Tổ chức công tác kế toán tại các bệnh viện đa khoa trung ương trên địa bàn thành phố hà nội trong điều kiện tự chủ tài chính tt tiếng anh

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MINISTRY OF EDUCATION

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MINISTRY OF FINANCE

AND TRAINING

ACADEMY OF FINANCE

HY THI HAI YEN

ORGANIZING THE ACCOUNTING WORK IN
CENTRAL GENERAL HOSPITALS IN HANOI IN
TERMS OF FINANCIAL AUTONOMY

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Specialty : Accounting
Code

: 9.34.03.01

SUMMARY OF DOCTORAL THESIS

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HA NOI - 2020


The thesis is finished at Academy of Finance

Scientific supervisors:

1. Assoc. Prof. Dr. Pham Van Dang
2. Dr. Hoang Van Ninh

Opponent 1:

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Opponent 2:

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Opponent 3:

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The thesis will be defended at Doctoral Thesis Committee for
Academy Level, ………………Location: ………………….Time:

After the publication, the thesis will be stored at:
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National Library of Vietnam and

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Academy of Finance Library


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INTRODUCTION
1. Significance
Innovation is an inevitable trend and an essential need of the society. In recent
years, the phrase "performance efficiency of public non-business units" has been
mentioned in many documents of the Party and State. Along with the process of
renewing the operational mechanism of public non-business units, the implementation of
autonomy mechanism in these units is a key stage, playing an important role in deciding
the success - failure of the innovation process. Health care is one of the pioneering fields
in the process of implementing autonomy, evidenced by the innovative contents in the
Decree No.85/2012/ND-CP on the operational and financial regimes applicable to public
health non-business units and the prices of medical examination and treatment services
of public medical examination and treatment establishments. This Decree has created a
breakthrough compared to the Decree No.43/2006/ND-CP providing for the right to
autonomy and self-responsibility for task performance, organizational apparatus,
payroll and finance of public non-business units. In 2015, the Government introduced
the Decree No.16/2015/ND-CP dated February 14th, 2015 on stipulating the
mechanism for exercising the autonomy of public administrative units. It is the
replacement of the Decree No.43/2006/ND-CP. With basic and comprehensive
innovation content, the Decree No.16 is not just an orientation, but an order requiring
all public non-business units in Vietnam to implement in the near future, in which
public health non-business units play a pioneering role. This is an opportunity and also

a great challenge for Vietnamese public health service providers during this period. In
order to adapt to the roadmap of promoting autonomy mechanism, one of the important
jobs that public non-business units need to do first is: reforming the financial
management - accounting of the units. Financial autonomy moves toward a clearer,
more coherent and comprehensive financial picture. It is because financial autonomy is
not only the issue of "self" balance of revenues - expenditures, but also the issues of
managing cash flows, resources, revenues and costs to utilize all resources of the unit in
the most effective and optimal way.
Accounting is one of the powerful tools that the units can use to have their
financial management access and adapt to the requirements and conditions of the
innovation process. In the past, organization of accounting work at public health nonbusiness units aimed to organize a data information system to manage and control
funding sources, usage and funding finalization, management and use of public materials
and assets; the compliance with revenue and expenditure estimates and the
implementation of revenue and expenditure standards and norms at the units. At present,
the process of implementing financial autonomy requires the provision of a more logical,
complete, timely and transparent information about all activities of the units in a more
specific and comprehensive manner. Therefore, changes from the renovation process
will certainly require the units to transform and perfect their accounting process.
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In addition, in 2018, a great change was marked with the introduction of the
Circular No.107/2017/TT-BTC replacing the Decision No.19/2006/QD-BTC guiding
the administrative accounting regime at public non-business units and the Circular
No.185/2010/TT-BTC guiding, amending and supplementing the Decision
No.19/2006/QD-BTC with comprehensive changes in accounting, especially in the
systems of accounts, financial statements and finalized financial reports. It is on the basis
of international public accounting standards, closer to the business sector, especially the
view of recording, reflecting and providing information on public services, which has

