AP DUNG KE TOAN CHI PHI Dl/A TREN HOAT DONG VAO TINH GIA THANH DICH VU
KHAM BENH, CHLfA BENH TAI CAC BENH VIEN CONG Cf VIET NAM HIEN NAY
• V O T H ! THANH THUY
TOM TAT:
Trong dieu kidn hdi nhap qud'c le' va nen kinh td' - xa hoi phat Iri^n nhtf hidn nay, cung nhtf nhffng thay d6i dang ke dtfdi lac dong cua ed chd' ttf chii, ttf chiu trach nhidm ve thtfc hien nhiem vu, td chtfc bp may, bidn chd' va tai chinh, cac benh vidn edng bat diu phai ddi mat vdi rat nhi^u kho khan va thach thtfc trong viec can ddi giffa eac nguon Itfc ban che' vdi eha't Itfdng dich vu ma bdnh vidn cung cap (Vien Chie'n Itfdc va Chinh sach Y le' (2009)), dieu nay tao ap Itfc bupc cac benh vidn cdng phai tim hieu va ap dung ky thuat ciia kd' toan quan tri chi pM sao cho hieu qua, eac ky thu^l n^y trtfdc kia thtfcfng chi dtfde sff dung trong doanh nghidp hoat dpng vl muc tidu ldi nhuan. Ke' loan ehi phi dtfa tren hoal ddng (Activity-based costing - ABC) la mdt trong nhu'ng each tid'p cSn ma cac bdnh vidn cdng d Viet Nam nen tim hieu va ap dung.
Tif khoa: Ke' toan chi phi, benh vien cdng, gia thanh kham chffa benh, Viet Nam.
1. Stf cSn thidt
Qua thtfe tidn, he thd'ng kd' toan quan tri ehi phi truyen thd'ng (phtfdng phap tinh gia thanh loan bp) da bpclp mot sd'han chd', gay anh htf6ng dd'n hoal dpng ra quyet dinh cua nha quan tri trong bdnh vidn. Nhffng han chd'Idn nha't cd the ke dd'n dd la vide ltfa chon dd'i Itfdng tap hdp chi phi va ky thuat phan bd chi phi. Theo phtfdng phap truyen thd'ng thtfdng ehi chpn mpi hay mdt vai lieu thtfe de phan bd chi phi san xua't chung (sd gid may hoat ddng, doanh thu,..). Song trong ihtfc td', chi phi san xua't chung bao gom nhieu ndi dung khae nhau, moi npi dung phat sinh cd dac diem khac nhau. Do vay, vide tinh gia thanh san pham thtfdng khdng phan anh dung chi phi eua no, anh htfdng dd'n viec quye't djnh gia dich vu ciia ddn vi iff do co the dmh gia qua cao hay qua IhS'p so vdi gia vd'n.
De khae phuc nhffng han ehe' do, cac nha kinh le' nghidn ctfu va tfng dung phtfdng phap tinh gia
thanh san pham mdi - phtfdng phap linh gia thanh dtfa tren cd sd hoat ddng (Robert Kaplan &
Anthony A Atkinson (2014)). Tac gia Chan (1993) vid't rang, ABC la mot phtfdng phap xae dinh chi phi hidn dai vdi nhieu tfu diem ndi trdi so vdi cac phtfdng phap xac dinh chi phi truyen thd'ng. Dilu nay khdng chi lidn tue dtfde khang dinh trong cac nghien ctfu ly luan (Innes J, Mitchell F (1995), Cooper R. The rise of Activity-based costing (1988), S. Udpa (1996)) ma eon dtfde chtfng minh tren thtfc id' bcfi nhieu nganh, nhieu linh vtfe. Bang each kd't hdp ke' toan chi phi dtfa trdn hoat ddng va kd' loan chi phi truyin thdng, eae nha quan in y Id' CO the Idn kd' hoach va kiem soat chi phi dieh vu y Id' td't hdn va dam bao ngan saeh eua bdnh vidn.
