What applies to non-medical expenses? Expenses of a medical organization: an economist’s memo. Cost estimate for a medical institution

“Several different terms are used to indicate the cost of resources consumed by a medical institution: costs, costs, expenses, cost. In most cases they are used as synonyms. However, each of these terms also has a specific meaning. Meanwhile, in many cases, these terms (with the exception of “cost”) can also reflect the amount of resource consumption in physical or labor terms (electricity consumption, electricity costs; labor costs, etc.).

Thus, some authors believe that expenses are part of the costs of manufacturing products and providing services sold in a given accounting period. The moment of transition of costs to the state of expenses is determined by the moment of shipment of products. Others, on the contrary, believe that, unlike expenses, expenses are strictly tied to the reporting period. There is a point of view that the concept of “costs” is broader than the concept of “cost”, which represents the costs of simple reproduction, running costs specific manufacturer."

A medical service, like any product, has a value, a monetary value, which is the price. Prices for services consist of two main elements: cost and profit.

To calculate prices for medical services, the concept of “profitability” is also used, which is generally determined by the ratio of profit to cost (there are other indicators of profitability).

"To calculate the cost medical services The structural units of a medical institution are divided into main and auxiliary.

The main divisions of a medical institution include: specialized departments of hospitals, departments (offices) of clinics, diagnostic centers, outpatient (treatment and diagnostic) departments and offices in which the patient is provided with medical services.

Supporting units include institutional services that support the activities of clinical and treatment and diagnostic units (administration, personnel department, accounting, medical statistics office, registry, pharmacy, sterilization, housekeeping services, etc.).

Meanwhile, another group is used - with additional allocation of service units. In this case, auxiliary units include units that help provide medical care: pharmacy, sterilization room, etc., and service units include units that ensure the functioning of the institution: administration, human resources department, accounting, business services, etc.” .

The following classification of costs for the provision of medical services, grouped according to various criteria, can be given.

By departments involved in the provision of services:

Costs of the main medical (clinical) department;

Costs of paraclinical (therapeutic and diagnostic) services - laboratory, radiology department, etc.;

Anesthesia service costs;

Costs of the operating unit (wages of nurses and attendants of the operating unit, Consumables etc.);

Consultations with specialists from other services (ENT, ophthalmologist, etc.);

Costs of auxiliary (service) departments - sterilization, procedural, etc.;

Housekeeping costs;

Costs of administrative and management personnel (AUP).

The structure of tariffs for medical services usually consists of the indicated main blocks, some of which, depending on the adopted methodology, the specifics of the service, and the payment procedure, may be excluded or replaced by others.

For participation in the provision of services (in relation to the process of providing services), expenses (expenses) are divided into:

Basic;

Invoices.

Basic - expenses directly related to the provision of services - wages, medicines, medical instruments, etc. It should be noted that the costs of heating, electricity, water supply are also among the main costs.

Institutional overhead costs include all types of expenses not directly related to the provision of medical services (clerical and business expenses, depreciation of non-medical equipment, salaries of administrative and management personnel, business travel expenses, etc.).

In other words, overhead costs are those types of costs that are necessary to ensure the activities of the institution, but are not consumed directly in the process of providing medical services.

Note that the assignment of specific types of expenses is always conditional.

According to the order of attribution to services (by the method of inclusion in the cost; by the method of attribution to the cost), costs are divided into:

Indirect.

Direct expenses are expenses that can be directly (immediately), without any auxiliary calculations, attributed to certain types of medical services provided. In other words, direct costs are associated with the production of specific specific types of services.

Direct costs include:

Salaries of key personnel;

Accruals for wages of key personnel;

The cost of all material resources consumed in the process of providing medical services (medicines, dressings, disposable supplies, food, etc.);

The cost of partially consumed material resources (wear and tear of soft equipment, depreciation of medical equipment used in the provision of this medical service, wear and tear of low-value and fast-wearing items).

Indirect - costs that cannot be directly attributed to specific types of services and therefore distributed indirectly, as a rule, in proportion to some indicators (established bases). Indirect costs are included in the cost of medical services through calculated coefficients. Indirect costs are associated with the production of several types of services or all services provided. Therefore, indirect costs usually relate to the entire institution or its divisions.

Indirect costs include, for example:

Remuneration of general institutional personnel;

Accruals for wages of general institutional (administrative and economic) personnel;

Utility and business expenses (costs of materials and items for current business purposes, office supplies, inventory and payment for services, including costs of current repairs, etc.);

Expenses for business trips and official travel;

Wear and tear of soft equipment in auxiliary departments;

Depreciation (wear and tear) of buildings, structures and other fixed assets not directly related to the provision of medical services;

Other expenses.

The basis for the distribution of indirect costs may be direct costs, wages of key personnel, space, etc. Thus, part of the indirect costs is distributed in proportion to the wages of key personnel (for example, the salary of administrative and business personnel). Others (for example, utility costs) can be distributed in proportion to the area, etc.

In some cases, indirect costs can become direct if, for example, electricity meters are installed in each office.

It should be noted that the main costs can be both direct and indirect, and overhead, as a rule, are indirect costs. For example, the costs of electricity and water supply are among the main costs, and at the same time they are indirect costs, attributed to the cost of the service using indirect methods. It is necessary to note the features of the classification of costs of diagnostic and treatment services. Costs directly related to the implementation of research and the provision of medical care are considered the main expenses. Most of these types of expenses can be classified as direct. However, if the cost of a bed-day, a completed case of treatment (inpatient or outpatient), etc. includes the costs of treatment and diagnostic services in an average amount, they will be distributed among the main clinical departments using auxiliary methods, i.e. will be classified as indirect costs.

As part of overhead and indirect costs, hospital-wide (general outpatient) and institutional costs can be distinguished.

According to the degree of dependence on the volume of services provided (in relation to production volume; according to cost dynamics), costs are divided into:

Conditionally permanent (permanent);

Conditional variables (variables).

Conditionally fixed (constant) - costs that are practically independent of the volume of services provided (room lighting, heating, etc.). The amount of fixed costs remains unchanged when the volume of production changes (time-based wages of workers, wages and charges for wages of the administrative and economic apparatus, rental of premises, etc.).

Conditionally variable (variables) - costs that change in accordance with the volume of services provided (medicines, consumables, food, etc.). In other words, the total amount of variable costs changes in proportion to the volume of production.

The grouping of costs by costing items reflects their composition depending on the direction of costs for the provision of services in accordance with the economic classification.

Costs attributable to cost, in accordance with the current accounting (budget) accounting system in budgetary organizations, include costs for all costing items aimed at providing medical services.

Classification by economic elements is based on the grouping of all costs that are homogeneous in economic content, regardless of the place where they are incurred (polyclinic, hospital, diagnostic unit, administrative departments, etc.), as well as on the object of the cost (outpatient patient, research blood, etc.).

When determining the cost of any type of medical services, the following grouping of costs by economic elements is used:

Labor costs;

Payroll accruals;

Direct material costs(medicines, food, etc.);

Overheads.

Labor costs refer to the costs of remunerating healthcare workers providing services.

Payroll accruals provide for the costs of paying contributions to state extra-budgetary funds.

Direct material costs include the cost of materials consumed in the process of providing a medical service in full (medicines, dressings, disposable supplies, food, etc.) or partially (depreciation of medical equipment used in the provision of this medical service, wear and tear of low-value and wear-out items) resources.

Institutional overhead costs include all types of expenses not directly related to the provision of medical services (clerical and business expenses, depreciation of non-medical equipment, salaries of administrative and management personnel, business travel expenses, etc.).

Expenses, depending on their nature, as well as the conditions for implementation and areas of activity of the taxpayer, are divided into expenses associated with production and sales, and non-operating expenses.

