Research On The Performance Audit Of Public Hospital Projects Based On The Perspective Of Internal Control

Background "Difficult and expensive" is an important issue related to people’s livelihood.It is also a worldwide difficult problem.Base the problem,the Chinese government launched a new round of health reform.The State Council promulgated the "The pilot reform of public hospitals in 2011 work arrangements".To improve the efficiency of the hospitals,the work arrangements required around four "separate" principle to promote the reform of public hospitals,established of a modern hospital management system,and stepped up investment in the health sector.But compared to the medical reform goal and the health service demand of the masses of the people,the existing health resources are still relatively insufficient.How to make scarce health resources to maximize effectiveness needs the health authorities to make an objective and fair evaluation.As a third-party evaluation(witness)service,through reporting an independent and objective audit opinion,audit serves the management and supervision work.With the rise of the new public management movement,the accountability demand of government performance is increasingly strong for the government regulators.So in the audit system,the performance audit is increasingly important.Performance audit has been widely carried out in Canada,Britain,Sweden,American,Holland,India,Japan and many other countries.Most foreign scholars to study the performance of public hospitals have been established on the basis of the government performance audit.At present,China’s domestic research for the public hospital performance audit system construction is still blank,especially theoretical framework and implementation path research have not been seen.In practical operation,public hospital auditaudit is financial revenues and expenditures based on compliance audit.Objective This study,in the context of health care reform,drawed on the latest achievements of audit theory about the perspective of internal control audit method,and started from the process of internal control in public hospitals based on the risk-based system which was established in control test.The purpose was to study the theory and practice of public hospitals in Beijing is funding the project financial performance audit,explore the public hospital audit model and possible implementation methods,and to better serve the supervision needs of public hospitals in the context of governance reform.Significance The paper conducted a preliminary attempt and exploration for the country to carry out the research on the theory and practice of performance audit of public hospital,and lay the foundation for the further study in the future.Performance audit results can provide scientific basis for management decisions,it is conducive to scientific management and evaluation of budget,and can improve the efficiency in the use of medical resources.Methods1.The historical analysis and system analysis method:Using historical analysis research the gradual process of evolution of budget performance audit theory and practice under he interaction of several factors in the external system environment changesand academic intervention.2.Inductive and deductive analysis:Based on the view of the internal control process in audit theory,combined with the relevant indicators of health economics performance,referring to the theory and method of evidence-based decision making,the paper built the theoretical system and analytical model of the project performance audit of public hospital owned by Beijing.Using the agency theory,stakeholder theory and other analysis tools,combining public hospital reform policy background and regulatory needs,the paper analyzed the audit mode using standard research methods in public hospitals,and made policy recommendations.3.Case Study:According to the performance audit of "medicine separate"projec in a public hospital owned by Beijing before and after the launch,by analyzing the hospital’s budget and financial revenue and expenditure in recent three years,the paper extracted the typical sample,audit the "medical separation" project performance with meta-analysis,on-site observations,walkthroughs and other auditing techniques,in order to test the rationality and operability of public hospital performance audit theory and the analysis model.4.Empirical Analysis:Through questionnaire survey and open interview,health and Family Planning Commission,Beijing Municipal Health Bureau,Beijing Municipal Hospital Authority,and all levels of the department of Health Policy formulated,and the management of public hospitals all had been site investigatedn,in order to collect the qualitative and quantitative data to evaluate the reliability of the audit conclusion by using the method of statistical analysis.Results By analysising the domestic and international public sector performance audit theory and methods,combining current situation of reform and development of public hospi tals,according to the type of hospital management activities,and the use of multi-disciplinary theoretical to construct theoretical analysis model of the public hospital performance audits.Meanwhile,combine the financial project case of "Medical separation" about the reform of public hospitals in Beijing pharmaceutical,from a practical level,testing the the possibility of performance audit in the public hospitals and existing problems.1.The research started from the overall goal of "medical separation" project,bese on the fiscal policy of Pan conversion,audit the establishment of the medical service fees whether can make up canceled registration fees,medical fees and drug addition income.Based on the compliance audits,after evaluating the data authenticity and legality that used in the performance audit,the paper distinguished the performance conditions of "Medical separation" project carried out before and after.In compliance audit of the performance audit process,the research focuses on the compliance audits of data impacting on the performance,mainly reflected in the importance of the level of professional judgment of auditors for compliance audits.2.In the performance audit process,the paper gets the homogeneous conclusions between evidence-based management and performance audit by analogy analysis.Applying the principles of evidence-based management,it builds performance Indicators through certified by card and Undocumented record card,from the perspective of internal control processes,and evaluats the investment and output on the project from the economy,efficiency,effectiveness three dimensions.3.In the design of performance index system,the paper selects the representative targets through departments repeated discussion,expert consultation,literature analysis and other progress.In the evaluation process,the data comes from the A hospital’ s financial data,HIS data,reported to the competent departments by A hospital and Beijing statistical information plat,etc.The true extent of the data is high.The study tested performance audit in the pilot hospital with practice,and verifed and summarized the existing theories and methods.4.The paper proposes to build on stakeholder engagement,and the service model oriented to the performance audit,to serve the supervision need of public hospitals under hospital governance reform.Conclusion The implementation of performance audit of public hospitals is in favor of full use of medical resources,provides a new tools for monitoring and evaluation to the management of public hospitals.It is feasible in practice,can help regulators make regulatory decisions.So the performance audit should be included into the existing audit service system to serve the public hospital reform,further more,strengthening hospital corporate governance.