NGHliN Cl/U
Thao luan v^ y nghia ciia viec thiet lap phuong phap phan bo chi phi theo hoat dong trong b^nh vien
"n^ (Jiang Qiimg VQ Hll Lan Huong
Vi^ Ke toan - K i ^ toaa Dai hpc Kinh \& qu6c dan
Tdm tdt: Bdi vidt ndy ttinh bdy mpl vdi ttao ddi vd viec Ap dyng phucmg phdp phdn bd chi phf Uieo hogt dpng (AcUvity-Based Costing - ABC) lai mpt don v\ rAt dgc tfiii ttong xd hpi dd Id bpnh vipn. Do dfic didm hogi dpng eda bpnh vien dd Id cAu ttiic td chiic cde hogt dpng phuc tgp, ndn cd rAl il nghidn ciiu vd vipc Ap dyng phuong phdp ndy cho tdng tfid cd bpnh vidn. Trfin co sd dd, tdc gid tidn hdnh nghifin cuu ndy dd xem xdt khd ndng dp dyng phuong phap phdn bd dii phf Uieo hogt dpng cd tfiyc sy mang Igi hidu qud cho hogt dpng tgi bpnh vipn.
Ttr khda: Kd loAn quAn tti, ABC, bdnh vidn cPng
1. Sir can thiet phai thiet iap he thdng ke toan quan trj trong benh vien cong
Djch vy y td Id mpt djch vy rAl dfic bipt, do dd edng lAc quAn ly ddi vdi hogi ddng ndy eung rAt dpc bidt vA phiic lgp. Tgi Vipl Nam, da s6 cde t>pnh vidn. dfic bidt Id ede bdnh vipn Idn ddu Id nhtrng bdnh vipn hogt dpng dya tren ngdn sdch nhd nudc (NSNN). Tuy nhidn ttong thdi gian sdp tdi, hd thd'ng l)dnh vipn cdng cua Vipt Nam sd dupc Ihay ddi, cho phO hpp vdi sy phdt ttidn ciia ndn kinh td cting nhu chii truang eiia Chinh phli irong qud trinh ddi mdi thd chd eung img dieh vy cdng (TrAn Thj Minh, 2016) Cy tfid ban, cAc bpnh vidn dupc ttao quydn ty ehii vd Idi ehinh nhfim gidm t>dt gdnh nfing ngdn sdch ddng Uidi ciing Id mpi cdng cy thuc ddy vipe tdng cudng chal Iupng hogi dpng eiia Bpnh vidn. Vipc chuydn ddi md hinh qudn tti ndy nhdm: tdng nguon Ihu cho bdnh vipn, cd thfim ngudn lyc CO sd dd dAu tu, md rpng bpnh vipn; ddp img dupe nhu cdu khdm chira bdnh ngdy edng eao vd hogt dpng thudng xuydn eiia bpnh vipn; chii dpng kinh phf chi tra hogt dpng tifinh vipn, cd ngudn kinh phi dd ttich Ipp ede quy; thay ddi y thdc, Ihdi dp Idm vipe eua nhdn vidn y Id...
Do dd, ttong tuong Iai, khi cdc Bpnh vipn edng dupe giao quydn hf ehii, mpi vAn dd cdn uu ttdn xem xdt Id vdn dd qudn tt| lai ehinh eiia cdc bpnh vipn sao eho vira ddm bdo ngudn lai chinh vd ngudn vdn ddu tu phdt tridn bdnh \ien, ddng Ihdi duy tri miic Vipn ptif vd ehi phi khdm chtia bpnh mpi edeh hpp ly, tinh ggn bp mdy quAn tri... Ddy cOng Id vAn dd dupc nhdn mgnh ttong budi Hpi thdo DPI mdi ttong qudn ly va qudn trj bpnh vipn cdng lgi Vifil Nam do Trung Idm ttidng tin vd Dy bao kinh td xd hpi qudc gia phoi hpp vdi td chuc y Id Uid gidi WHO Id chiie tgi Hd Npi vao ngdy 13/12/2016. Sau ktii dupc giao ly chii, cdc bfinh vipn khdng cdn dupc N ha nudc ho trp ngdn sdeh, ngudn Uiu ehfnh ciia Bfinh
vipn ehil ydu dya vdo thu vipn ptii vd bdo tiidm y id. Do dd, vipc qudn til ctii ptii ttong tifinh vipn cdng sd ( ^ dupc quan tdm ntiidu hon nira dd ddm tido cAc tidnh vipn cd ttid ddm lido dupc hogt dpng eiia minh didn ra mpi cdch hipu qud ntiAl.