Depending on the intended purpose, the costs differ for:

Provision of medical services;

Maintenance of medical equipment; maintenance of premises;

Providing food; transport support, etc.

According to the method of consumption in the process of providing medical services, costs are divided into:

Completely consumed during the provision of medical services (medicines, dressings, disposable supplies, food, etc.);

Partially consumed material resources (depreciation of medical equipment used in the provision of this medical service, wear and tear of low-value and wearable items).

By location of costs:

Costs in main departments (departments, offices, etc.);

Costs in auxiliary departments (sterilization, etc.);

General hospital costs - costs for maintaining the hospital management staff (medical director, chief nurse, etc.), help desk, etc.;

General outpatient costs - costs for maintaining the management staff of the outpatient clinic (head of the outpatient clinic, chief nurse, receptionist, etc.), etc.

General hospital and general outpatient costs are the costs of servicing the treatment process and management, respectively, attributable to the hospital or clinic as a whole. These costs include the salary with accruals of the chief of medicine (the head of the clinic), the chief (senior) nurse of the hospital or clinic and other staff of the hospital or clinic who do not provide direct medical care, the costs of maintaining their offices, etc.;

General institutional costs: costs of maintaining administrative and economic personnel (chief physician, accounting, housekeeping services, etc.), etc.

General institutional costs are the costs of servicing the treatment process, management, attributable to the institution as a whole (maintenance of the chief physician, accounting and other administrative and economic services of the medical institution).

Practice shows that currently one of the most pressing problems of pricing is determining the costs of a medical institution by department. Since medical institutions usually have a number of departments and provide a large number of medical services, it becomes difficult to allocate costs attributable to a specific department to a specific service. Below we will consider a number of approaches to the allocation of costs, to their distribution among departments, etc. The principles used for the correct accounting of cost items are important not only for the formation of tariffs, but also for the economic analysis of the activities of medical institutions and solving other problems.

By expense area:

For current expenses aimed at ensuring the ongoing maintenance of the institution;

For capital expenditures aimed at development and expansion of activities.

By inclusion in the cost:

Inventoried;

Period costs.

By role in the production process:

Production;

Non-productive.

By degree of adjustability:

Adjustable;

Unregulated.

Upon payment of expenses incurred:

Actual;

Cash registers.

Let us provide definitions of cash and actual expenses in relation to budgetary institutions.

Actual expenses of an institution are expenses incurred by institutions for activities provided for according to estimates of income and expenses, financed from the federal budget, budgets of constituent entities Russian Federation, local budgets, as well as carried out using funds received from entrepreneurial activity, target funds and gratuitous receipts, documented by the relevant documents, including expenses for unpaid creditor accounts, obligations to the budget, state extra-budgetary funds, accrued wages, scholarships, etc.

Cash expense is an operation to write off funds from the account of a treasury body or in credit organization in payment of obligations accepted in the prescribed manner by the recipient, subject to payment from the funds of the corresponding budget.

Other, broader definitions can be given.

Actual expenses are the amount of resources actually consumed by the institution in the form of medicines, food, employee labor, energy, etc.

Cash expenses are the paid portion of the resources consumed by the institution.

By degree of accuracy:

Actual (expired);

Future (planned).

Regarding the problem:

Significant;

Insignificant.

According to the method of reflection in accounting:

Explicit, taking the form of direct payments to suppliers, factors of production (salaries; medicines and food products purchased by a medical institution, etc.);

Implicit (implementation of transport transportation for the needs of the hospital in the form of sponsorship; allocation of workers by the enterprise to carry out economic works for a medical institution and without formalizing the relationship; use of medicines and food products purchased by patients at their own expense, etc.).

Note that the current regulatory documents use special types of classifications for special purposes. Thus, in accordance with Article 253 of the Tax Code of the Russian Federation (TC RF), expenses associated with production (or sales) and recognized for tax purposes are divided into:

Material costs; labor costs;

Amounts of accrued depreciation;

Other expenses" .

Article 70 of the Budget Code of the Russian Federation indicates the directions of expenditures of budgetary institutions. This is also a specific classification. The article reads:

“Ensuring the fulfillment of the functions of budgetary institutions includes:

Remuneration of employees of budgetary institutions, monetary support (monetary remuneration, monetary allowance, wages) of employees of public authorities ( government agencies), local government bodies, persons holding government positions of the Russian Federation, government positions of constituent entities of the Russian Federation and municipal positions, state and municipal employees, other categories of employees, travel and other payments in accordance with employment contracts (service contracts, contracts) and the legislation of the Russian Federation Federation, legislation of the constituent entities of the Russian Federation and municipal legal acts;

Payment for the supply of goods, performance of work, provision of services for state (municipal) needs;

Payment of taxes, fees and other obligatory payments to the budget system of the Russian Federation;

Compensation for damage caused by a budgetary institution in the implementation of its activities."

5.1. Costs and their structure in healthcare

Numerous organizations represented in the field of medical services are divided into three groups: public, private non-profit and private for-profit. In countries with budgetary healthcare systems, public hospitals account for up to 80% of the total bed capacity. In countries with a compulsory health insurance system, this share is lower – about 50-60%. In countries where private health insurance predominates, private hospitals predominate. Each of the identified groups of organizations has many organizational and legal forms. The development of certain forms is determined in each country by historically established ideas about commercial medicine.

The functioning of various organizations in healthcare requires the expenditure of appropriate resources. These costs form production costs medical, medico-social, health services, determining to a large extent the volume of financing and prices for the corresponding services. Costs can be viewed from the perspective of either the individual producer or society as a whole. In some cases, both approaches give the same result, in others - different. This is because not all results are in monetary form; some of them are being implemented directly, bypassing the purchase and sale relationship, and have a direct impact on the well-being of society or individuals. Social and private costs coincide only in the absence of externalities.

All over the world, healthcare involves an increasing amount of resources used, which inevitably causes an increase in the costs of producing medical services. Appearance new technologies The medical and health process increases the dependence of healthcare on technological means: the traditional “doctor-patient” system is increasingly being replaced by the resource-intensive “doctor-technology-patient” system. Scientific discoveries and the achievements of medical science give rise to mass demand for new, expensive, and until recently very rare medical services and related products (for example, transplant operations of artificial and living organs and tissues). Satisfying this demand requires attracting additional economic resources. Prospect of emergence and mass distribution new dangerous diseases necessitates the allocation of significant funds for large-scale scientific research and the development of adequate protection measures.

In healthcare, the dependence of average production costs on the volume of services provided is also described by a U-shaped curve. As the size of a medical organization increases, average costs decrease to a certain minimum and then begin to increase. At the same time, medical organizations are not homogeneous in terms of the composition of patients served, the complexity of the services provided, the cost of training specialists, the volume of scientific research, etc., therefore low average costs in themselves are not indicators of higher efficiency. In addition, the inability to transport and save medical services very often creates a situation where the long-term average cost curve reaches its minimum value at volumes much greater than the actual demand, i.e., the optimal production volume cannot always be realized.

The increasing complexity of the infrastructure related to the protection of public health leads to an increase in administrative costs, costs of maintaining various types of inspections, information blocks, statistical services, etc. Everything related to the coordination of the activities of various entities constitutes in total transactional cost growth factors.

The peculiarities of the operation of market mechanisms in healthcare lead to the fact that the costs of creating the possibility of providing medical care become socially necessary character. This manifests itself in the following four points:

1) the significant participation of government agencies in the formation of costs for protecting public health directly determines the public (not market) inclusion of these costs in the overall production process;

2) information asymmetry in relation to the consumer of medical services creates conditions for direct social inclusion of the benefits received in the total final consumption of society;

3) the dominant monopoly positions of medical service providers lead to the transformation of actual costs into socially necessary ones;

4) the presence of a significant number of intermediary entities gives the private interest of the consumer and producer of medical services elements of public economic interest.

