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Regular Expenditure Structure of Hanoi Obstetrics and Gynecology Hospital from 2016 to 2019


Refund the excess amount if the advance payment is more than the actual treatment cost. At the end of the working day, the hospital accounting department summarizes the amount collected during the day and submits it to the cashier department. The cashier balances the expenditures, leaving the treasury (safe) with a reasonable amount of cash according to regulations, and deposits the remaining amount into the deposit account at the State Treasury for monitoring, management and use.

- For socialized revenue sources: the hospital develops a joint venture and shareholding project for the type of service performed (ultrasound, digital X-ray, CT scan, etc.) and submits it to the Department of Health for approval. For joint venture activities, the hospital signs contracts with companies that install the machines and allocates revenue and expenditure according to the approved project. For shareholding activities, the hospital establishes a separate Management Board to monitor, manage and use.

- For other service revenue sources, other revenue: the hospital signs contracts with contractors to collect service fees from parking lots, drugstores, and canteens. Monthly or quarterly, the contractor makes a lump sum payment to the hospital. The contractor monitors and manages related costs.

The hospital declares and fulfills its tax obligations to the State for taxable revenues as prescribed such as joint ventures, parking services, drugstores, canteens, etc. Every year, the hospital has fully and promptly paid taxes to the State.

The hospital's revenue sources are quite large and complex. The Finance and Accounting Department monitors and updates daily and regularly reports the actual situation, advantages and disadvantages so that the Board of Directors can grasp and issue appropriate handling decisions. The financial disclosure regime is implemented according to current regulations.

* Building a budget at Hanoi Obstetrics Hospital

The use of financial resources including funds from the State budget, health insurance, hospital fees, service fees, aid and other sources of revenue of the hospital, in general, ensures proper spending according to regulations, implemented according to the Spending Regulations.


internal criteria and current financial regimes. Regular activities include the following four groups of items:

Table 2.5. Structure of regular expenditure activities of Hanoi Obstetrics and Gynecology Hospital from 2016 - 2019


TT


Content

2016

2017

2018

2019

Amount (million)

copper)

Proportion

(%)

Amount (million)

copper)

Proportion

(%)

Amount (million)

copper)

Proportion

(%)

Amount (million)

copper)

Proportion

(%)

I

Personal Payment

10,662.6

27.6%

11,804.7

27.6%

13,955.0

21.2%

15,210.7

20.4%

1

Salary

4,830.5


5,412.5


6,052.3


6,478.8


2

Salary allowance

2,344.4


2,554.0


2,992.8


3,481.6


3

Contract labor wages

1,104.9


1,800.3


2,120.3


2,296.5


4

Contributions

1,382.8


1,459.7


1,893.3


2,028.8


5

Collective welfare and

other personal payments

200


578.2


896.3


925


II

Professional service

24,372.4

63.0%

27,109.5

63.3%

45,631.5

69.3%

52,749.3

70.6%

6

Payment of public services

1,463.2


1,713.3


2,406.3


2,706.4


7

Office supplies

528.5


516.7


781.2


527.2


8

Media contact information

389.3


306.8


311.2


285.6


9

Business trip expenses

264.8


182.3


241.3


255.2


5

Surgery, procedure,

overtime

1,871.4


2,842.2


4,112.9


4,543.9


11

Medicines, supplies and expenses

other professional services

19,855.2


21,548.2


37,778.6


44,431.0


III

Regular shopping and repairs

through

875.5

2.3%

1,064.9

2.5%

2,793.7

4.2%

2,876.4

3.9%

IV

Other costs

2,791.3

7.2%

2,842.9

6.6%

3,473.6

5.3%

3,850.7

5.2%

TOTAL

38,701.9


42,822.0


65,853.8


74,687.1


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Regular Expenditure Structure of Hanoi Obstetrics and Gynecology Hospital from 2016 to 2019

(Source: Financial report of Hanoi Obstetrics and Gynecology Hospital from 2016 to 2018)

2019 and author's own calculation)


Through the above table, it can be seen that the proportions of groups I and II tend to reverse. While professional expenses increase gradually, personal payments decrease gradually over the years. The reason is that in recent years, the number of staff in the Health Sector has not changed. The hospital has proactively streamlined staff in some unnecessary positions and instead recruited new highly qualified staff. The increase in salary costs is mainly due to an increase in the basic salary. On the other hand, the following year's career revenue increased sharply compared to the previous year. This means that the expenses also increased sharply, mainly due to professional expenses because this group accounts for a large proportion of the total regular expenses of the hospital. The remaining expense groups account for an insignificant proportion and do not fluctuate much.