Cdng lAc quAn tti chi phf d cdc bpnh vipn cdng hipn nay chu ydu dupc ttiyc hipn theo (^ I9/2006/QD-BTC.
Tuy nhidn, cAc npi dung ttong quydt djnh 19 chii ydu hudng ddn cOng lAc kd todn tdi ehfnh tgi cdc don vj cdng Ipp. Nhu vAy, ttong tuong lai khi cdc Bpnh Vipn cdng dupe giao quydn ty chii, cAc Bpnh vipn sd phAi cho dpng hon trong cdng lAc quAn tti ehi phf cda co sd minh. Hay ndi cAch khAc, vide xem xdt xAy dyng hp thdng kd loAn quAn tti trong bpnh vipn edng td rAl cAn ttiidt ttong tucmg lai.
Hidn nay, vide xdy dyng hp Uidng kd lodn qudn tti ehua ttiye sy phd bidn d Vipt Nam, dfic bipt Id cdc don vf ePng ipp. Ngay ttong khdi doanh nghipp hogt dpng kinh doanh vdi myc tidu hdng dAu Id Igo ra lpi nhudn, cde nhd qudn trj doanh nghidp ciia Vipi Nam vdn cdn mo hd vd kd lodn qudn ttj. (PGS.TS Nghidm Vdn Lpi, 2015). Do dd. trong khdi don vj cOng, cdng td kd loAn qudn Ir] cdn mo hd vd Idng Ifio. Do dd, nhu cdu dfit ra ddi vdi cdc don vl cdng ndi ehung, vd ede Bdnh vi§n edng ndi ridng, bdn cgnh hp ihdng kd todn tdi ehfnh Iheo ddi Unh hlnh tdi difnh, cdn thidt phdi Um hidu xdy dyng hp thdng kd todn qudn trj dd ddm bdo vipc ttieo ddi qudn ly chi phi dupe didn ra mpt cAch phu hpp vA hipu qud nhAl.
Trong dd vAn dd phdn bd chi phi Id mPt trong nhung khia cgnh quan trgng, mang tfnh xuong sPng cua hp Ihdng kd lodn qudn tri- Trdn eo sd dd, bdi vidl ndy sfi phAn ti'ch vide dp dyng phuang phdp phdn bd ehi phf theo hogt dpng ttong cdng tfie qudn ly bpnh vifin. Mye tffiu ddu ttfin cua bdi vidl Id phdn tfch phuong thiic sir dyng phuong phfip ndy irong Bpnh
vidn ttfin todn ttid gkSi vd dua ra nhiing phdn dodn vd khd ndng dp dyng hp tfidng ABC ttong cdc bpnh vidn.
2. t nghia cua viec sd dung he thong phan bo chi ptii theo boat florig tai benh vien
Cde tifinh vifin Uiudng ddi mpl vdi nhiing khd khdn iTOTig vAn dd edn bdng giiia ngudn tyc Idi difnh cd gkii hgn vd chi ptii phdt sinh ttong cAc hogt dpng. Ddc bipt, ehi ptu phye vy cho nghidn ciiu frong cdc l>dnh vidn rdi l6n kem nhu dii ptu thii ngtildm !^ thupt rndi, ctii phi i ^ d n cuu logi thudc mdi.... Di giai quydl nhung khd ktifin nAy, nhidu t>dnh vidn diing trudc dp lye dd Id xdy difng hd thdng qudn tti dii ptii sao cho tidt kidm vA tiipu q u i Trong finh trgng nAy, ntiidu bpnh vipn sAn sang chi bA chi phf d mpt miie dp hop Iy eho vipe ttiidt Idp hd Q}6ng qudn trj chi ptu lgi bpnh vidn nhdm ndng cao hipu quA hogt dpng ciia hp Uidng. S.Gujral, ICDongre va cdng sy, (2010) dd cho rAng cdc tipnh vipn Ihudng sir dyng kd lodn dli phi nhu Id ttdu chi dd xdc djnh Vipn phf.