In the case of budgetary financing of medical institutions, the calculation of expenses according to individual estimates is based on standard staffing levels, consumption rates for medicines and dressings, standards for the provision of household and soft equipment, etc. In other cases, when calculating costs, not standard, but actual expenses for the provision of therapeutic, preventive and other medical care.

There are three main methodological approach to determining costs in healthcare:

1) a method based on calculating the costs associated with the provision of each service (operations, procedures, manipulations, etc.). Based on this method, an invoice can be submitted to an individual patient, an insurance company; it is used in the formation of contract prices and private practice prices;

2) a method based on determining the costs required to treat the “average” patient in a given medical institution. This method makes it possible to determine the average standard, which is important when determining the financing standard.

3) calculation of costs depending on nosological forms of the disease (diagnostic-related groups, clinical and statistical groups). This method can be used in the public health insurance system.

Changes in costs are influenced by groups of factors. More rational use of funds, improved organization of the diagnostic and treatment process, reduction of treatment time, etc. – all this leads to cost reduction. On the other hand, their growth is caused by the intensification of healthcare, the introduction of new medical equipment, the use of expensive medicines and materials, etc.

Classification of costs of military medical institutions when providing paid medical services

O.F. Kuzmich,

Ph.D. econ. Sciences, Associate Professor of the Department of Accounting, Economic Analysis and Property Valuation, State Academy of Advanced Training and Retraining of Personnel for Construction and Housing and Communal Sector (129329, Russia, Moscow, Igarsky proezd, building 2; e-mail: [email protected])

I.V. Ryzhov,

Doctor of Economics Sciences, Professor, Professor of the Department of Management and Marketing, State Academy of Advanced Training and Retraining of Personnel for Construction and Housing and Communal Sector (129329, Russia, Moscow, Igarsky proezd, building 2; e-mail: [email protected])

Annotation. The article presents a cost calculation for paid medical services in military medical institutions, which makes it possible to correctly distribute costs and include them in the cost of medical services provided. On this basis, a nomenclature of cost calculation items in military medical institutions is proposed.

Abstract. The article presents the calculation of the cost of paid medical services of the military medical institutions, allowing proper distribution of expenses and their inclusion in the cost of medical services. On this basis it is proposed nomenclature calculation of the expenditure at the military medical institutions.

Key words: medical services, costs, costs, calculation, cost.

Keywords: health services, costs, expenses, cost estimate, cost price.

To improve the practice of calculating the cost of medical services and accounting for the costs of their provision, analysis of the composition of costs and their classification become important. The solution to this problem involves an economically justified grouping and characterization of costs and the creation of conditions for the correct distribution of costs and their inclusion in the cost of medical services provided by military medical institutions (MMU).

In the theory and practice of accounting, costs are divided into basic and overhead, direct and indirect, costs of the current (reporting) month and future periods, simple (element-by-element) and complex (integrated), production and non-production, etc. In the current accounting methodology, the grouping of costs is based on the following characteristics: according to their economic role in the production process, according to the method of inclusion in the cost, in relation to the reporting period, but homogeneity and reflection in the calculation, according to the area of ​​occurrence.

Accounting in public sector organizations is currently regulated by a number of regulatory legal acts, the main of which include:

Budget Code of the Russian Federation;

Federal Law of December 6, 2011 No. 402-FZ “On Accounting”;

- “Instructions for the application of the Unified Chart of Accounts...”, approved by Order of the Ministry of Finance of Russia dated December 1, 2010 No. 157n, hereinafter referred to as Instruction No. 157n (applied by all public sector organizations, including state (municipal) institutions of all types).

Based on the Unified Chart of Accounts and Instruction No. 157n, accounting entities (public sector organizations) apply the corresponding Charts of Accounts and Instructions for

their application (Table 1).

As a grouping of operations carried out in the sector government controlled, depending on their economic content, there is a classification of operations of the general government sector.

The classification of operations of the general government sector consists of the following groups:

100 “Income”;

200 “Expenses”;

300 “Receipt of non-financial assets”

400 “Disposal of non-financial assets”;

500 “Receipt of financial assets”

600 “Disposal of financial assets”;

700 “Increasing obligations”; 1

800 “Reduction of liabilities”1.

Group 100 “Income” includes, in particular, Article 130 “Income from the provision of paid services (work)”, which includes income from the provision of paid services (work) and compensation of costs, including:

Income from the provision of paid services (work);

Compensation of state expenses;

Compensation of expenses of state (municipal) institutions;

Income from reimbursement of expenses incurred in connection with the operation of state (municipal) property assigned to the right of operational management;

Reimbursement of expenses for carrying out enforcement actions by bailiffs;

Fee for using the hostel;

Income from the provision of medical services, the topic of compulsory health insurance;

provided to insured persons in the system

Table 1

Subjects of accounting and acts that approved the Chart of Accounts and Instructions for its application

Subject of accounting Act which approved the Chart of Accounts and Instructions for its application

State institutions; State authorities (local government); Budgetary and autonomous institutions (in terms of operations related to the fulfillment of public obligations, as well as the use of budget investment funds); Other participants in the budget process Order of the Ministry of Finance of Russia dated December 6, 2010 No. 162n “On approval of the Chart of Accounts for Budget Accounting and Instructions for its Application”

Budgetary institutions Order of the Ministry of Finance of Russia dated December 16, 2010 No. 174n “On approval of the Chart of Accounts for accounting of budgetary institutions and Instructions for its application”

Autonomous institutions Order of the Ministry of Finance of Russia dated December 23, 2010 No. 183n “On approval of the Chart of Accounts for accounting of autonomous institutions and Instructions for its application”

Income of medical institutions of state and municipal health care systems from the provision of medical services provided to women during pregnancy, women and newborns during childbirth and the postpartum period;

Payment for borrowing material assets from the state reserve;

Other similar income1.

Group 200 “Expenses” is detailed by items within which transactions related to expenses are grouped:

210 “Wages and accruals for wage payments”;

220 “Payment for work and services”;

230 “Service of state (municipal) debt”;

240 “Free transfers to organizations”;

250 “Gratuitous transfers to budgets”;

260 “Social Security”;

270 “Expenses on transactions with assets”;

290 “Other expenses”.

The established cost items in their economic content are an estimate of the cash costs of a military medical institution, an estimate of financing or an estimate of budgetary costs, and not the costs of diagnostic and treatment work to provide medical care, which should be included in the cost of specific medical services.

From the point of view of the problem of calculating the cost of medical services provided by military medical institutions, it is necessary to know not only the types and composition of expenses incurred (elemental expenses), but also where, for what type of services the expenses were incurred, that is, a reasonable classification according to cost items is necessary. It should also be noted that changes in the organization of accounting (budget) accounting in military medical institutions are caused by the need to obtain information on the actual costs per unit of medical service provided.

1 See: Order of the Ministry of Finance of the Russian Federation of December 21, 2012 No. 171 n “On approval of the Instructions on the procedure for applying the budget classification of the Russian Federation for 2013 and for the planning period of 2014 and 2015.”

In this sense, the object of accounting for the costs of a military medical institution are the actual costs associated with the provision of medical services, which can be grouped according to various criteria in order to form indicators of the cost of the medical care provided and its unit - the medical service.

Grouping costs by expense items of the budget classification (according to economic elements) does not reflect the purpose and purpose of expenses, the relationship of costs with results, does not fully reflect their role in the technological process of providing medical services, or the relationship with various factors. It is necessary to group the costs, highlight among them the main ones, directly aimed at the provision of medical services, inextricably linked with the technological process of providing services, and the costs of servicing the process of providing services and management, i.e. group costs according to their purpose and role in the process of providing medical services (basic, overhead, elemental, direct, indirect).