a. Personal payment

Including expenses for salaries, wages, salary allowances and salary-based payments (health insurance, social insurance, unemployment insurance and union funds), collective welfare, subsidies and other allowances. This is to compensate for labor loss, ensuring the maintenance of the labor reproduction process for civil servants, public employees and contract workers of the Hospital. Personal payments account for 20% - 30% of the total regular expenses of the hospital. Every year, the hospital is allocated state budget funds to pay salaries to staff at the time of budget allocation at the beginning of the year. The additional part due to regular salary increases and increases in basic salary during the year, the hospital must cover itself from the source of 35% of the unit's salary reform. In 2019, the hospital must pay all personal payments from career revenue.

- For hospital civil servants and public employees, the salary coefficient and salary allowance coefficients are approved by the competent authority, applying the current basic salary level. For contract staff, the salary is paid according to the agreement and the Director is the one who decides. Based on the monthly timesheet


At the end of the month, the departments report to the Finance - Accounting Department to synthesize and calculate the salary payment for the staff. After deducting the contributions, the actual salary is paid regularly every month via ATM card at BIDV Investment and Development Bank - where the hospital registers to pay salaries to staff. After completing 1 month of work, the staff will receive their salary. Hanoi Obstetrics and Gynecology Hospital is the unit with the largest number of internal contract staff in the industry. Due to the limited number of staff assigned, but to ensure there are enough employees to serve patients, the hospital signs internal contracts with many subjects, at different salary levels: foreign experts (Belgium) with a salary of 100 million VND/month; CKI, CKII doctors who have worked at facilities of the Health Sector; newly graduated doctors, pharmacists and subjects with other professional qualifications such as accountants, physicians, nurses, etc.

- Contributions (social insurance, health insurance, unemployment insurance, union fees): including 24% from hospital expenses and 10.5% from staff salary deductions. The hospital calculates and pays in full, and compares data with the City Social Insurance every month.

- Collective welfare expenses: Collective welfare expenses are paid according to current regulations, detailed in the hospital's internal spending regulations. This expense level is not large and stable over the years.

b. Professional services:

This is the expenditure group that accounts for the majority of hospital expenditures (up to 70%) and has been increasing steadily over the years due to the increasing number of patients and the increasingly expanding scale of hospital operations. Because the price of health insurance services has been structured with costs for electricity, water, fuel, waste treatment, and environmental sanitation directly to perform the service, the State budget only partially supports the cost to pay for these contents. In 2016 - 2018, the State budget allocation is calculated based on the regular expenditure norms for each bed.


approved hospital plan (average 10 million VND/bed per year, equivalent to 1 billion VND for the entire hospital). In 2019, the hospital was only granted a small amount of funding to support professional activities, the rest the unit paid for itself from the unit's revenue.

This group of expenses can be divided into two basic contents: expenses for management activities, ensuring regular hospital operations (electricity, water, stationery, etc.) and expenses for activities directly serving patients (medicine, blood, consumables, replacement supplies, etc.).

- Management expenses: based on current spending guidelines, spending norms are discussed and agreed upon on the basis of savings and efficiency at the Conference of civil servants, public employees and workers. Specific contents are specified in detail in the hospital's internal spending regulations and are spent in 2 forms:

+ Direct payment: electricity, water, fuel, business trip expenses (in case of business trip to other provinces with invoice).

+ Lump sum expenses for departments and individuals to implement: office supplies, business expenses (in case of business trips outside the province, there will be invoices and lump sum business expenses within the city).

The Administrative Department is responsible for coordinating with the Finance - Accounting Department to monitor the daily use of electricity, water, fuel... to ensure reasonable and proper spending.