been and will have a major impact on the accounting process of public health nonbusiness units.
In Vietnam’s public health non-business units today, the provision of public
health services of central general hospitals is relatively diverse and complex. In big cities
like Hanoi, this diversity is further expressed by geographical characteristics, population
characteristics as well as the socio-political and social developments of the capital of the
country. With the inevitable trend of reforming the operating mechanism towards
promoting autonomy, central general hospitals in Hanoi are one of public non-business
units that are under high pressure with both opportunities and challenges. In order to be
able to secure the entire operational budget of their own units, the development and
replication of public services which are not financed by the State budget as in the
direction of marketization, while still ensure the harmony between benefits and political
responsibilities associated with social security, are the goal and the prerequisite choice.
And one of the optimal ways to achieve this goal in central general hospitals - as
analyzed above is to innovate, improve and perfect the financial management, through
completing the accounting work organization in the hospitals.
For the above reasons, through theoretical and practical research, the author has
chosen the topic: “Organizing the accounting work in central general hospitals in
Hanoi in terms of financial autonomy".
2. Objectives
2.1. Overall objectives
The thesis is to research theories and practice in order to propose solutions for
organizing the accounting work in central general hospitals in Hanoi in the condition of
implementing the financial autonomy mechanism according to the Decree
No.16/2015/ND-CP and reforming accounting - public finance in Vietnam.
2.2. Specific goals
To achieve the above objectives, the thesis must complete the following
specific tasks:
- Systematizing all theories of financial autonomy and accounting work organization
in public non-business units, content of financial autonomy and accounting work
organization in public health non-business units public.

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- Presenting, analyzing and evaluating the current situation of the accounting work
organization in central general hospitals in Hanoi today through studying the process of
implementing the autonomy mechanism at these hospitals.
- Based on the theoretical basis and analysis of the current situation, the thesis
provides solutions, recommendations and conditions for implementing those solutions in
practice to improve the accounting work in central general hospitals in Hanoi in the
coming time.
3. Research objects and scope
3.1. Research objects
The research objects of the thesis are theoretical and practical issues about
organizing accounting work in public health non-business units in the condition of
financial autonomy.
3.2. Research scope
- Regarding the research space: The study selects subjects which are central
general hospitals under the Ministry of Health in Hanoi, because Hanoi is one of the two
cities with the largest number of public hospitals in the country, and the central general
hospitals under the Ministry of Health are typical and have all features and factors to
conduct this research. Central general hospitals in Hanoi include hospitals under the
Ministry of Health (03 hospitals), hospitals affiliated to other ministries and sectors such
as Transport Hospital (under Ministry of Transport), 108 Military Central Hospital
(under the Ministry of National Defence), 19-8 Hospital (under the Ministry of Public
Security), Construction Hospital (under the Ministry of Construction), etc. Through a

preliminary survey of these hospitals, it is found that there are many similarities in the
operating procedures in the hospitals. In addition, there are information security process
in hospitals under the Ministry of Defense and the Ministry of Public Security, as well as
characteristics of the scale and type of diseases in hospitals under other ministries and
sectors, which cause certain limitations on data access to research. Therefore, the thesis
focuses on analyzing and evaluating in-depth the accounting work in 03 hospitals
directly under the Ministry of Health including: Bach Mai Hospital, E Hospital and Huu
Nghi Hospital with all types of public non-business units implementing financial
autonomy, along with the diversity of size, content and information quality.
- Regarding the research period: The thesis focuses on researching and
evaluating the results of implementing financial autonomy in central general hospitals in
Hanoi in the period 2014 - 2018, the current situation of organizing the accounting work
at these hospitals when implementing the Circular No.107/2017 /TT-BTC on guidelines
for public sector accounting (Circular 107 has been applied since 2018), proposal
solutions are towards 2030.
4. Methodology
- Methods of survey
Using investigation tools such as: information collection sheets, in-depth
interviews, etc. to collect information directly from the central general hospitals in
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Hanoi. With this method, the thesis uses a questionnaire prepared according to a
structure corresponding to the research content to collect information from the leaders or
chief accountants of the hospitals.
- Methods of document collection
The thesis collects documents and data at management agencies including

