Organizing the accounting work in central general hospitals in hanoi in terms of financial autonomy

Reviewing domestic literature shows that there have been many studies on

organizing accounting work in public hospitals in particular and public non-business

units in general. However, there have been no studies to systematically and

comprehensively present the relationship between organizing accounting work and

implementing financial autonomy. At the same time, the studies were conducted before

the application of the Circular No.107/2017 /TT-BTC on guidelines for public sector

accounting, replacing Decision 19/2006/QD- BTC

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NON- BUSINESS UNITS IN TERMS OF FINANCIAL AUTONOMY There are many approaches to study organization of accounting work in an accounting unit. If the approach is according to the order and content of accounting work, organizing accounting work should be studied according to the following contents: accounting documents, accounting accounts and accounting books, financial statements, etc. If the approach is according to the order of collecting, processing and supplying information, organizing accounting work should be studied according to the following order: (1) Organizing the collection of accounting information; (2) Systematizing and processing accounting information; (3) Organizing the provision of accounting information, etc. With the aim of researching organization of accounting work in hospitals in terms of financial autonomy, due to the changes in information needs when these units implement autonomy, this thesis applies the latter approach to have a clearer analysis of the current status of accounting work in central general hospitals in Hanoi in terms of financial autonomy. 2.3.1. Organizing accounting apparatus 2.3.2. Organizing accounting information acquisition in public health non- business units 5 5* Concept of acquiring accounting information in public health non-business units rements of organizing accounting information in public health non- busine atizing and processing accounting information in pub rements of processing accounting information in public health non- busine ricing methods to process accounting information in public health non-bu to systematize and process accounting inform to systematize and process accounting inform ganizing provision of accounting information in public health non- busine ation and requirements of * Requi ss units * Methods of acquiring accounting information in public health non-business units * Organizing accounting document system in public health non-business units 2.3.3. Organization of system lic health non-business units 5 6* Requi ss units * Applying p siness units * Organizing accounting account system ation in public health non-business units * Organizing accounting book system ation in public health non-business units 2.3.4. Or ss units 5 7* Subjects that need to use accounting inform 9 accoun ccounting reports to provide accounting information in public health izing analysis of accounting information in public health non- busine zing the application of information technology to the accounting work organization on. This is an important premise for in-depth research in the next chapters of the thesis. ACCOUNTING WORK IN CENTRAL GENERAL HOSPITALS IN HANOI OF FINANCIAL AUTONOMY IN CENTRAL GENE red as typical and highly representative among all central general hospit ting information in public health non-business units * Organizing the preparation of financial statements and finalized financial statements, management a non-business units * Organ ss units 2.3.5. Organizing accounting examination 2.3.6. Organi CONCLUSION OF CHAPTER 2 In chapter 2, the thesis systematizes the theoretical framework of financial autonomy and accounting work organization in public non-business units, thereby pointing out the factors affecting financial autonomy and accounting work organization in public non-business units. On that basis, the thesis describes financial autonomy in public health non-business units and points out requirements for organizing accounting work in public health non-business units in terms of financial autonomy. At the same time, the thesis analyzes the basic content of organizing accounting work in public health non-business units according to the procedure of receiving, processing and supplying accounting informati Chapter 3 CURRENT SITUATION OF ORGANIZING IN TERMS OF FINANCIAL AUTONOMY 3.1. CURRENT SITUATION RAL HOSPITALS IN HANOI In the research scope, the thesis considers 03 central general hospitals under the Ministry of Health in Hanoi including: Bach Mai Hospital, Huu Nghi Hospital and E Hospital. Although the number of hospitals in the study is limited, these are the hospitals that can be conside als in Hanoi. 3.1.1. Overview of central general hospitals in Hanoi 1 93.1.1.1. General overview of central general hospitals in Hanoi All 3 hospitals are the last level on the medical treatment ladder, providing specialized, complex, high-tech and well-equipped services. However, besides the advantages brought about by the specific nature of the general hospitals - creating diversity in the medical techniques and services provided, all three hospitals have certain 10 disadv nancial autonomy mechanism. tions. Their expertise and reputation are very high, these hospitals have strong n the period from 2014 to 2018 9, 2019, the Resolution 33/NQ-CP on the pilot implementation of compr three hospitals has also shifted toward e autonomy mecha crease rapidly both in 0% of total recurre work, good control of inform antages compared to other central specialized hospitals in the process of implementing fi 2 03.1.1.2. Current situation of the development of central general hospitals in Hanoi Central general hospitals in Hanoi are characterized by large-scale concentration, high expertise and history of development. These are large-scale hospitals with very high concentration: the number of hospital beds is more than 1.000; the number of staff on the payroll is more than 1.000 people, especially hundreds of professors and doctors with leading qualifica financial capacity, and the total revenue from non-business activities is trillions of dong in a year. 3.1.2. Results of implementing financial autonomy in central general hospitals in Hanoi i 2 13.1.2.1. Process of implementing financial autonomy in central general hospitals in Hanoi E Hospital and Huu Nghi Hospital have been promoted to the type of public non- business units that ensure all regular operating costs since 2018. Particularly in Bach Mai Hospital, on May 1 ehensive autonomy and self-responsibility mechanism of 04 hospitals under the Ministry of Health. Thereby, organization of accounting work in s controlling instead of directly managing all revenues and expenditures. 