De ap dung phtfdng phap ABC, benh vidn co the chuyd'n dich tCr vide ap dung cho mOt so' hoal ddng cua bdnh vidn hoac eo the' chuyen dieh ludn bSng vide ap dung cho tat ca cae boat ddng trong
392 So 12-Thdng 9/2018
KETOAN-KIEM TOAN
benh vien. Khac vdi cac nganh cdng nghidp khac, thie't lap he thd'ng ABC trong bdnh vien doi hoi nhffng each tie'p ean khae, chang ban stf thay ddi thai dp cua bae sT, chat Itfdng eua cac he thd'ng IT, sff ung hd cua ban quan iy, lien he giffa hidu qua hoat dpng vii cac bidn phap chat ltfdng,... Mot dieu can Itfu y nffa la trtfdc khi ap dung phtfdng phap ABC, cac benh vien can xem xet ldi ieh ciia cac bae sT (la do'i itfdng quan trpng nhat trong benh vien, la ngtfdi trtfc tid'p tao ra doanh thu) va stf ung hp ciia hp ddi vdi he thd'ng chi phi mdi.
2. Ndi dung ke' toan chi phi difa trdn hoat dong ap dung vao viec tinh gia thanh djch vu kham chfia benh.
He thdng kd'toan ehi phi dtfa trdn hoat dpng cd the dtfdc ap dung trong ITnh vtfc y td'khi bdnh nhan la nhu'ng s^n pham dpc nhat. Trong hd thd'ng ke' loan nay, chi phi dtfde edng don cho cac boat dpng lieu hao ngudn ltfe va ap dung cho eae san pham (benh nhan) dtfa trdn hoat ddng d\i(}c ydu cau trong qua trinh san xual (dieu tri).
Budc 1: Nhdn dien cdc chi phi trifc tiep Theo ND85, ehi phi trtfe tie'p lien quan de'n hoal dpng kham bdnh, chtfa bdnh bao gdm:
-Chiphi ve thud'c, hoa cha't, valltf lieu hao, vat tif thay the.
- Chi phi ve dien, ntfdc, nhidn lieu, xff ly cha't thai, ve sinh mdi trtfdng.
- Tien ltfdng, phu cap, cac khoan dong gdp theo che'dd.
- Chi phi duy tu, bao dtfdng, sffa chtfa lai sancd dinh, mua sSm thay the'cdng cu, dung cu trtfe tidp sff dung de thtfc hidn dich vu ky thuat.
-Kha'u hao tai sancd'dinh theo che'dp apdung ddi vdi doanh nghiep nha ntfde; ehi phi ehi tra lai lien vay theo cac hdp ddng vay vdn, huy ddng vdn de dau ttf, mua sSm trang thid't bi de thtfc hidn dich vu (ne'u cd).
Budc 2: Nhdn dien cdc hoat ddng khdm chda benh
Hoat dpng kham va dieu tri tai benh vidn ra't phtfc tap, lien quan de'n rat nhieu chii thd', nhieu hoal dpng, cd the' khai quat nhtf sau:
- Tie'p nhdn benh nhdn: Benh nhan dtfdc tiep nhan tai phdng kham hoac phong cap ctfu. Cae thdng tin ca nhan va ti^n sff benh cua benh nhan se du'dc xac dinh va ghi nhan ban dau tai eae bd phan nay, sau dd dtfdc chuyd'n dd'n cac bo phan tid'p theo de tie'p luc cap nhat, xff ly.
- Khdm benh: Tai phong kham (hoac phong cap cffu), bac SI thffc hien vide kham bdnh, chi dinh cac xet nghiem hoac thffc hien cac dich vu ky thuat lam cd sd cho vide chan doan. Trong trffdng hdp cho benh nhan dieu tri ngoai tru, bac sT se ke ddn thud'c va chuyen eac thdng tin nay dd'n nha thud'c bdnh vien. Thong tin ve eac dieh vu y le' bdnh nhan thffe hien va ehi phi sff dung thude dffpc chuyen dd'n bd phan ketoan vidn phi.