- Direct professional activities:

+ In addition to the general working time of 8 hours/day and night work and overtime (if any) as prescribed by the Labor Law; the specific nature of the medical sector is to implement the on-call and surgical procedures regime according to the schedule assigned by the heads of departments (professional on-call). On-call and surgical procedures allowance


implemented according to Decision No. 73/2011/QD-TTg of the Prime Minister dated December 28, 2011 on the regulation of special allowances for civil servants, public employees, and workers in public health facilities. Officers participating in on-call and surgical procedures are paid on-call, surgical procedure allowances, and meal allowances for 24/7 shifts and holidays. The specific expenditure levels for each type of surgery and each department are specifically regulated in the hospital's internal spending regulations. The regime under Decision 73 has been implemented since 2012, however, at that time, the fee collected from a portion of hospital fees did not include on-call and surgical procedure costs. Therefore, the State budget is subsidizing this expense. In 2016, the hospital was granted funding to implement Decision 73 to collect back payments for 2012 and 2013, an amount of 1.26 billion VND to pay staff. From 2016 onwards, a portion of hospital fees were transferred to the service price mechanism, with costs for direct care and surgical procedures structured. The state budget does not subsidize this portion of the funding, and the hospital must cover it from its own revenue.

+ Medicines, blood, consumables, replacement supplies...: Every month and quarter, from the detailed cost list of each discharged patient, the accountant will summarize all incurred costs and send them to the City Social Insurance agency for appraisal and settlement. This expense item accounts for more than 80% of the total professional expenses and is quite stable (not much increase or decrease over the years).

The characteristic of the Health Sector is that these goods must be purchased in advance by the hospital from its revenue or from the social insurance agency's provisional budget to ensure sufficient quantity and quality for use by patients. However, whether the amount of expenses spent is accepted as reasonable and settled is the deciding factor. Therefore, the hospital must determine the quantity needed for purchase and strictly manage it during the use process.


Using for patients is an extremely important step to avoid loss and waste of resources for the hospital.

c. Regular purchases and repairs.

With the goal of strengthening facilities to improve the quality of medical examination and treatment services, for many years the Hospital has always paid attention to investing in purchasing and repairing fixed assets. However, according to the accounting system, the expenditure for purchasing and repairing is monitored from two sources: regular expenditure (from the State budget and career revenue) and the Career Development Fund. For the group of regular purchasing and repairing expenditure items, it only reflects small, regular expenditure activities to ensure the minimum operation of the hospital such as purchasing working equipment, repairing computers, equipment, etc. This expenditure level accounts for a small proportion of total regular expenditure (average 3.5%). The main expenditure from the Career Development Fund is to purchase modern machinery and equipment, and to renovate and repair major infrastructure facilities to improve the quality of medical examination and treatment, meeting the needs of serving patients.

d. Other expenses: include expenses for reception, support, fees, etc. Other expenses account for a small proportion of the unit's total regular expenses (average 6%) and tend to decrease over the years. Implementing the financial autonomy mechanism, the hospital saves unnecessary expenses to reduce costs, increase the difference to set up funds and spend additional income for staff.

2.2.2. Managing the implementation of revenue and expenditure estimates at Hanoi Maternity Hospital

The implementation of the plan takes place within a budget year (from January 1 to December 31 each year). The implementation of the financial plan is carried out by all departments, divisions and all staff.


Hospital, because all departments must develop an operational plan as the basis for the spending plan. In other words, all must contribute to creating sources of revenue and must spend. However, the direct subject of the organization implementing the revenue and spending plan is the Finance - Accounting Department. The work is carried out as follows:

a. Budget delivery:

- Every year, based on the actual expenditure data of the previous year, the expected revenue and expenditure of this year, the target of the following year and current policies, the hospital builds the annual State budget estimate and sends it to the Department of Health for appraisal and synthesis. Based on the needs of the unit, the Department of Health submits to the Department of Finance and the Provincial People's Council the State budget estimate of the entire sector, including Hanoi Obstetrics and Gynecology Hospital. By the end of the year, the Provincial People's Committee issues a decision to assign the budget to the health sector. Based on the total revenue and expenditure estimate assigned, the Department of Health allocates the budget to Hanoi Obstetrics and Gynecology Hospital and provides funding for the unit to implement.

Based on the allocated budget, Hanoi Obstetrics and Gynecology Hospital rebalances the revenue and expenditure contents to be consistent with the previously established budget. The revenue and expenditure contents are detailed in the internal expenditure regulations of the unit, discussed at the Conference of civil servants and approved by the Department of Health. After approval, Hanoi Obstetrics and Gynecology Hospital publicly announces and informs all departments and divisions for information and implementation.

b. Organization and personnel

The Finance and Accounting Department is a professional and technical department under the direct leadership of the Board of Directors, directly led by Associate Professor, Dr. Nguyen Duy Anh - Director of the hospital; advising the director in managing hospital finances, establishing norms and standards for spending activities.

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