Ministry of Health (The Planning and Finance Department, The Medical Examination
and Treatment Management Department) and Ministry of Finance (Department of
Public Expenditure). In addition, there are data and documents that the thesis collects
directly from the departments of finance and accounting of the 03 hospitals: Bach Mai
Hospital, E Hospital and Huu Nghi Hospital. On the basis of the collected data, the
author has selected the necessary and appropriate data to analyze.
- Methods of statistics, synthesis and systematic analysis
Based on survey data, the thesis conducts statistical analysis and evaluates the
current situation of accounting work in central general hospitals in Hanoi in terms of
financial autonomy.
5. New findings of the thesis
- In terms of theory: The thesis systematizes and clarifies some basic theories about
organizing accounting work in public health non-business units according to the 4-step
process of receiving, processing and providing information on the basis of the theoretical
generalization of public non-business units as well as the content of financial autonomy in
public health non-business units. Thereby, the thesis points out the factors affecting the
accounting work organization in the public health non-business units in the condition of
financial autonomy, and at the same time points out the requirements posed to the
accounting work organization in these units in the condition of financial autonomy.
- In terms of practice: The thesis analyzes and clarifies the current situation of the
accounting work at 03 central general hospitals under the Ministry of Health in Hanoi,
including: Bach Mai Hospital, E Hospital and Huu Nghi Hospital since applying the
accounting according to the Circular No.107/2017/TT-BTC in the context of
implementing financial autonomy from 2014 to 2018. Thereby, the thesis points out
some shortcomings in all three information procedures, from collecting to processing
and providing accounting information in all three hospitals. The thesis analyzes and
clarifies the causes of limitations in order to propose a system of solutions to improve
accounting work in central general hospitals in Hanoi in the context of strongly
implementing the financial autonomy mechanism.
6. Outline of the thesis

In addition to the introduction, conclusion, list of reference and appendices, the
thesis is divided into 4 chapters:
Chapter 1: Literature review and methodology.
Chapter 2: Organizing the accounting work in public health non-business units in
terms of financial autonomy.
Chapter 3: Current situation of organizing accounting work in central general
hospitals in Hanoi in terms of financial autonomy.
Chapter 4: Solutions for completing the organization of accounting work in
central general hospitals in Hanoi in terms of financial autonomy
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Chapter 1
LITERATURE REVIEW AND METHODOLOGY
1.1. LITERATURE REVIEW

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.
1.2. INHERITABLE SCIENTIFIC AND PRACTICAL VALUES AND
RESEARCH GAP

1.2.1. Inheritable scientific and practical values
With the above overview of domestic and foreign literature, the thesis inherits the
research results related to the basic theories of public non-business units and

organization of accounting work in public non-business units; Organizational and
operational characteristics of public hospitals in Vietnam; Current situation of organizing
accounting work in public hospitals in previous stages related to the accounting
implementation according to the Decision No.19/2006/QD-BTC and the Circular
No.185/2010/TT-BTC providing guidance on amending and supplementing the publicsector administrative accounting regulations issued under the Decision No.19/2006/QDBTC, and assessments and analysis of the situation related to the thesis.
1.2.2. Research gap
Overview of literature shows that there have been no researches systematically
approaching the issue of organizing accounting work in public hospitals in terms of
financial autonomy according to the Circular No.107/2017/TT-BTC on both theoretical
and practical basis. That is the research gap of the thesis. This confirms the
independence and non-duplication of the thesis.
Chapter 2
ORGANIZING THE ACCOUNTING WORK IN PUBLIC HEALTH NONBUSINESS UNITS IN TERMS OF FINANCIAL AUTONOMY
2.1. BASIC THEORY OF FINANCIAL AUTONOMY AND ORGANIZATION
OF ACCOUNTING WORK IN PUBLIC NON-BUSINESS UNITS

2.1.1. Basic theory of financial autonomy in public non-business units
2.1.1.1. The concept of financial autonomy in public non-business units
From the perspective of financial management, the financial autonomy
mechanism is that the superior management agency (the manager) allows lower units
(the subject to be managed) to actively operate and have self-determination of financial
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activities in the framework of the law on financial management with the aim of
improving operational efficiency of the unit. And in terms of public non-business units,
the concept of financial autonomy in public non-business units is that public nonbusiness units are empowered by the State in the active exploitation, management and
use of financial resources and make decisions on the exploitation, management and use
of financial resources to improve the quality of providing public services, thereby