The internal organization of the process of providing medical services in military medical institutions is built on the principle of specialization. For example, in hospitals, specialized departments of various profiles (surgical, therapeutic, etc.) provide medical care to patients with only certain nosologies corresponding to the profile of the department. In these departments, the direct treatment process is carried out, the distinctive feature of which is the placement and maintenance of patients in them. At the same time, in such institutions there are paraclinical departments, which are also associated with the process of carrying out diagnostic and treatment work, which is expressed in the provision of various types of diagnostic and therapeutic services by specialized departments of various profiles. In these departments, patients are not directly accommodated and are not maintained during diagnostic and treatment work (laboratory, endoscopy department, functional diagnostics room, X-ray department, etc.).

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Koblova Galina Ivanovna. Organization and methodology of cost accounting in healthcare institutions: Dis. ...cand. econ. Sciences: 08.00.12: Saratov, 1999 205 p. RSL OD, 61:00-8/815-1

Introduction

CHAPTER 1 Economic features of the functioning of healthcare and their impact on the organization of accounting in modern conditions 10

1.1. The importance of accounting in the context of reforming the healthcare management system 10

1.2. Foreign experience in organizing and financing healthcare and its significance for domestic practice 30

1.3. Features of formation of costs for medical services in the conditions of development of market relations 44

CHAPTER 2 Organization of cost accounting for medical care in healthcare institutions 68

2.1. Organization of financial and management cost accounting 68

2.2. Improving the classification of cost accounting in healthcare institutions 93

2.3. Organization of cost accounting for medical services in healthcare institutions 108

CHAPTER 3 Main directions for improving methodological recommendations for calculating the cost of medical services 119

3.1. Features of methodological approaches to calculating the cost of medical services 119

3.2. Accounting and analytical support for the medical institution management system 145

Conclusion 15 6

List of used literature 164

Applications 181

Introduction to the work

The economic reforms carried out in the country are aimed at creating market relations in the national economy, which predetermines the need to create a medical care system that is adequate to laws and principles market economy. A new approach to the organization of healthcare, the choice of forms and methods of its management, places increased demands on economic information, the main supplier of which is accounting. However, as the study showed, the traditional organization of accounting in medical institutions does not correspond to the new conditions of their activities in the health insurance system, because at its core it is a system for recording cash and actual expenses of budgetary funds of the health insurance fund (as an additional source of financing) in the context of items expenses of the budget classification and is focused not on identifying such economic indicators as the cost of medical care provided, the financial result and its use for its intended purpose, but on accounting for the use of cost estimates for the maintenance of medical institutions.

In connection with the transition to market relations, a fundamentally different organization of healthcare, which is based on the recognition of the commodity nature of medical services and the diversity of forms of ownership of medical institutions, problems of financing and pricing arise. which in turn is associated with the problem of maintaining an optimal balance of expenses and income, calculating the cost of medical services to provide quality medical care, etc.

Thus, the need for scientific research of the healthcare system is determined by the need for a rational solution to these problems and involves solving the problem of finding a more promising option for organizing cost accounting and calculating the cost of medical care.

social services in medical institutions, corresponding to the conditions of market relations, which determined the choice of the topic of the dissertation research.

State of knowledge of the issue.

The work of domestic scientists (Pupshikh T.F., Martynchik S.A., Khromchenko O.M., Boyarintseva N.A., Kadykov F.N., Popov G.A.) is devoted to solving theoretical problems of the system of management, planning and financing of healthcare. , Shipova.M., Shamshurin N.G., Svetlichnaya T.G., Zyyat-dinov K.Sh., Zakirova S.A., etc.).

Issues of accounting in non-production institutions are developed in detail in the works of Dedkov E.P., Goloshchapov V.A., Mastalyina N.A., Malov S.A. etc. However, the works of these authors relate to the conditions of administrative methods of healthcare management and the organization of traditional budget accounting and reporting.

The study of the theory and practice of medical institutions has led to the conclusion that insufficient attention is paid to the problems of improving accounting in the context of healthcare reform, in particular to the problems of accounting for the costs of providing medical care in medical institutions that provide paid services.

It should be noted that the proposed methodological recommendations (Denisov I.N., Obayan A.S., Shevsky V.I., Lunskaya L.L., Slagaeva E.V., Chelidze N.P.) on cost accounting and cost calculation medical services in the works of domestic economists are not widely used in practice due to the complex calculation mechanism that replicates production accounting.

Purpose and objectives of the study.

The purpose of this study is to improve the economic mechanism and increase the efficiency of health care.

opinions in the formation of costs for medical services, namely the development of theoretical provisions and practical recommendations for organizing the accounting of costs of medical care in accordance with the requirements for calculating the cost of medical services based on the study and practical understanding of current domestic practice, its compliance with the requirements of a market economy and international standards. To achieve this goal, the following tasks are defined in the work:

explore trends in the development of the healthcare management system, analyze the progress of its reorganization;

determine the role of accounting in the healthcare management system and justify the need to improve accounting for the costs of providing medical care in market conditions;

explore foreign experience in financial and information support of healthcare from the point of view of its possible application in the Russian Federation;

To study the settlement system of insurance organizations with medical treatment
preventive institutions and calculation of tariffs for medical
services and develop recommendations for its improvement;

comprehensively analyze the system of traditional budget accounting and determine the main directions for organizing cost accounting in medical institutions;

explore the composition of costs of health care facilities (medical and preventive institutions) and justify the classification of costs for the provision of medical services;

Analyze existing methods for calculating costs
medical services and give specific recommendations for their improvement
nu.

Object and subject of research.

The object of the study was selected medical institutions of different profiles, subordinate to the Ministry of Health of the Government of the Saratov Region, operating in the compulsory health insurance system: City Hospital No. 1 (Balakovo), Emergency Hospital (Engels), Polyclinic No. 14, City Clinical Hospital No. 1, City Clinical Hospital No. 2, City Clinical Hospital No. 3, City Anti-TB Dispensary.

The subject of the study was a set of theoretical and practical issues of organizing cost accounting in healthcare institutions. Current regulations, statistical information from the Ministry of Health of the Russian Federation and the Ministry of Health of the Government of Saratov and the Saratov region were used as information for the study.

Methodological basis and information base of the study.

The methodological basis is the works of Russian and foreign economists on general issues economic theory, materials of government and departmental documents of Russia regulating the functioning of compulsory health insurance. Materials from periodicals, statistical collections, factual materials from surveyed medical institutions, developments of Russian research organizations, and international standards for accounting and reporting were used.

Scientific novelty.

The scientific novelty of the work lies in the formulation, theoretical justification and solution of a set of issues of improving the organization of cost accounting for the provision of medical care in the context of reforming the economic mechanism of healthcare:

a new grouping and classification of costs has been proposed according to the items of the budget classification of medical institutions in the provision of paid medical services in terms of their functions and the role of costs in providing quality medical care, in relation to the technical process, by the method of inclusion in the cost, by economic elements, by costing items ;

a methodology for accounting for the costs of providing paid medical services using the “direct costing” method in healthcare institutions was proposed;

a methodology for separating accounting and use of budget financing and compulsory health insurance funds and other extra-budgetary revenues to health care facilities has been proposed;

a scheme for organizing the provision of management personnel with accounting and analytical information on the formation of production costs, calculated within the limits of direct costs, has been developed;

a system of additional synthetic and analytical sub-accounts has been proposed to the Chart of Accounts for accounting the execution of cost estimates of institutions on the budget to account for the costs of providing paid medical services;

a system of registers has been proposed for grouping and consolidated accounting of costs for the provision of paid medical services, used to obtain accounting and analytical information for making effective management decisions;

a methodology has been developed for distributing the costs of auxiliary production and assessing their mutual services.