3.1.2.2. Situation of revenues in the hospitals Financial autonomy has helped hospitals develop comprehensively the provision of medical services and ancillary services, especially on-demand services. In fact, thanks to characteristics of central general hospitals, their favorable locations in Hanoi and their advantages of leading professional qualifications of the country, in recent years, the hospitals have been well implementing the autonomy mechanism, especially the financial autonomy to ensure and manage the hospital's revenues and expenditures according to the financial principles and the State Budget Law. Th nism has created conditions to help revenues from health services in absolute terms and accounting for an increasingly large proportion. 3.1.2.3. Situation of implementing spending tasks in the hospitals In the process of implementing financial autonomy, the total recurrent expenditure from these sources increased from 1.5 to 3 times in the period from 2014 to 2018. In which, the proportion of expenditures for professional operations from this source was about 65% of total expenditure on average, personal payment was around 2 nt expenses. Therefore, in organizing accounting ation about these two expenditures plays an important role in quality. 11 2 23.1.2.4. Results of financial autonomy implementation great financial source to invest in medical equipment, expand and develo nt venture, associate as well as impro ls and the payment of additional income is implemented on the princip saving expenditure, receive higher payme IZING ACCOUNTING WORK IN CE ANOI g, especially accounting in the public sector, hospitals have No.10 The difference between recurrent revenues and recurrent expenditures in hospitals has tended to increase but not evenly 2 3 .1.2.5. Situation of settling and using funds Settlement and use of funds, especially non-business operation development funds, have been a p the infrastructure system, develop activities joi ve professional qualifications and skills for the team of medical doctors through training programs. 2 43.1.2.6. Situation of additional income payment The content of additional income spending is specified in the internal spending regulations of the hospita le: Departments, provisions and individuals having high working efficiency and considerable contribution in increasing revenue and nt and vice versa. 3.2. THE CURRENT SITUATION OF ORGAN NTRAL GENERAL HOSPITALS IN H 3.2.1. Situation of the accounting apparatus organization and accounting policy applied in central general hospitals in Hanoi 2 53.2.1.1. Regarding accounting policy The basis for the hospitals to organize the accounting is the State's regulations on the accounting regime applicable to non-business units. From January 1, 2017, the State Budget Law 2015 and the Accounting Law 2015 have come to effect, marking a new reform of finance and accountin implemented and applied these new regulations into practice. The Circular 7/2017/TT-BTC on guiding the public sector accounting has been applied by hospitals since January 1, 2018. 2 63.2.1.2. Regarding the organization of accounting apparatus Survey results show that the current accounting apparatus of the hospitals is often organized in a centralized accounting model. In terms of the number and qualifications of accountants in the hospitals Due to the different characteristics and sizes of each hospital, the number of accountants in each hospital is different; particularly Bach Mai Hospital has 82 accountants, more than 3 times higher than the other two hospitals. Through the survey, it is f ntly, in ound that the accounting staff's qualifications have improved significa which, accounting personnel with a university or higher degree account for over 80% of the total number of accounting staff. In terms of division of labor in accounting departments in the hospitals Based on the volume of accounting work and the qualifications of accountants, the chief accountant assigns each accountant to undertake one or several accounting 12 operat ve incorporated some contents of management accounting in their accoun ds. For the accountants who are facilitated by the directors of the hospit ivil servant rank-promotion exam, the hospitals only support in term ime to build their systems of accounting vouchers in accordance with the charac tus of the units. Except for Huu Nghi H 2: Organizing accounting voucher checking g vouch account books comparison. At the end of the annual accounting period g information in centra ospitals are currently applying the Circular No.10 ions. Although there is no proper management accounting department, the hospitals ha ting apparatus organization. In terms of the financial source to train and improve the qualification of accountants The regulations on internal hospital expenditures also mention that funding to support short-term training, improving skills and working capacity for accountants in the hospitals is often taken from the State budget source and non-business operation development fun al to participate domestic training courses to improve their professional qualifications and skills or c s of time. 3.2.2. Organizing accounting information acquisition in central general hospitals in Hanoi Step 1: Organizing the accounting document acquisition The survey results show that the hospitals have based on the current non-business accounting reg teristics, operational scale and accounting appara ospital, the other 2 hospital have used electronic invoices directly extracted from the software. Step The survey results shows that most hospitals have organized to check accountin ers before using them, especially for electronic documents related to hospital fee collection. Step 3: Organizing the use of accounting vouchers for recording After being checked, accounting vouchers are arranged and classified according to different criteria. Step 4: Preserving, storing and destroying accounting vouchers After recording accounting books, vouchers are kept at the accounting department to serve the needs of checking and , accounting vouchers will be archived according to regulations. 