Nhung thdng tin vd qudn tri etii ptu giiip eho vifie xdy dyng dy tofin tipp ly vfi sdl vdi thyc td, ptiAl hidn ra nhting hogt dpng khdng tiidu quA vd dy dodn nhiing ttiay ddt ddi vdi nhu cAu ngudn lyc tdi ctiinh ktii ed nhtrng thay doi ttong hogt dOng cua bpnh vipn
Trong ttudng hpp cua co sd sAn xuAl, mpi ttong nhiing nhAn id chd ydu dd qudn ly doanh ngtiidp dupe hipu qud la kha ndng udc Unh ctiinh xdc nhAl ctii phi sdn xudL Chi phf sdn xudt Id ePng cy thidt ydu dd udc Unh chi ptu cho mdi quydt djnh dupc dua ra ciia nhd qudn Iy. M.Carvalho vd epng sy (2010) dd chi ra rAng, hAu hdi cdc bdnh vidn ma cd hp thdng quAn tti chi phi ddu Sli dyng phucmg phdp tmydn thdng (absorbtton costing) dd phdn bd chi phi. Phuang phdp phdn tid chi phi kidu tmydn thdng thudng khidn eho vide xdc djnh ctii ptii gidn Udp ldng Ihdm. Trong khi dd, cdc bdo tdi chinh thi khdng eung cAp dupe Ihdng tin dd giAi Ihfch sy chdnh Idch gttia Ihyc Id so vdi udc linh ddi vdi limg vAn dd cy thd, ddng nhiing quydt djnh cua nhd qudn tti lidn quan ddn vAn dd ehi ptil Igi khdng dupe nfiu trfin cAc bdo cdo kd lodn.
Trong khu vye sdn xuAl, nhiing khd khdn Udm ldng ttong vide Iya chgn phuong phdp phfin bd etii phi eho san phdm sao cho phii hpp vd ehfnh xdc trong cdc doanh nghidp sAn xudt dd dupc Um hidu rAl rPng rfii bPi cde nhd nghidn ciiu (C.Dmry, 2001), (M.Lueas, 1997).
Bdn cgnh dd hgn chd quan ttpng cua phuang phfip ptidn l)d dli ptif ttuydn Ihdng ttong Unh vyc ndy ciing dd dupc nghidn ciiu cung vdi nhting lpi thd cua phuang ptidl ptidn t>6 ctii ptu theo hogt dpng (AeUviUes-based- costtng) (R. Kaplan, and H. Johnson, 1987)
Khu vyc ptii sdn xudi vdi cAu true ctii ptii vd sdn phAm dAu ra phiie lgp nfin thudng uu tidn lya chpn cdc phuang ptiAp phAn bd ctii ptif hifin dgi (variable costing method vd acUvittes tiased eosttng method) ( (Z. Tukovd, and J. Sttouhal, 2010) hon Id phuang phdp phdn t>6 cW phf ttuydn ttidng. Hp ttidng phdn bd ehi
ptii cdng phai ttidn chAng hgn nhu phuong phAp ABC, ttii nd cdng h6 tiq cho vipc tfing cudng tfnh hipu qud ciia qudn Iy va su dyng ehi phi. Phuang phap phdn t>d ehi ptii theo hogi ddng (ABC) cung cAp thdng ttn vd chi phf clu ttdi hon. Do dd, frong linh vyc hpal dpng ciia tidnh vipn, phucmg phdp ndy cd Ihd giiip vipc giAm ttiidu ctii ptii va td'i uu hda quAn tti ctii phi. (E.