Practical significance.

The practical significance of the dissertation lies in the development of basic provisions and specific recommendations for organizing cost accounting for the provision of medical care to medical institutions in market conditions. Research into the results of the dissertation will contribute

creating effective information support for healthcare management.

Approbation of research results.

The main results of the study were reported and received approval at scientific sessions and conferences of the SGSEU in 1996 - 1998. and were published in collections on the topics: “Socio-economic problems of the development of society in the transition period to the market” (Saratov, 1996), “Improving accounting and analysis of economic activities in the transition to a market economy” (Saratov, 1998), “Reforming accounting analytical work at enterprises" (Saratov, 1998), "Improving the organization of accounting and analysis in a market economy (Saratov, 1999).

Publications.

The main provisions of the study are presented in 5 published works, with a total volume of 2.4 pp.

Work structure.

The dissertation consists of an introduction, three chapters, a conclusion, a list of used sources and literature, and applications.

The introduction substantiates the relevance of the topic and the need for scientific research into the healthcare system, characterizes the state of knowledge of the problems, sets the goal and objectives of the research, presents the object and subject of the research, as well as the scientific novelty of the work.

In the first chapter; “Economic features of the functioning of healthcare and their impact on the organization of accounting in modern conditions” critically analyzes the system of state (budgetary) healthcare, examines the main trends in the development and improvement of the healthcare management system, shows their influence on the organization of accounting, examines the main features of the formation

analysis of the costs of medical services as the final product of health care facilities, the features of the development of health care management systems in countries with developed economies are considered, and the role of improving accounting in the context of health care reform in general is determined.

In the second chapter: “Organization of cost accounting for the provision of medical care in health care institutions”, the current procedure for accounting for the costs of medical institutions is critically analyzed, the economic feasibility of introducing management cost accounting and calculating the cost of medical services is substantiated, a new, different from the traditional, grouping and classification of costs by expense items of the budget classification for the provision of paid medical services. A system of additional synthetic and analytical accounts has been proposed to the current Chart of Accounts for accounting for the execution of cost estimates for institutions and organizations on the budget.

In the third chapter: " Guidelines on calculating the cost of medical services" analyzes the features of methodological approaches to calculating the cost of medical services from the point of view of their application in practice, substantiates the need for a radical and constructive change in cost accounting and calculating the cost of medical services using the "direct costing" method, considers the advantage of division and accounting expenses of medical institutions for fixed and variable, features of the distribution of general medical expenses for the main medical and technological departments and auxiliary activities, the economic feasibility of introducing new registers for accounting expenses of medical institutions is considered.

In conclusion, the main conclusions and proposals are formulated.

The importance of accounting in the context of reforming the healthcare management system

Economic reforms currently being implemented are aimed at creating a market economic mechanism. The emergence of market relations necessitates the formation of similar relations in healthcare. Taking into account the social significance of medical services and the impossibility of their subordination solely to commercial interests, it is necessary to form such an economic health care mechanism, when, on the one hand, high efficiency of medical services would be achieved, and on the other hand, the representation of their main range would be ensured, regardless of the state of personal income of consumers.

Since the late 60s, there has been a tendency in Russia to deteriorate all indicators characterizing the health of the population. In the 90s it intensified even more. This is directly related to changes in socio-economic living conditions, local wars, an increase in the number of refugees and internally displaced persons, and an increase in crime. True, in 1994-1995 in the dynamics of slowing down the process of deterioration: the rates of general and infant mortality and the incidence of certain controlled infections (diphtheria, scarlet fever, measles, whooping cough) have decreased. However, this does not provide grounds for concluding that the medical and demographic situation in the country has stabilized.

The deteriorating health status of the population is due not only to a complex of general socio-economic factors, but also to a number of negative trends in the healthcare system, such as:

1. Acute shortage financial resources. After relative stabilization in health care financing associated with the introduction of compulsory health insurance (CHI) in 1995-1996, the situation worsened again. The emergence of a new source of financing in the form of contributions to compulsory medical insurance of the working population began to be blocked by a decrease in budgetary allocations, which is largely due to non-compliance with the law “On health insurance of citizens of the Russian Federation”.

2. Reduced level of controllability of the health care system. The complexity of the health care system has been largely lost. The efforts of different departments related to health protection were disjointed. The importance of strategic and current health care planning has noticeably decreased. The loss of the previous administrative levers for managing the network of medical and preventive institutions (hereinafter referred to as health care facilities) was not compensated for by methods of economic management. Both healthcare authorities and compulsory medical insurance bodies and structures are losing their leverage over healthcare institutions and the medical care system as a whole (see Fig. 1 and Fig. 2).

The diagram shows that the administrative subordination in force before the start of the health system reforms completely coincides with financial flows. Thus, centralized, unified financing also determined subordination. The basis of administrative management was the principle of economic dependence. In the new conditions of decentralization of funding sources, the main element of management in the healthcare system should be economics, which determines the effectiveness of medical care. Funds must be allocated for specific medical services, which, in turn, must have an objective price. In this case, the element of economic dependence on a simple administrative decision (“To give or not to give money”) takes the form of economic dependence of receiving adequate and timely payment (financing) on ​​timely and high-quality medical care, regardless of the source of funding

Organization of financial and management cost accounting

The fact of manifestation of accounting as a system for collecting, processing and transmitting economic information in the process of functioning of a business organization lies in determining the element-by-element structure of such a system. Of the totality of its constituent elements, the most characteristic is the system of accounting accounts linked using double entry. The following elements can be identified as other elements of the system: assessment of economic facts; documentation; calculation (estimate); inventory, balance; reporting.

In accordance with this, accounting includes a set of economic facts that can be counted or, in other words, accounting covers the facts of changes in the economic assets and resources of an enterprise, measured in numbers by price and quantity and reflected in special information carriers - accounting documents.

A set of accounting accounts is intended to summarize information about a set of economic facts related to a specific accounting object, which are economic assets, sources of their formation, economic processes that make up the content of the enterprise's activities.

The accounting system is created and functions primarily as the basis of the information system of a separate economic organization, which acts as an integral part of the public economy. In this sense, a specific version of the organization of accounting is revealed in the dialectics of the general, the individual and the special.

In other words, the complex element-by-element structure of the accounting system is revealed in a certain version of the organization of accounting and control through a reflection of the relative isolation, discreteness, limited space and time of the economic process of an individual enterprise, institution or organization with its inherent specific features that make up its qualitative and quantitative certainty and, in turn, through the reflection of the features of a particular variant of the organization of accounting and control, as an expression of its integrity in the sense of correlation, implementation in the information system of a certain enterprise of the general element-by-element structure of the accounting system.

The main content of changes in the economic mechanism of domestic healthcare was the inclusion of the health care system in the system of market commodity-money relations. This determines the recognition of the commercial nature of the product of a medical institution - a medical service that has its own value and price. Therefore, the urgent need to obtain information about the process of formation of the cost of medical services equally arises both for a private, commercial medical institution, and for an institution providing free medical care at the expense of charitable foundations, because With different payment systems for medical services performed and different sources of replenishment of spent funds, the common thing is the need to control the process of creating the final product.

The main feature of the organizational structure of most treatment and prevention institutions is the presence of a number of treatment and prevention units, each of which is designed to implement a specific medical program and, in general, they represent a closed technological cycle. These are treatment departments in hospitals, medical offices in outpatient clinics. In the same time, important feature the sphere of medical services is that the production and consumption of medical services coincide in space and time, i.e. if at some point in time there is no demand for medical services (the medical and preventive departments are not overloaded), the need for funds for the maintenance of a specific medical and preventive unit clearly remains in order to ensure its readiness to receive and use patients. In other words, it is necessary to develop an organization for accounting for the costs of providing medical care and the production of medical services in conjunction with the organization of accounting for the costs of maintaining the institution as a whole. The latter is nothing more than the organization of accounting for the use of cost estimates for the maintenance of a medical institution. This determines the features in the organization of accounting for the costs of medical care.