3.2.3. Situation of systematizing and processing accountin l general hospitals in Hanoi 2 73.2.3.1. Situation of organizing the accounting account system Regarding building the systematic list of accounting accounts The survey shows that the h 7/2017/TT-BTC. Particularly, depending on the specific operational characteristics 13 of eac the determination of the reflected contents of the accounting accounts and th ocessing accounting information in the accounting section of raw materials, materi rting drugs and medic ing information on accounting of hospital fees and health insura pital fees and health insurance reatment ent to joint ventur g and closing accounting books m bookkeeping on computers, so in the bookkeeping depart At the end of an accounting year, a hers. h hospital, the detailed account systems have different contents, which has led to the inconsistency between the hospitals Regarding e accounting methods of some key operations of the hospitals - Pr als and tools, tools - accounting process for importing - expo al supplies - Processing account nce - Accounting for collection of hos - Regarding the current status of expense recognition related to medical examination and t - Processing accounting information on accounting of fixed assets - realization of depreciation of fixed assets - Processing accounting information on accounting of salary and additional income paym - Processing accounting information in the accounting practice related e, association and public - private partnership in the hospitals. 3.2.3.2. Situation of the organization and application of the accounting book system Selecting an accounting model and defining the accounting book system In the three hospitals considered in the thesis, Bach Mai Hospital and Huu Nghi Hospital have chosen the voucher record accounting, and E Hospital has chosen the general journal entry accounting. Developing the process for opening, recordin All hospitals perform bookkeeping using accounting software systems. The construction and design of the recording process on accounting books is carried according to the accounting software program ordered by the hospitals. Preserving and archiving accounting books All hospitals perfor ment, all accounting books are stored on computers and bookkeepers are mainly responsible for the direct entry in the accounting books. ccounting books are printed, arranged and preserved in the archive department with accounting vouc 3.2.4. Situation of organizing accounting information provision in central general hospitals in Hanoi 3.2.4.1. Situation of organizing accounting information provision according to current regulations Before December 31, 2017, the preparation and presentation of financial statements and finalized financial statements of the hospitals were implemented 14 according to the public accounting regime issued under the Decision No. 19/2006/QD- BTC and the Circular No.185/2010/TT-BTC amending and supplementing the Decision No.19/2006/QD-BTC. In 2018, this is the first year that central general hospitals in Hanoi complying with the Circular No.107/2017/TT-BTC. Situation of making finalized financial reports, financial statements and management accounting reports Many hospitals at first encountered problems when preparing financial statements such as how to balance between Total Assets and Total Capital and how to detect the cause of imbalances. Besides, during the survey, the author received the most feedback related to the cash flow report such as "confusing, complicated" of this report. Situation of analyzing finalized financial reports, financial statements and management accounting reports The analysis of information on financial statements and finalized financial reports in the hospitals has just stopped at justifying financial statements and finalized financial reports. 2 83.2.4.2. Situation of the organizing information provision according to the requir In addition to the systems of financial statements and finalized financial reports in acc overnance needs of the hospital. g software such as DA agement software, health insurance assess ocused on by public hospitals. ION OF ACCOUNTING WORK IN CENT ocess of organizing the accounting work in the ce g is generally suitable for the current scale and charac ements of internal management and governance in hospitals ordance with the Circular 107/2017/TT-BTC, the hospitals have developed the number of reports to serve the management and g 3.2.5. Situation of accounting examination in central general hospitals in Hanoi The accounting inspection is carried out by competent agencies outside the hospitals and internal inspection at the hospitals. 3.2.6. Situation of information technology application in accounting work in central general hospitals in Hanoi According to the survey, all the hospitals have applied accountin S or MISA and some software to support the hospitals' professional operations such as hospital fee software, pharmacy man ment software, human resource management software, etc. This shows that the application of IT in accounting has been f 3.3. ASSESSING THE CURRENT SITUAT RAL GENERAL HOSPITALS IN HANOI 3.3.1. Results achieved in the pr ntral general hospitals in Hanoi 2 93.3.1.1. Organizing accounting apparatus The centralized form of accountin teristics of the hospital operations. 15 3 0 .3.1.2. Organizing accounting information acquisition The hospital has performed quite well in organizing the information acquisition through the accounting voucher system. 