Cardinaels, F. Roodhoofl, and G. van Herck, n.d.).
\^dc tfiidl IAp hp ttid'ng ABC frong bpnh vipn khi cho rAng, thdng tfn dupe cung cdp lidi hd thdng ABC cd ddng gdp quan frpng eho vide qudn ly bdnh vidn frong vide Idn kd hogch vA kidm sodi qudn ly, t>di vi phuong ptiAp ndy thay ddi hdnh vi td ehiic bAng cAch chu ttpng, quan tAm dPn cde hogt dpng dya ttdn khdi Iupng ciia cdc hogt dOng ndy.
Vide su dyng ABC tt^ng cdc bdnh vidn hiia h?n sd tgo ra dupc rAl ntiidu Ipi fch, dAc bidt Id kha ndng udc tfnh chi phf ttiye td ciia cdc hogt dOng, xdc dinh mdi Iidn hp giua ehi phi va phuang Upn thyc tiipn nhiing hogt dpng ndy, dd xde djnh mue dp dnh hudng ciia Kmg ctii ptii ddn ldng chi phf eiia cd doanh nghidp vd do ludng dupe khd ndng tgo ra Igri nhuAn eua doanh ngtiidp- Vide xem xdt khd ndng tgo ra Ipi nhuAn Id rAt quan ttpng frong Irudng hpp ndy txW vi nd giup phdi hipn ra sy ktidc bipi giOa gid tri ed thd ihu hdi dupc cho mpi hogt dpng nhpt djnh vd chi phi Ihyc id sau khi tinh cd chi phi chung (overhead cost) (B. Popesko, Z.
Tukovd, and J. Sttouhal, 2011)
Mgc dil vipc Sli dyng phucmg phdp phdn bd chi phf theo hogt ddng dupc thidt kd chu ydu sii dyng eho doanh nghidp sdn xuAl, vipe dp dyng phuong phdp ndy trong doanh nghipp phi sAn xudt khOng phdi IA khdng cd nhung cdng edn hgn chd. Vipe dp dyng phuong phdp ABC ttong linh vyc sdn xuAt dd Ihu hiit sy quan tdm eua rdt nhidu hpc giA vd cdc ntiA ngtiifin ciru frong sudl nhting nfim 1990, nhung ddn gitra ttiAp ky ndy, chung ta mdi bdt ddu nh$n ra nhiing gid tti eiia phuong ptidp ndy ttong Ifnh vyc chdm sdc sue khde.
3. Ket iuan
Nhu vpy, rd rdng vipc sii dyng phucmg phdp ptiAn bd chi ptii theo hogi dpng khdng chf phii hpp vdi cAc doanh ngtiipp sAn xuAl md cdn bpe ip rAt nhidu uu didm frong ngdnh djch vy. Phuang phdp ndy tjdn cgnh vipe giiip eho cde dem vj khdm ehua bpnh cd thd ptidn t)d chi phf mdt cdch chinh xdc hon, hipu qud hon, md qua dd cdn glijp cho don vj ndy udc Unh khd ndng tgo ra lpi nhupn eiia minh. Mfic dii vAy, vipc Ap dyng phuang phAp ndy trong Bpnh vipn, dAc bipi IA d miic dp ldng thd ttdn toAn tipnh vipn, sfi gfip rAl nhidu khd khfin. Do cdu ttiic ehi ptif cOa Bdnh vidn d mdi bp phAn lgi khAc nhau vd ddi lupng sdn phAm dAu ra Igi dfic Uiil. Do vpy, bdi vidt ndy cd y nghla nhu mOt hudng gpi md cho cdc nghidn ciiu vd ktid nfing dp dyng phuang phdp ndy tgi cdc hp thdng bpnh vipn d Vipi Ncim, dgc bipi Id cdc bpnh vipn IdnX
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