seen significant growth in quantity and quality. The growth rate of In Vitro Fertilization (IVF) increased by 95% after 5 years, an average increase of 19%/year; The success rate of IVF increased from 7.5% (2013) to 51.3% (2017), equivalent to the success rate of In Vitro Fertilization (IVF) at infertility treatment centers in the world and the region. Other infertility treatment methods also achieved a growth rate of 29% after five years, an average increase of 6%/year, with a success rate of 26.4% (IUI).

The rate of successful care and feeding of extremely premature infants (under 28 weeks of gestation) increased from 57% (in 2013) to 66.6% (in 2017), reducing the mortality rate of extremely premature infants to 33.4%. The mortality rate of premature infants (from 28 to 32 weeks of gestation) also decreased from 13.5% to 9.0% after 5 years. The rate of successful care and feeding of extremely low birth weight infants (under 1000g) reached 57.14%; equivalent to the Neonatal Unit Centers at major hospitals across the country.

In the past 5 years, the hospital staff has been awarded 102 Certificates of Merit and Certificates of Merit of various types by the People's Committee of Binh Duong Province and the Department of Health of Binh Duong; 6 individuals were recognized as Emulation Fighters at the grassroots level, 1 individual was recognized as Emulation Fighters at the provincial level. In particular, in 2017, Doctor Huynh Thi Kim Chi, Director of the Hospital, was awarded the Third Class Labor Medal by the President of the Socialist Republic of Vietnam for her achievements and contributions to the cause of public health care. With the good feelings that patients and customers have given to the Hospital, all staff of Binh Duong Obstetrics and Pediatrics Hospital vow to make continuous efforts to contribute to the development.

Binh Duong province's health sector and worthy of the trust of local people as well as the Southeast region.

3.2. Organizational and operational characteristics

3.2.1. Operating characteristics

Currently, Binh Duong Maternity and Pediatrics Hospital includes the following activities:

after:

Medical examination and treatment activities are activities that mainly include medical examination and treatment activities.

Outpatient treatment

Roomexamination

Patient admission

Emergency room

Inpatient departments

Patient discharged from hospital

Emergency resuscitation

CLINICAL

Surgery

medical examination and treatment for patients with health insurance, patients without health insurance and medical examination and treatment upon request. Medical treatment activities include inpatient and outpatient treatment activities for patients.

PARACLINICAL

Diagnostic imaging

Testing

Functional exploration

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Diagram 3.1: Description of examination and treatment activities at the hospital

(Source: Administrative Organization Department of Binh Duong Maternity and Pediatrics Hospital)

(1) Admit patients to the clinic or transfer them to the emergency room

(2) and (3) Transfer patients to inpatient departments after examination or emergency care.

(1) and (5) Outpatient treatment indications.

(6) Assign patients to perform technical services (DVKT), surgery, etc.

(7) Provide drugs, medical supplies (MPS), and chemicals to departments/offices to perform professional tasks.

(8) The patient is discharged from the hospital and completes the discharge payment procedures.

Hospital training activities, including:

Continuous training, technology transfer for health workers. Rotation training for newly graduated doctors and nurses. Training to issue practice certificates.

Specialized training for doctors and nurses. Preclinical training.

Manage medical college students to practice at the hospital.

Training can be done in-house on models or directly examining patients or in classroom training.

Scientific research activities, in recent times, science and technology in the medical field have achieved many important achievements, the results have been successfully applied in diagnosis, treatment and prevention of human diseases such as: Application of stem cells in treatment, endoscopic surgery, diagnostic imaging, etc.

Disease prevention: Along with medical examination and treatment, disease prevention is also an important task of the hospital. Disease prevention propaganda for the people is a necessary task, it will reduce the rate of disease in the people, reduce medical costs, contribute to preventing the spread and damage caused by epidemics in case of outbreak by propagating to all staff, relatives of patients at the hospital information about epidemics, ways to prevent and promptly implement instructions, announcements of the Ministry of Health and epidemics.

International cooperation: To acquire modern technical knowledge, the hospital expands cooperation with countries around the world and the region to acquire advanced techniques, apply them to medical examination and treatment, scientific research and training. Nowadays, international integration and enhanced international cooperation are the path to medical modernization. People can enjoy high-tech services, early detection of difficult diseases, and reduce mortality rates. Specifically: Organizing reporting sessions,

Exchanging expertise with leading experts in surgical fields from various medical backgrounds, the wastewater treatment project has come into practical operation.

It can be seen that the due attention paid to international cooperation has helped strengthen relationships with colleagues and friends around the world, promoting the strengths of each Hospital in taking the lead in cooperation and developing advanced and modern techniques as well as enhancing professional capacity and facilities.

Economic management in hospitals: Strictly implement Decree 60 and State regulations on hospital budget revenue and expenditure, gradually organize and implement accounting for medical examination and treatment costs in hospitals, especially in the current situation of financial autonomy and self-responsibility.

Funding for these activities is mobilized from three sources: State budget, revenue from medical examination and treatment services and joint ventures. Each hospital has its own specific operations with different scales and different proportions of revenue sources.