Features of methodological approaches to calculating the cost of medical services

The advantage of the proposed method is that it determines the cost of detailed dental services and, by grouping them in the required set, we can determine the cost of DRG. In addition, it becomes possible to include scientifically based costs in the price, and use them to determine the amount of funding for the clinic. Finally, payment on a completed case basis through DRG prices will encourage medical staff to complete treatment and improve work results by simultaneously increasing qualitative and quantitative indicators.

The advantage of this approach is a fairly accurate accounting of all costs for specific services, the creation of an information base for future calculations and an economic basis for the introduction new system wages directly dependent on the quantity and quality of work performed.

However, it is necessary to note the following defects of this approach:

Not all simple services can be reduced to a set of detailed ones (you can take into account the time required to fill out a medical history, the number and costs of performing diagnostic studies, but it is impossible to determine how many times a doctor should approach a specific patient);

High information capacity and the lack of direct linkage with current accounting create difficulties in collecting source data;

This approach allows for the possibility of re-accounting the same expenses of a medical institution for various medical services (for example, taking a doctor’s labor costs when conducting a specific laboratory analysis to be equal to 5 minutes, the possibility of simultaneous performance of several tests is not taken into account);

The possibility of taking into account direct costs not related to the standard of medical service provision is not reflected, for example, in the case of a complication, concomitant disease, drug intolerance, the set and quantity of medicines changes, and there may also be a natural loss of resources (expiration date, etc.) .

The proportional methodology is based on the distribution of the costs of a medical institution among its divisions and the reduction of the calendar costs of the divisions to the calendar volume of activity (both standard and actual). Overhead costs are allocated either in proportion to the salaries of key personnel or the area of ​​departments.

The advantage of this approach is the relatively simple collection of source material, its compliance with the current forms of accounting for the expenses of a medical institution. Calculating the cost using this methodological approach is a good basis for analyzing financial and economic activities because Only by comparing the costs and volumes of activity of the unit as a whole can one judge the effectiveness of its work.

The disadvantage of this approach is that it is absolutely adequately applicable only to medical units providing homogeneous services (for example, treatment of patients in an inpatient department). The problem of distributing costs for departments providing various services is solved by introducing conventional units as a result of activity (in order to compare the labor intensity to the cost of various services) or by distributing costs in proportion to the working time of the doctor and nurse. For example, the services of a clinical diagnostic laboratory are extremely varied (more than 300 types of tests), but by bringing the department’s expenses to the working time budget, you can calculate the cost of each analysis. However, with this approach the accuracy suffers significantly, because labor costs are not always proportional to direct costs (research can be labor-intensive, but not resource-intensive and vice versa). In this case it is necessary expert review in the introduction of additional conventional units (for direct costs).

Naumov, Alexander Nikolaevich

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Introduction

Main part

Conclusion

Practical part

Introduction

Effective management of an enterprise's production activities increasingly depends on the level of information support for its individual divisions and services. As practice shows, enterprises with a complex production structure are in dire need of operational economic and financial information that helps optimize costs and financial results and make informed management decisions.

To form the cost of products, works, services, as well as to make optimal management and financial decisions, it is extremely important to correctly distribute costs into direct and indirect. Cost analysis helps to find out their effectiveness, determine whether they will be excessive, check the quality of work, set prices correctly, regulate and control costs, plan the level of profit and profitability of production.

Indirect costs are costs that cannot be directly attributed to the cost of each specific product produced by the enterprise: material overhead, manufacturing overhead, administrative and sales overhead.

Indirect costs (maintenance of management and maintenance personnel, lighting, heating, operation of machinery and equipment, rental of premises, water supply, routine repairs, etc.) cannot be directly attributed to a single resulting cost object. They are included in the costs of individual types of products (works, services) after determining the total amount at the end of the reporting period (for example, a month) by distribution in proportion to the conditions provided for by the organization’s accounting policies.

The purpose of the course work is to reveal the concept of costs as one of the main criteria for the stable existence of an enterprise.

To achieve this goal, the following tasks will be solved in the course work:

Types of services of a medical institution;

Cost of medical services;

Methods for allocating indirect costs;

The procedure for calculating indirect costs.

Main part

1. Types of services of a medical institution

Healthcare produces services, that is, it belongs to the service sector. The specificity of a medical service is that it provides vital functions for a person, and at the same time retains its economic essence, being an ongoing labor process. At the same time, a medical service is an event aimed at the prevention of diseases, their diagnosis and treatment, which has an independent, complete meaning.

There are detailed, simple, and complex medical services.

A detailed medical service is an elementary and indivisible service (injection, medical history, etc.), which is not the object of pricing.

A simple medical service - elementary and indivisible

“Patient” + “Specialist” = “One element of prevention, diagnosis or treatment”

For example: an operation that can be decomposed into independent (divisible) moments, which do not have independent meaning and are valid only in the aggregate. And therefore, despite the complexity of the process, the operation is classified as a simple medical service.

A complex medical service is a set of simple services that reflect the technological process of providing care that has developed in each specific institution. For hospitals - a treated patient, for outpatient clinics - a completed case of treatment.

A comprehensive medical service is a set of different types of medical services aimed at obtaining some result that cannot be obtained by providing a simple and complex service (medical examinations).

2. Cost of medical services

The cost of medical services is a valuation of the labor and material resources used in the process of providing services, which is made using costing. The main costing items for a medical institution are:

· Remuneration (basic and additional).

· Accrual of wages.

· Medicines.

· Food.

· Wear and tear of soft equipment.

· Depreciation deductions.

· Business and official travel.

· Payment for transport services.

· Payment for communication services.

· Payment of utility services.

· Payment for other services and other operating expenses.

· Major repairs.

· Maintenance.

Costing is the calculation of the cost per unit of service or medical service performed.

Costing items for a certain type of service performed reflect the type of service (examination, operation, etc.), the specifics of the medical institution (narcology, oncology, therapy, etc.), the nature of its implementation (hospital, clinic, etc.) , which affects the names of expense items of a medical institution.

It is customary to distinguish three main classifications of costs:

1. Based on participation in the process of providing medical services, expenses (expenses) are divided into basic and overhead.

Basic - expenses directly related to the provision of services - salaries, medicines, medical instruments, etc.

It should be noted that according to this classification, the costs of heating, electricity, water supply (that is, utilities) are also among the main costs, since they are directly involved in the provision of medical care.

Institutional overhead costs include all types of expenses not directly related to the provision of medical services (clerical and business expenses, depreciation of non-medical equipment, salaries of administrative and management personnel, business travel expenses, etc.).

In other words, overhead costs are those types of costs that are necessary to ensure the activities of the institution, but are not consumed directly in the process of providing medical services.

2. According to the order of attribution to services (according to the method of attribution to the cost of a specific service), costs are divided into direct and indirect.

Direct expenses are expenses that can be directly (immediately), without any auxiliary calculations, attributed to certain types of medical services provided. In other words, direct costs are associated with the production of specific defined types of services.

Direct costs include:

Salaries of key personnel;

Accruals for wages of key personnel;

The cost of all material resources consumed in the process of providing medical services (medicines, dressings, disposable supplies, food, etc.);

The cost of partially consumed material resources (wear and tear of soft equipment, depreciation of medical equipment used in the provision of this medical service, wear and tear of low-value and fast-wearing items).