- Dieu tri not trii: Trong qua trinh benh nhan dieu in ndi trii, la'l ca thdng tin ve didn tie'n benh ly, phae do dieu tri, tinh trang sffc khoe, cac kd't qua xel nghiem va chan doan hinh anh cua tffng benh nhan,.,. phai dffde cap nhai va Itfu trff cu the' trong CSDL nghidp vu cua benh vidn.
- Ldm thu luc ra vien cho benh nhdn: Sau khi ke't Ihijc qua trinh dieu tri, khoa lam sang hoan thanh hd sd ra vien, trong dd co vide xac nhSn nhanh chdng, day du va chinh xac so Itfdng thud'c, vat ttf y te', cac dich vu ky thuat,... ma ngtfdi benh sff dung trong qua trinh dieu tri.
Hoal ddng kham va dieu tri bdnh cd lien quan dd'n nhieu bp phan nhtf bp phan tie'p nhan, eac khoa lam sang va can lam sang, vidn phi npi - ngoai irii, quan ly kho dtfdc va ke' toan. Cac chii the' tham gia vao chu trinh gdm benh nhan, bac sT, y la, y la hanh ehinh, ky thuat vidn, ke' loan dtfdc, ke'loan vien phi. Vdi dac ihu trong cdng tac kham va dieu tri, bdnh nhan dieu tri d khoa nay nhtfng cd the dtfdc chuyen khoa dieu in hoae nhan eac dich vu y te' ttf nhieu khoa/ phdng, do vay ta't ca cac hoat ddng deu dtfdc lap hdp, theo ddi moi chi phi phat sinh gan lidn vdi tffng benh nhan trong sud'l qua trinh dieu tn.
Budc 3: Tap hop chi phi chung cdn phdn bd Phtfdng phap phan bd dtfdc ap dung tinh loan cho cae phan chi phi ehung cho nhieu benh nhan/dich vu. Trong nhffng trtfdng hdp khong ed du thdng lin chi phi d mu'c chi tie't thi phtfdng phap phan bd la ltfa chpn duy nha't cd the. Ve nguyen tac, phtfdng phap phan bd xac dinh va phan bo chi phi chung ttfng btfdc eho cac ddn vi phat sinh chi phi va phan bo dan de'n san pham cud'i eijng.
Budc 4: Phdn bd cht phi chung vd tinh gid thdnh dich vti
Cae btfdc tie'p theo nhtf ltfa chpn tidu thtfc phan bd ABC thtfdng ltfa chpn mot he thd'ng cac tidu thffc Itfdng ffng vdi cac ngudn kinh phi de phan bd chl phi chung, xae dinh mffc phan bd dtfa tren mffc
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dp lieu dung hoat ddng eiia ttfng loai san pham, dich vu va sau cung la long hdp ta't ca cac ehi phi de tinh gia dich vii kham ehffa bdnh.
3. Vidu minh hpa
Khoa than nhan tao tai Benh vien eung ea'p 2 loai dich vu chiim sdc.
+ Chay than nhan tao ydu cau benh nhan loc mau 3 lan 1 luan. Tai do, cac benh nhan phai sff dung cac loai may mde thie't bi rS't dac biet va dat lien dd' tid'n hanh loc mau.
+ Tham phan phuc mae thdng qua mang bung eho phep benh nhan cd thd dtfdc cham sde hang ngay lai nha. Khoa giam sat benh nhan tha'm phan phiJe mac thdng qua mang bung va ydu eau hp luan theo quy trinh cham sdc tai nha.
Bao cao kd'l qua boat dpng eiia khoa dffde the hidn d Bang 1.
