公立醫院會計處理及稅務問題之研究

公立醫院每年龐大之公務預算補助負擔幾已無力負荷，產業競爭態勢的轉變，醫院自給自足之呼聲與策略已然形成。目前除台大、榮總由於病患較多，開源不是問題，只需努力節流，即可與大型財團法人醫院競爭外，其餘公立醫療機構不論人力、資力多已捉襟見肘，除面對經營危機與威脅外，亦遭受內外環境多重之衝擊，因此若無法大幅精簡人事，財務錙銖必較靈活運用，將難以營運；所以，公立醫院也應逐漸提升生產力、服務品質、注重成本控制與效率及醫療品質的提升。本研究主要使我們更清楚的釐清現代公立醫療的時代背景，衡量自償性資金、自給自足與醫療品質等因素，更周全檢討各公立醫院近年來潛在改善方向，作為未來公立醫院改革方針參考。本研究探討我國公立醫院財務報導與會計處理應改善之處；若採行一般公認會計原則之可行性又如何？擬探討之問題如下：一、確認財務報導範圍那些單位應包括在同一個體中？二、公立醫院財務報導應使用那種方式衡量餘絀？三、如何依一般公認會計原則使公立醫院財務報導更具有用性？四、資本支出與長期負債與美國政府會計適用之差異？最後作成結論與建議，以供相關單位及後續研究者參考。

關鍵字

會計制度；稅務；公立醫院

並列摘要

The scales of most public hospitals are district or area based. The operation of public hospitals greatly depends on governmental subsidiary. When governmental finance viability gets worse, the challenge public hospitals face is more difficult than that of private ones. If public hospitals can not simplify the personnel and strengthen effective information connections of financial resources would hard to operating. So public hospitals must enhance production efficiency, service quality, cost control and enhance medical services. The study let us to understand the background, self-sufficiency of financial index and medical quality of public hospitals. And propose the improvement direction and in accordance to the countermeasure for public hospitals. The study to recompile the current financial statements and accounting of public hospitals. The purposes of the research are (1) to ensure which entities should be report in the same entity? (2) which approach to measure revenue and expense or expenditure in financial statements of public hospitals? (3) how to use GAAP to make usefulness of public hospitals’ financial report? (4) what are the differences between the accounting treatments of capital expenditure and long-term liability in Taiwan and U.S.