3 1 .3.1.3. Organization of systematizing and processing accounting information is relatively consistent with t eed to retrieve detailed information, as well as collate and check reports in regulated forms and in accordance with the requir ed financial reports. has been also implemented in all stages and all accoun .6. Organizing the application of information technology to accounting work e different. zed accounting system organization is only suitable at the presen been no management accounting department in the accounting appara e hospitals has not been paid a The current accounting account system of the hospitals he accounting regime in the current regulations, contributing to recording and reflecting regularly, continuously, systematically operations of the hospitals. The accounting book system in the hospitals is quite logical, ensuring data linkage in the whole unit and meeting the n data on financial statements. 3 2 .3.1.4. Organizing provision of accounting information Thanks to the application of accounting software, the hospitals have prepared relatively complete ements of providing information for the users of financial statements and finaliz 3 3 .3.1.5. Organizing accounting examination The accounting examination in the hospitals has been carried out relatively regularly and continuously. Checking ting processes. 3 4 .3.1 Depending on the characteristics of the operations, requirements, management skills and financial resources of each hospital, the application of information technology and the efficiency of use ar 3.3.2. Limitations in organizing accounting work in central general hospitals in Hanoi 3 5 .3.2.1. Organizing accounting apparatus Firstly, the centrali t time, but not suitable for the development in the scale and types of operations of the hospitals in the future. Second, there has tus of the hospitals. Hence, the financial management of th ttention, making the hospitals not be active in balancing and controlling financial resources in the hospitals. Third, the accounting apparatus is not compact, light, and has not made the optimal use of resources from hospital management software and the development of information technology. 3 6 .3.2.2. Organizing accounting information acquisition - The recording of factors related to the contents of the accounting vouchers is sometimes not complete and timely; 16 - The acquisition of accounting information in the process of importing - exporting drugs are still passive, depending on other departments, especially the pharm d r exists e checking of accounting vouchers is only in the first stage, but after entering vouch reserving documents in the hospitals has not been scientifically, leadin of management and administration of each hospital, this creates rms of determining the reflected content of accounting accounts and ac acy management department. Hence, it is not timely, the objective and clear in expressing the central role and the controlling role of accounting at this stage. - The preparation and use of e-invoices are still limited, and the utility from e- invoices has not yet been optimize - The accounting voucher system for accounting management does not exist o but still has many limitations - Th ers into the machine, the accountants do not check or omit the inspection. - Storing and p g to difficulties in checking 3 7 .3.2.3. Organization of systematizing and processing accounting information Firstly, in terms of designing and building a systematic list of accounting accounts - There are hospitals that have not used, or misused economic content of accounting accounts. - Although the design and opening of detailed accounts depends on the characteristics and requirements inconsistencies between hospitals, causing difficulties for other users of reports, especially governing agencies. Secondly, in te counting methods for a number of key operations in the hospitals Limitations in processing accounting information in the accounting of impor pharmaceutical management software and a gs is recorded and reflected at the end of the month in diff departments to treatment departments and patient rooms, but the ting and exporting drugs - Information on drug storage is manually entered into accounting software by the hospitals, and there is no connection between ccounting software. - Information on exporting dru erent ways between the hospitals. - It is a risk of drug leakages that the cost has been accounted when drugs are exported from the pharmacy patient has used or not used the drugs. Limitations in processing accounting information in the accounting of medical e ion of health insurance revenues and expenses in the period are incons ng standards. xamination and treatment activities - The recognit istent and not complying with the revenue recognition principles in international public accounti - There have been no criteria for the allocation of general expenses to each department 17 Limitations in processing accounting information in the accounting of fixed assets - There is still confusion and lack of understanding the nature of the depreciation of fixed assets - Not fully understanding the regulations on the scope and subjects of the depreciation of fixed assets. Limitations in processing accounting information to pay salaries and income for staff in the hospitals e the problem of dev There is no appropriate accounting treatment to harmoniously solv eloping high-quality human resources Limitations in processing accounting information in the accounting of joint venture and association activities ly reflect the nature of LD, L he accounting book system s. ubmit financial statements and finalized financial reports of hospit ondly, there are many difficulties and problems in making financial reports, such a nalized financial reports at the hospit l govern an internal control department, they directly assign ntents of their work. essing efficiency, and support daily management and operations has not been c Accounting for this activity in hospitals does still not real K. Third, limitations in the application of t The detailed accounting books are opened according to the subjectivity of the hospitals, which is incons

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