He tho'ng ehi phi hien tai phan bd trffc tie'p eac khoan chi cd the xac dinh dtfdc ngudn gdc cho 2 loai dich vu tren. Tuy nhien, chi phi chung lai khdng dtfdc phiin chia theo loai dich vu. Tong chi phi dieh villa 1.806.151.000 ddng dtfdc phan bd
cho cae dieh vu theo phtfdng phdp ly Id gdnh chiu chi phi truyen thd'ng. Vdi phtfdng phap nay, dich vu chay than nhan lad ehid'm khoang 61% doanh thu, ttfdng tfng vdi 1.117.463.000 dong, phan cdn lai la eho tham phan phuc mac thdng qua mang bung la 688.688.000 ddng (Bang 2).
Giai thich each tinh:
+ Chia chi phi quan ly chung thanh 4 vung.
Saudd vdi mdi viing chpn 1 nhan to'phat sinh ehi phi dai dien cho cac ngudn life dtfdc sff dung bdi 2 loai dich vu tren. Vide phan tich dtfpc the' hien d Bang 3a.
Sau do xem xel hd sd bdnh an va eae ngudn tai lieu khae dd' tinh loan ra sd' Itfdng cua mdi nhan td phat sinh chi phi can thiet cho mdi loai dieh vu, the' hien d Bang 3b, 3e.
+ Chi phi dieu dtfdng bao gdm hdn hdp rS't nhieu loai ehi phi ea nhan khae nhau: Chi phi dang ky dieu dtfdng, chi phi cho chffng chi hanh ngh^
dieu dffdng, ehi phi quan ly dieu dffdng va chi phi van hanh may mdc. (Bang 4a, 4b)
+ Dd'i vdi chi phi thie't bi: Thffc le', tha'y rang Bang 1. Bao cao ket qua hoqt dpng cua Ktioo ttiqn nhdn tqo (Phi/dng phdp truyen thong)
Chl tieu Doanh thu
So luong benh nh§n So lan cham soc Tong doanh thu (I.OOOd) Chi phi cung cap (lOOOd)
Chi phi thong thudng (thuoc, ong tiem) Chi phi khac (dung cho trudng nop dac biet) Tong chi phi cung cap
Chl ph[ Chung (LOOOd)
Chi phi quan ly chung (luu tru, quan iy) Chl phi thie't bl (i<hau hao, bao tri)
Chi phi dieu dudng (dang ky dieu dudng, chLIng chi hanh nghe dieu dudng, quan iy dieu duong, thiet bi ky thuat) Tong chl phi chung
Td'ng chi phi hoat dpng (I.OOOd) Thu nhap thuan (I.OOOd) LdinhuJn(I.OOOd)
Thu trung binh cho mdi ian cham soc Chi phi trung binh cho moi ian cham sdc Ldi nhudn tCf moi ian cham soc
long
164 34,067 3.006,775
664 900 310,695 975,695
785 825 137,046 883.280 1 806,151 2,781,746 225,029
Chay than nhan tao
102 14,343 1,860 287
512,619 98.680 611,299
1,117.463 1,728.762 131,525
129,700 120,530 9.170
Tham phan phuc mac thong qua mang bung
62 20,624 1.146.488
152.281 212.015 364,296
688,688 1.052.984 93,054
55,590 51,060 4,530
394 So 12-Ttiang 9/2018
KETOAN-KIEM TOAN
Bang 2. Bdo cao ket qua tioqt dong cua Khoa ttidn nhdn tqo (Theo phUdng phdp ABC)
Chi tieu Doanh thu
86 iuong benh nhan So ian cham soc TSng doanh thu (I.OOOd) Chl phf cung cap (1 .OOOd) Ghi phi thdng thudng (thud'c, d'ng tiem) Chl phi khac (dung cho trudng hop dac biet) long chi phi cung cap
Chi phf Chung (1,OOOd) Chi phi quan iy chung (iuu tru, quan iy) Chi phi thie't bl (kha'u hao, bao tri)
Chi phi di§u dudng (dang ky dieu dudng, chOng chi hanh nghe dieu dudng, quan ly dieu dudng, thiet bi ky thuat) Tdng chi phi chung