Indirect costs are costs that cannot be directly attributed to specific types of services and are therefore distributed indirectly, usually in proportion to some indicators (established bases). Indirect costs are included in the cost of medical services through calculated coefficients. Indirect costs are associated with the production of several types of services or all services provided. Therefore, indirect costs usually relate to the entire institution or its divisions.

Indirect costs include, for example:

Remuneration of general institutional personnel;

Accruals for wages of general institutional (administrative and economic) personnel;

Utility and business expenses (costs of materials and items for current business purposes, office supplies, inventory and payment for services, including costs of current repairs, etc.);

Expenses for business trips and official travel;

Wear and tear of soft equipment in auxiliary departments;

Depreciation (wear and tear) of buildings, structures and other fixed assets not directly related to the provision of medical services;

Other expenses.

The basis for the distribution of indirect costs may be direct costs, salaries of key personnel, space, etc. Thus, part of the indirect costs is distributed in proportion to the salaries of key personnel (for example, the salaries of administrative and business personnel).

Others (for example, utility costs) can be distributed in proportion to the area, etc.

In some cases, indirect costs can become direct if, for example, electricity meters are installed in each office.

It should be noted that the main costs can be both direct and indirect, and overhead costs, as a rule, are indirect costs. For example, the costs of electricity and water supply are among the main costs and at the same time they are indirect costs, attributed to the cost of the service using the indirect method.

It is necessary to note the features of the classification of costs of diagnostic and treatment services. Costs directly related to the implementation of research and the provision of medical care are considered major expenses. Most of these types of expenses can be classified as direct. However, if the cost of a bed-day, a completed case of treatment (inpatient or outpatient), etc. the costs of treatment and diagnostic services are included in an average amount; they will be distributed among the main clinical departments using auxiliary methods, i.e. will be classified as indirect costs.

As part of overhead and indirect costs, hospital-wide (general outpatient) and institutional costs can be distinguished.

3. According to the degree of dependence m of the volumes of services provided (in relation to the volume of services provided; according to the dynamics of costs), costs are divided into semi-fixed (fixed) and semi-variable (variable).

Conditionally fixed (constant) - costs that are practically independent of the volume of services provided (room lighting, heating, etc.). The amount of fixed costs remains unchanged when the volume of services provided changes (time-based wages for workers, wages and charges for the administrative and economic apparatus, rental of premises, etc.).

Conditionally variable (variables) - costs that change in accordance with the volume of services provided (medicines, consumables, food, etc.). In other words, the total amount of variable costs varies in proportion to the volume of services provided. Based on the above, it is clear that utility costs are basic and it is not always advisable to include them in overhead costs. In some cases, it is advisable to distribute utility costs in proportion not to the wage fund of the main personnel, but in proportion to the space occupied by the departments.

3. Accounting and distribution of indirect costs

Indirect costs cannot be attributed to the release of specific products; they are associated with the maintenance and management of main production. Accounting for indirect costs is carried out on accounts 25 “General production expenses” and 26 “General expenses”.

Active account 25 “General production expenses” records costs that are associated with servicing the main or auxiliary production. The following types of expenses are reflected on the debit of account 25:

· shop expenses for the maintenance and operation of equipment;

· wages for service personnel;

· costs of heating, lighting and maintenance of premises;

· payment of lease of fixed assets;

· deductions for depreciation and repair of general production equipment;

· costs of insurance of property for industrial purposes and other expenses similar in purpose.

Active account 26 “General business expenses” records costs that are associated with managing the enterprise. The following types of expenses are reflected in the debit of account 26:

· costs of maintaining management staff and general economic services;

· deductions for depreciation and repair of general economic assets;

· expenses for payment of information, audit, consulting and other services;

· payment for rent of property intended for general business needs and other expenses similar in purpose.

Table 1 shows accounts 25 “General production expenses” and 26 “General expenses”

Table 1

At the end of each month, accounts 25 “General production expenses” and 26 “General operating expenses” are closed and the amount of costs is ultimately written off to account 20 with the following entries.

DEBIT 20 “Main production” CREDIT 25 “General production expenses”;

DEBIT 20 “Main production” CREDIT 26 “General expenses”.

Accounts 25 and 26 do not have a balance and are not reflected in the balance sheet.

Currently, indirect costs make up the majority of costs, and in a number of industries, their share in the total cost often exceeds the entire amount of direct costs, so their importance is great both from the standpoint of accounting and cost distribution.

In addition, for the correct formation of cost finished products The distribution of indirect costs between the costs of individual types of products is important. In the case when several types of products are produced, indirect costs are written off to the cost of finished products in a certain ratio.

4. Procedure for calculating indirect costs

Practice has revealed several methods for distributing indirect costs: in proportion to the wages of key personnel, in proportion to the volume of work performed, in proportion to the occupied space, in proportion to the base unit (step-by-step method). The latter is the most effective for calculating costs when determining the price of a paid medical service, since it allows you to realistically compare the costs of auxiliary services and departments of a medical institution and its main divisions that directly provide medical care.

The principle of allocating the costs of subsidiary departments among the main departments is as follows: the main department, which uses the majority of the services of the subsidiary department, should be assigned a proportionately larger share of the costs of that subsidiary department.

Let's look at this distribution as an example:

Information data necessary for calculation.

1. Department costs, rub.

Auxiliary:

Administrative Service 1904

Food block 1010

Laundry 610

Basic:

Obstetric Department of Pathology of Pregnant Women (AOPB) 730

Maternity ward 1358

2. Staffing of departments number, people

Administrative Service 3

Food block 3

Laundry 2

Obstetric Department of Pregnant Pathology 33

Maternity ward 81

3. Occupancy of branches 100%

4. Volume of laundry services volume of work, kg

For catering unit 2

Obstetric Department of Pathology of Pregnant Women 139

Maternity ward 151

5. Number of beds number, pcs

Obstetric Department of Pregnant Pathology 60

Maternity ward 50

6. Average length of stay days

Obstetric Department of Pregnancy Pathology 10

Maternity ward 6

Table 2 shows the distribution of indirect costs using a step-by-step method

table 2

EXPLANATIONS FOR CALCULATIONS.

1. Distribution of administration costs among auxiliary departments:

Calculation of column 2:

Administration (number of employees per state * number of days of hospital stay):

For catering unit 3*16 =48

For laundry 2*16 =32

For AOPB 33*16 =528

For the maternity ward 81*16 =1296

TOTAL: 1904

Administration sub-costs are determined by summing columns 1 and 2.

2. We distribute laundry costs among auxiliary departments:

total amount of laundry services 2kg + 139kg + 151kg = 292kg

washing costs 610 + 32 = 642kg

calculated coefficient 642\292 = 2.2

Calculation of column 4:

Distribution of costs for laundry (obtained coefficient * washing volume)

For the catering unit 2.2 * 2 = 4

For AOPB 2.2 * 139 = 306

For the maternity ward 2.2 * 151 = 332

We determine laundry sub-costs by summing columns 3 and 4.

3. Distribution of catering department costs by department:

total costs for the food department 1062

calculated coefficient (volume of services\number of beds) 1062\110 = 9.65

Calculation of column 6:

For AOPB 9.65 * 60 = 579

For the maternity ward 9.65 * 50 = 483

We determine the sub-costs of the catering unit by summing columns 5 and 6.

The cost of medical services is calculated based on the actual costs of the institution, including both direct and indirect costs. Administration costs consisted of wages and administrative expenses of the administrative apparatus per 1 bed day, taking into account tariff rates and established standards.

As can be seen from the calculations, the institution’s costs in the amount of 5612.0 rubles are distributed between two main departments, but which include the costs of three service departments. Next, taking into account the characteristics of the treatment, you can determine the price of the medical service.

