Study On CostAccounting Of Hospital Inspection Items Based On Triangular Fuzzy-Time Driven Activity Based Costing

BackgroundDeepening the reform of the medical and health system makes the long-standing problems in hospital cost management,such as imperfect contents of hospital cost accounting and incomplete cost management framework,increasingly prominent.Hospitals are places that provide medical services and other related health services.There are many kinds of diseases,differences in patients' own conditions and great diversity of medical and health services,which all add difficulty to the cost control of hospitals.At the present stage,public hospitals generally adopt a combination of full cost accounting and experience cost allocation rules to determine the cost of various medical services.Due to the untimely and inaccurate service cost information,the cost has not been effectively controlled,and the overall optimization of resources has not been well solved,the current cost accounting method is difficult to adapt to the characteristics of diversity of medical services.Under this background,the idea of the fine cost management has gradually attracted the attention of many hospital managers.As a tool of the fine cost management,Time Driven Activity Based Costing(TDABC)has the characteristics of low implementation cost,low maintenance cost,resource allocation,idle capacity management and cost control,and has gradually attracted the attention of scholars and hospital managers.However,TDABC did not reach the original idea of Professor Kaplan and other scholars in practical application.The two necessary indicators(actual production capacity percentage and time required for unit operation)in constructing the time equation were estimated through questionnaires or interviews.However,the relevant data estimated by management personnel were subjective and varied,which affected the accuracy of the cost estimation results to a certain extent.So,introducing the concept of triangular fuzzy number(TFN)into the time-driven activity-based costing method can more accurately estimate the cost and operation time under the condition of uncertainty under the premise of considering the uncertainty of time and cost parameters,so as to better grasp the unused resource capacity.Secondly,inappropriate identification of unused idle costs in these resources will have a significant impact on the decision-making of managers.Based on triangular fuzzy time-driven activity-based costing,unused resource capacity can be more accurately identified.Triangular fuzzy number can use three values(lowest possible value,most possible value and highest possible value)to accurately describe the actual production capacity percentage and the time required for unit operations,making up for the lack of data estimation uncertainty in the process of data input(cost and time)by TDABC.Therefore,Triangular Fuzzy-Time Driven Activity Based Costing(TF-TDABC)is a suitable method to accurately estimate the cost of hospitals and other medical centers under uncertainty.At present,the research of using TDABC to calculate the cost of medical items is mostly concentrated in the ultrasound department and CT department of the hospital,less TDABC is applied to the cost calculation of the inspection items in the laboratory,and more of the cost calculation of the inspection items is still the activity-based cost method.In this study,TFN and TDABC are combined to test items cost accounting,which not only makes up for the shortage of simple time-driven activity-based method to calculate the cost of medical items,but also enriches the related research on the cost accounting of test items.Research Significance and PurposeIn this study,TDABC and TFN are applied to the cost accounting of inspection service items in the clinical laboratory of public hospitals.According to the characteristics of the inspection items,TF-TDABC cost accounting process is formed.The rationality of the accounting results is analyzed by comparative analysis method to test the effectiveness of TDABC in the cost accounting of medical items.At the same time,find out the idle capacity of the laboratory and put forward feasible measures to control the inspection cost.TF-TDABC can make up for the lack of subjectivity of TDABC indicators and improve the accuracy of cost accounting data,thus helping managers to control hospital costs more effectively.MethodsIn this study,the medical testing center of S hospital is taken as the research object,and TF-TDABC is used to calculate the cost data of the testing items of five sub-departments of the laboratory from January to September 2019.First of all,through reading a lot of relevant documents about hospital cost management,such as TDABC,TFN and hospital cost management,then initially constructing the accounting steps of TF-TDABC.Secondly,in the depth understanding of the specific process and cost accounting of the medical service items provided by the clinical laboratory of the S hospital,consulting experts' estimation of actual production capacity percentage and unit operation time by Delphi expert consultation method,obtaining relatively unified data through three rounds of expert consultation,then carrying out cost estimation according to TF-TDABC steps,comparing the estimation results with the results of traditional cost estimation methods,and analyzing the idle cost situation.Through research,it is found that:First of all,TF-TDABC is used to allocate resources to inspection items according to time factors.After TF-TDABC cost calculation,the costs of blood and humoral tests,clinical biochemical tests,clinical immune tests,clinical molecular biology tests and clinical microbiological tests are 26,69,88.7,129.19,151.3 and 165.6 yuan/case respectively.The results of traditional cost accounting methods are 37,19,97.24,129.89,122.96 and 121yuan/case respectively.Through interviews with relevant experts in the laboratory and finance departments,the results of TF-TDABC accounting take into account the complexity and diversity of the inspection items in the inspection process,and the results are more accurate.Secondly,through TF-TDABC cost accounting for inspection items,it is found that there are 12.81%idle costs for wages and salaries,62.18%idle costs for equipment-related expenses,62.83%idle costs for other materials,68.28%idle costs for properties and other expenses in the inspection department.Through combing the whole inspection process,it is found that idle cost is related to market demand and inspection process,which can be controlled by adjusting personnel scheduling and other methods.Thirdly,TF-TDABC has adopted a separate allocation method for all kinds of expenses in the auxiliary operations,inspection operations and reporting operations of all kinds of inspection items,fully considering the particularity of different inspection items,which is helpful for the inspection department to effectively control the cost accounting of different inspection items.Discussion and suggestionsThis study found that triangular fuzzy time-driven activity-based costing introduces the concepts of triangular fuzzy number and time into the assignment of activities,omitting the complicated calculation of resource cost division,simplifying the cost accounting steps,and establishing the cost accounting steps of medical projects based on department cost data,it estimates the cost of data compared with the traditional cost accounting method is more accurate,can fairly reflect the cost difference between different inspection items,helps the hospital cost of fine management.Therefore,it is suggestes that the financial departments of the hospital should be familiar with the cost accounting method,further improve the financial system,apply the method to the cost accounting of other medical items,explore a more reasonable pricing standard for medical items,improve the cost management level of the hospital,and provide feasible measures to reduce the medical burden of residents.At the same time,the application of TF-TDABC in the cost accounting of the inspection items can help the laboratory to find the unused capacity.It is suggested that the hospital laboratory should respond to the national call to further reduce the inspection cost,improve the utilization efficiency and control the proportion of idle cost according to the cost accounting data.