Tdng chi phi hoat ddng (1,000d) Thu nhap thuan (1,000d) Ldi nhu$n(1,OOOd)
Thu trung binh cho mdi lan cham sdc Chi phi trung binh cho mdi ian cham soc Loi nhuan tCf moi lan cham soc
long
164 34.067 3,006.775
664.900 310.695 975,595
785,825 137 046 883,280 1806 151 2,781 746
225,029 Chayth^n
nhan tao
102 14,343 1.860,287
512,619 98.680 611,299
466,610 116,489 661 966 1,245,065 1,856,364 3,923
129,700 129,426 0,274
Tham phan phuc mac thong qua mang bung
62 20 624 1 146,488
152.281 212.015 364.296
319.215 20 557 221.314 561,086 925,382 221,106
55,590 44,869 10,721
Bong 3a Chi phf quan ly chung cua tffng vung
Chl phi co ban (thue nha, khau hao) Chi phf quan ly va ho'tro nhan vien He thong thdng tin lien lac va hd so benh an Drch vu chung (dien, nudc..,)
long
So tiSn (LOOOd) 233.226 354.682 157.219 40.698 785.825
Nhan to phat sinh CP Dien tich khdng gian So luong benh nhan So luong dich vu Kw SLJ dung (Udc tinh)
Bong 3b NhSn to phat sinh chl phi quan iy
Dien tich So ludng benh nhan So iudng dich vu Kilowatt si^J dung udc tinh
Chay th$n nhan tao 18,900
102 14 343 563.295
Tham phan phuc mac thong qua mang bung 11.100
62 20,624 99,406
long 30,000
164 34,967 662,700 Tinh chi phi qudn ly chung cua tdng vung nhu sau: (DVT: I.OOOd)
So 12-Thang 9/2018 395
Bang 3c Chi phf quan ly c^ung cua tdng vung
Chi phi CO ban (thue nha, kha'u hao) Chl phi quan iy va ho'tro nhan vien He thdng thdng tin iien lac va hd so benh an Djch vu Chung (dien, nudc,,,)
long
Chayth$n nhan tao 146.932 220.595 64 489 34.593 466.610
TTiam phan phuc mac thong qua mang bung
86,294 134,087 92.730
6.105 319.215
long 233,226 354 682 157,219 40 698 785.825 Bdng 4a
Cac khoan chi phf d|ch vu iSieu dudng Chi phi dang ky dieu duong CP chLing chi hanh nghe dieu duSng CP quan ly dieu dudng CP van hanh may ipc mau
long
Sotien(I.OOOd) 239.120 404.064 115 168 124.928 883.280
Nhan to phat sinh CP Thdi gian lam viec loan thdi gian Thdi gian lam viec loan thdi gian So luong dich vu thuc hien So lUdng dich vu loc mau tai Khoa
Bang 4 b Cao khoan chl phi d|ch vu dieu dudng Thdi gian iam viec toan thdi gian (Dang ky dieu dudng) Thdi gian iam viec toan thdi gian (chifng chi hanh nghe dieu dudng) long sd iuong djch vu ice mau thuc hien
So iUdng dich vu loc mau tai Khoa
Chayth^n nhan tao
5 15 14.343 14.343
Tham phan phuc mac thong qua mang bung
2 4 20,624
0
Tong 7 19 34,967 14.343 Tinh todn chi phi dich vu dieu dudng nhU sau: (DVT: I.OOOd)
Cac khoan chl phf d|Ch vu dl€u dddng Dang ky dieu dudng
ChLIng chi hanh nghe dieu dudng Quan ly dieu dudng Van hanh may ipc mau
long
Chay thikn nhan tao 170.800 318,998 47 240 124.928 661,966
Tham phan phuc mac thong qua mang bung
68,320 85,066 67,928
221,314
Tong 239,120 404,064 115,168 124,928 883,280
djch vu chay than nhan tao sff dung khoang 85%
long cac nguon Iffc va tham phan phuc mac thong qua mang bung khoang 15%.