Implementing the autonomous mechanism, aiming to promote and make the most effective use of existing facilities, activities in hospitals include many different activities and are divided into two basic groups: career activities and production and business activities. On the principle of compensating for revenue and expenditure, with accumulation for development but subject to the management and regulation of the State, production and business activities are mainly medical examination and treatment on demand. In addition, to serve the main professional activities at the hospital, it is necessary to organize other auxiliary activities such as parking, laundry, catering, patient transport vehicle rental, etc. Organizations and individuals trading in medical equipment install equipment, hospitals organize medical examination and treatment on demand. Each party calculates its own costs, divides income according to the level of participation of the parties according to the agreement, the ratio of benefits between the hospital and the partner is usually 3/7 or 4/6 calculated on the difference between revenue and expenditure. Accounting for expenses and common income, depending on each hospital, can be directly monitored by the hospital or assigned to partners, dividing responsibilities and benefits before executing the contract.

The installation of diagnostic and treatment equipment is aimed at socialization, medical examination and treatment activities can also be carried out in other forms such as:

contribute capital to open clinics, carry out medical examination and treatment projects, detect diseases early, etc. For large hospitals, they often organize medical examination and treatment departments according to specific requirements. Other hospitals do not organize medical examination and treatment departments according to specific requirements but combine them with medical examination and treatment activities in the form of beneficiaries.

The personnel directly or indirectly performing medical examination and treatment activities on demand are mainly part-time, only a small part is specialized in performing service functions. A part of the personnel is obtained through cooperation with outside sources, which are experts and good doctors currently working at hospitals, universities and other units.

3.2.2. Organizational characteristics

At Binh Duong Maternity and Pediatrics Hospital, a specialized hospital in the province, the number of staff is about 200 people divided into 15 departments. The hospital's management system is organized according to a direct model. The top is the Board of Directors, below are the departments. The management is shown in the following diagram:

Diagram 3.2: Management apparatus at Binh Duong Maternity and Pediatrics Hospital

(Source: Administrative Organization Department of Binh Duong Maternity and Pediatrics Hospital)

Depending on the financial autonomy, hospitals have the right to autonomy in organizational structure and staffing at different levels. The Director and Deputy Director are appointed, reappointed, transferred, transferred, dismissed and removed from office by the Provincial People's Committee according to the provisions of law. The hospital is allowed to decide to establish, dissolve or reorganize departments, offices and other affiliated organizations based on the approval of the Ministry of Health, to establish different organizations and centers, to create conditions for better management of hospital operations, to motivate staff, civil servants and employees at the hospital to work effectively, ... to establish councils (science - technology council, drug - treatment council, ...) to carry out political tasks according to the provisions of law. The functions, tasks and working relationships of departments, offices, centers and other organizations under the hospital are decided by the Director and depending on the functions, tasks

Each hospital's services and the establishment of these departments are also different, including clinical and paraclinical examination and treatment departments that perform examination and treatment according to each specialty and patient group.

Diagram 3.3: Organization of accounting department of Obstetrics and Pediatrics Hospital

The accounting department performs all functions, plans, administrative management, establishes standards for medical supplies consumption, stores and compiles statistics on professional activities, encodes records, and accounts for medical supplies consumed for each medical record, and performs the functions of management accounting. The organization of the accounting apparatus is a combination of financial accounting and management accounting. At Binh Duong Maternity and Children's Hospital, the chief accountant is responsible for the general and specific aspects of management accounting, including: Preparing revenue and expenditure estimates; Managing revenue and expenditure, revenue and expenditure of hospital services; Analyzing information to provide financial advice to the hospital's Board of Directors; and Preparing reports.

3.2.3. Characteristics of hospital financial management mechanism

Implement the financial management mechanism according to Decree 16/2015/ND-CP dated February 26, 2015 of the Government on "regulations on autonomy, self-responsibility for performing tasks, organization, staffing and finance for public health units". Binh Duong Maternity and Pediatrics Hospital implements the accounting regime, invoice regime, voucher regime, accounting books, financial reporting regime according to legal documents on accounting and regulations on state budget, financial policies, and related taxes including:

- State Budget Law No. 83/2015/QH13 dated June 25, 2015;

- Accounting Law No. 88/2015/QH13 dated November 20, 2015;

- Decree No. 174/2016/ND-CP dated December 30, 2016 of the Government detailing and guiding the implementation of a number of articles of the Law on Accounting;

- Circular 107/2017/TT-BTC dated October 10, 2017 of the Ministry of Finance on guidance on administrative accounting regime.

- The currency used in accounting records is Vietnamese Dong;

- Currently, the hospital is applying the form of accounting with vouchers; depreciation of fixed assets according to the periodic method on December 31 every year, and taxes according to the direct method. On that basis and depending on actual operations, accountants can open additional level 2 and level 3 sub-accounts for accounting purposes.

- From 2018, according to Circular No. 107/2017/TT-BTC guiding the administrative accounting regime, financial reports are made according to the annual accounting period, not quarterly reports as previously prescribed, the deadline for submitting financial reports is within 90 days from the end of the annual accounting period. Report

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