The step-by-step method is effective in calculating the costs of auxiliary departments in accordance with the selected basic units, allows you to accurately and quickly respond to changes in the costs of performing simple and complex services due to inflation, wage growth, the use of new medicines and realistically approach the calculation of the price of medical service.

The essence of the method of step-by-step (stepped) cost distribution is that the distribution of costs occurs in stages - one by one. First, the costs of the first division are distributed to all other divisions (except for this division itself), then the costs of the second division are similarly distributed, etc.

If we take a laboratory as an example, it will have costs such as salaries of laboratory assistants, administrative employees (for example, the head of the laboratory), cleaners, i.e. all employees directly working in the laboratory. In addition, this should include the cost of equipment, materials, tools, drugs, devices used by the laboratory, equipment care products, and the cost of assembling the premises.

Definition of the basic unit. The base unit is the unit of volume of services provided by an auxiliary department, with the help of which you can determine the volume of use of these services by other departments. For example, for laundry, the basic unit would be the weight of the laundry (in kg).

When choosing a base unit, you must also consider the difficulty of obtaining information on the selected cost units. Sometimes a more precise choice is not worth the effort it takes to obtain the information. In this sense, for an emergency department, the simplest cost unit would be the number of patients admitted to that department, rather than patient minutes.

Cost Allocation. Costs are distributed proportionally based on the selected basic accounting units. The general distribution order is from auxiliary to main departments, as a result of which all costs of auxiliary departments must be “assigned” to the main ones. Once the subsidiary department's costs have been allocated, it is no longer taken into account and is subsequently excluded from the incremental allocation process.

Conclusion

Indirect costs are understood as costs associated with the organization and management of production, related to the entire production as a whole (costs of heating and lighting, lubricants etc.) and not directly related to the manufacture of specific products. They cannot be directly included in the cost of a certain type of product or service. They are distributed indirectly, that is, in proportion to one or another characteristic and are included in the cost of accounting objects using special methods. The justified distribution of indirect costs between products, so that the calculated cost of individual types of products (works, services) is as reliable as possible, remains one of the most difficult problems of calculation. Indirect expenses include all other expenses incurred by the taxpayer in the reporting (tax) period. In this case, the amount of indirect costs for production and sales incurred in the reporting (tax) period is fully attributed to the decrease in income from production and sales of this reporting (tax) period.

Thus, the category of indirect costs includes all other expenses of the organization: material costs incurred during the performance of work or activities related to general production (shop) expenses, administrative, managerial and business expenses, wages of shop personnel (shop management and shop maintenance personnel ), wages of employees of the organization's management apparatus and administrative and economic personnel, depreciation of fixed assets that are used in production or management activities, but do not relate to objects directly used in the production of products, performance of work or provision of services.

List of used literature

1. Analysis of economic activities of budgetary organizations: Uch. allowance Ed. D. A. Pankova, E. A. Golovkova. M.: New edition, 2010 (Series “Economic Education”)

2. Artyukhov I. P., Morozova T. D. Economic resources of medical institutions in conditions of market relations: Uch. manual for students. Publishing house KrasGMA, 2009

3. Accounting in budgetary institutions / V.R. Zakharyin.

Omega - L. 2010

4. Journal "Budgetary healthcare institutions: accounting and taxation", 2010 N 5.

5. Kadyrov F. N. Economic analysis and planning of the activities of medical institutions / Supplement to the journal “Healthcare”, 2009

6. Nefedov, Dolgaya V.M. et al. Accounting of a medical institution. M.: Book world, 2009

Practical part

indirect cost medical costs

1. Group the economic assets of the dental company “Stomatology” (see Table 1.) by type of property and sources of education, present the grouping results in the balance sheet according to the scheme presented in Appendix 1;

2. Create accounting records for the business transactions listed in the journal;

3. Based on the journal of business transactions (see Table 2), reflect business transactions for October 2007 on the accounts;

4. Calculate turnover and balances on synthetic accounting accounts;

5. Draw up a turnover sheet for synthetic accounting accounts;

6. Fill out the balance sheet at the end of the reporting period.

Table 1

	Name of property and sources of its formation	Amount, rub.
	Filling materials
	Targeted funding
	Debt on utility bills
	Dental equipment
	Authorized capital
	Unfinished object
	Bandages and dressings
	Office equipment
	Debt of the Industrial District Department of Internal Affairs for security services
	Bills of the Security Council of the Russian Federation
	Depreciation of fixed assets
	Clinic building
	Debt to suppliers
	retained earnings
	Cash in the cash register
	Long-term bank loan
	Reserve capital
	Wages owed to employees
	Reserves for upcoming payments
	Tools and equipment
	Funds in the current account
	Workwear
	Tax debt to the budget
	Property insurance debt
	Debt to founders for dividends
	Medications
	X-ray machine
	Short-term loan debt
	License
	Future expenses
	Patient debt
	Debt to social insurance and security authorities

Journal of business transactions for October 2007

	Construction materials were purchased for routine renovation of the clinic premises.
	Debt for construction materials was paid using a short-term bank loan
	Debt transferred from current account: Department of Internal Affairs of the Industrial District; for a short-term loan; to suppliers
	Received from the current account to the cash desk for travel expenses of the deputy director
	Issued from the cash desk for travel expenses of the deputy. to the director
	According to the advance report of the deputy director, travel expenses are included in general business expenses
	Deputy the director deposited the balance of the unused advance into the cash register
	Received from the current account to the cash desk for payment of wages
	October wages issued
	Unpaid wages were returned to the current account
	Transferred from the current account to pay off tax debts to the budget
	Transferred from the current account to pay off social insurance and security debts
	Part of retained earnings is used to pay dividends to the founders of the enterprise
	A short-term bank loan has been credited to the current account
	Materials received from supplier
	Medicines used up and written off
	Construction materials were released for current repairs
	The contractor's invoice for repairs to the clinic building was accepted for payment.
	Salaries accrued to medical personnel
	Administrative staff salaries accrued
	Deducted from accrued wages: Personal income tax Debt of employees on accountable amounts
	UST accrued from wages of employees (26%): Medical personnel Administrative staff
	Depreciation has been calculated on fixed assets: Dental equipment To the computer Clinic building
	Payment documents for dental services provided were presented to patients
	The actual cost of services is written off (if the balance of work in progress at the end of the month is 24,500 rubles)
	Are written off to the financial result: general running costs
	The financial result from the provision of services is determined
	Cash received from patients
	Funds from the cash register are transferred to the current account
	Debt on utility bills was paid from the current account

BALANCE SHEET

	At the beginning of the period, rub.	At the end of the period, rub.
I. NON-CURRENT ASSETS Intangible assets
Fixed assets
Construction in progress (investments in non-current assets)
Long-term financial investments
TOTAL for section I
II. CURRENT ASSETS
including: raw materials, supplies and other similar assets
costs in work in progress (distribution costs)
finished products and goods for resale
Future expenses
Value added tax on purchased assets
Accounts receivable
including: buyers and customers
debt of founders for contributions to the authorized capital
other debtors
Short-term financial investments
Cash
Other current assets
TOTAL for section II
III. CAPITAL AND RESERVES Authorized capital
Extra capital
Reserve capital
Targeted funding and revenues
Retained earnings (uncovered loss)
TOTAL for Section III
IV. LONG TERM DUTIES Loans and credits
Other long-term liabilities
TOTAL for section IV
V. SHORT-TERM LIABILITIES Loans and credits
Accounts payable
including: suppliers and contractors
debt to the organization's personnel
debt to state extra-budgetary funds
debt to the budget
other creditors
Debt to private owners (founders) for payment of income
revenue of the future periods
Other current liabilities
TOTAL for Section V

Turnover sheet for synthetic accounts

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