4. K^'t luan
Ke't quii xac dinh chi phi cho tffng loai dich vu theo 2 phffdng phap co sff khac nhau. Theo phffdng phap iruyen tho'ng, chi phi chung dffde phan bo cho dich vu chay than nhan tao nhieu hdn do dich vu nay tao ra doanh thu nhieu hdn. Theo phffdng phap ABC, chi phi chung phat sinh nhieu hay il trong
trffdng hdp nay khong phai la do doanh thu tao ra nhieu hay it ma la do nguon phat smh chi phi cua tffng loai dich vu la khac nhau, d phffdng phap nay chi phi cua dich vu chay than nhan lao con nhieu hdn phffdng phap truyen tho'ng, chinh vi dieu nay nen dSn de'n thu nhap thuan va ldi nhuan tff m6i lan cham soc cua 2 phifdng phap la khac nhau. Vdi phffdng phap ABC, chi phi du'dc tinh toan chinh xac hdn dd xac dmh du"dc ro nguon phat sinh chi phi cho tffng loai dich vu •
3 9 6 Sd 1 2 - T h o n g 9/2018
KETOAN-KIEM TOAN
TAI LIEU THAM KHAO:
/. Chinhphu (2012), Nghi dinh sd 85/2012/ND-CP ve ca che hoal dgng, cO che Idi chinh ddi vdi cdc don vj sU nghiep y le cong ldp vd gid dich vu khdm benh. chSa benh ciia cdc ca sd khdm benh, chda bSnh cong lap. Ban banh ngdy 15/10/2012
2. Cooper R. The rise of Aclivily-based costing (J 988), when do 1 need an aciivity-hased costing system.
3. Innes J. Mitchell F (1995). A survey of activity-based costing in Ihe U.K.s largest companies.
4 Vien Chien lugc vd Chinh sdch Y te(2009), Ddnh gid tdc dong ban ddu cua viec thtfc hien lU cha tdi chinh benh vien ddi vdi cung dng vd chi Ird dich vu y te.
5. Yee-Ching Lilian Chan (1993), Improving hospital cost accounting with activity-based costing.
6. Robert Kaplan & Anthony A Atkinson (2014), Advanced managemeni Accounting. Third Edition.
7. S. Udpa (1996). Activity-based costing for hospital
Ngay nhaD bai: lS/8/2018
Ngay phan bien danh gia va su'a chffa: 28/8/2018 Ngay chap nhan dang bai: 6/9/2018
Thong tin tdc gid:
TS. VU THI THANH THUY
Vien Quan tri va Cong nghe FPT - Dai hoc FPT
IMPLEMENTING THE COST ACCOUNTING METHOD ON CALCULATING MEDICAL
COST IN VIETNAMESE PUBLIC HOSPITALS
• PhD, v u THI THANH THUY
FPT Technology a n d Management Institute, FPT University
ABSTRACT:
According to Health Strategy and Policy Institute (2009), public hospitals in Vietnam are facing many challenges in providmg the best quality services vi'ith limited resources under ihe impacts of intemational integration and socio-economic development and significant changes related to autonomy and self-responsibility in performing tasks, organizational structure, payroll and finances. These challenges make public hospitals to find and effectively implement the cost accounting method which is usually used in profit-seeking enterprises. Activity-based costing, which is an accounting method, is appropriate for public hospitals in Vietnam.
Keywords: Cost accounting, public hospital, medical cost, Vietnam.
So 12-Thang 9/2018 397