摘要
本文以某市一家公立医院A为研究对象,采用单案例研究,基于该医院DRG支付背景下的成本管理变革实践,从结构化理论视角出发,考察了成本管理变革过程中的制度因素及嵌入在制度中的变革者的行为反应。研究发现,A医院并未按照政策制定者的初衷,基于作业成本法进行医院病组成本管理,而是采用了基于成本发生地的病组成本管理方法。出现这一松耦合现象的主要原因在于:第一,固有惯例导致语意结构聚焦于科室与成本发生地;第二,财务部门资源配置权力的缺乏导致变革落地面对较大阻力;第三,信息技术制约和变革者角色认知模糊导致基于成本发生地的成本管理模式在组织内部获得了更高的合法性。本文结合结构化理论,对上述原因进行深入剖析,不仅拓展了结构化理论的应用情境,也为组织开展成本管理变革与数字化转型提供参考借鉴。
This paper takes a public hospital A in a city as the research object,adopts a single case study method and discusses the practice of cost management reform under the background of DRG payment from the perspective of structural theory.This paper investigates the institutional factors in the process of cost management reform and the behavior response of the reformers embedded in the system.The study finds that hospital A did not follow the original intention of policy makers to use activity-based costing as the cost management method to formulate the disease group s cost,however used the place-based costing where the cost occurs.The main reasons for this loose coupling phenomenon are:first,the inherent practice leads to the semantic structure focusing on the department and the place where the cost occurs;second,the lack of resource allocation power of the financial department leads to great resistance to the implementation of change;third,the restriction of information technology and the vague cognition of the role of change leaders lead to the higher legitimacy of the place-based costing.Using the structural theory,this paper makes an in-depth analysis of the above reasons,which not only expands the application scenario of the structural theory,but also provides a reference for organizations to carry out cost management reform and digital transformation.
作者
刘俊勇
安娜
段文譞
刘家祺
LIU Jun-yong;AN Na;DUAN Wen-xuan;LIU Jia-qi
出处
《中央财经大学学报》
CSSCI
北大核心
2022年第3期59-68,共10页
Journal of Central University of Finance & Economics
基金
国家自然科学基金面上项目“预算管理程序公平:决定因素与影响后果”(项目编号:71672208)
国家社会科学基金一般项目“数字化转型下中国管理会计创新与应用研究”(项目编号:21BGL009)
国家社会科学基金一般项目“商业智能对企业管理控制系统的影响机理研究”(项目编号:21BGL095)。
关键词
成本管理变革
DRG支付
结构化
Cost management change
DRG payment
Structural theory