increasing income for officials, civil servants and employees in units.
2.1.1.2. Characteristics of financial autonomy in public non-business units
First, financial autonomy in public non-business units is the right to freely decide
all activities on mobilizing, distributing and using financial resources to achieve the set
goals of the units implementing autonomy.
Second, financial autonomy in public non-business units is always associated with
financial self-responsibility.
Third, financial autonomy in public non-business units is not meant to completely
allow the units to operate according to the subjective decision of the head of the unit.
Fourth, financial autonomy in public non-business units is fully implemented and
focused on the self-balancing of revenues - expenditures.
Fifth, financial autonomy for public non-business units aims to ensure that the
units are constantly expanding and developing, meeting the increasing demand for
public services of the society, and completing the tasks assigned by the State.
2.1.1.3. Roles of financial autonomy in public non-business units
Financial autonomy is an inevitable requirement when the State gives autonomy
to public non-business units.
As an incentive, financial autonomy also increases the creative initiative and sense
of self-responsibility in the operations of public non-business units.
However, it should be clearly understood that giving autonomy is not
synonymous with empowerment of liberty. Rights go hand in hand with responsibilities
and obligations.
2.1.1.4. Factors affecting financial autonomy in public non-business units
Firstly, it is the willingness of State management agencies to empower public
non-business units.
Second, the capacity to conduct the autonomy and self-responsibility of public
non-business units is also an important factor.
Thirdly, it is the people's willingness to respond to the implementation of
autonomy and self-responsibility in public non-business units.
2.1.2. Basic theory of organizing accounting work in public non-business units

2.1.2.1. Concept, characteristics and roles of organizing accounting work in
public non-business units
* Concept
According to the author's point of view, organization of accounting work in public
non-business units is the connection between accounting jobs, between accountants in a
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unit, in order to collect, process, analyze and provide honest, timely, complete and most
effective financial accounting information in the unit.
* Characteristics of organizing accounting work
* Roles of organizing accounting work
2.1.2.2. Requirements and principles for organizing accounting work in public
non-business units in terms of financial autonomy
2.1.2.3. Factors affecting organization of accounting work in public nonbusiness units in terms of financial autonomy
* Legal system for financial and accounting management in the public non business units in each period
* Human resources and quality of human resources doing accounting work in
the units
* The views and perceptions of the head of the public non-business unit
* Means of facilities and elements of computerization serving the accounting
work in public non-business units

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2.2. CONTENT OF FINANCIAL AUTONOMY AND REQUIREMENTS FOR
ORGANIZING ACCOUNTING WORK IN PUBLIC HEALTH NON-BUSINESS
UNITS IN TERMS OF FINANCIAL AUTONOMY

2.2.1. Content of financial autonomy in public health non-business units
Financial autonomy in public health non-business units is analyzed on two aspects
by answering two questions: What are the rights and financial responsibilities that public
health non-business units enjoy when applying autonomy? And how do these units
implement their rights and self-responsibilities of financial autonomy?
 Financial autonomy and self-responsibility
 How to organize the implementation of financial autonomy and responsibility
of public health non-business units
2.2.2. Requirements of organizing accounting work in public health nonbusiness units in terms of financial autonomy
First, depending on the type of autonomy in public health non-business units,
there will be differences in content, level of autonomy in tasks, organizational structure,
human resources and financial autonomy.
Second, financial autonomy gives public health non-business units the autonomy
in planning.
Third, financial autonomy always goes hand in hand with accountability. In order
to achieve accountability, the process of implementing financial autonomy in units

requires providing logical, complete and timely and transparent information.
Fourth, the financial autonomy mechanism is a policy aimed at serving the
objective of socializing resources.


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2.3. ORGANIZING ACCOUNTING WORK IN PUBLIC HEALTH NONBUSINESS 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 nonbusiness units
* Concept of acquiring accounting information in public health non-business
units
* Requirements of organizing accounting information in public health nonbusiness 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 systematizing and processing accounting information

in public health non-business units
* Requirements of processing accounting information in public health nonbusiness units
* Applying pricing methods to process accounting information in public health
non-business units
* Organizing accounting account system to systematize and process accounting
information in public health non-business units
* Organizing accounting book system to systematize and process accounting
information in public health non-business units
2.3.4. Organizing provision of accounting information in public health nonbusiness units
* Subjects that need to use accounting information and requirements of
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accounting information in public health non-business units
* Organizing the preparation of financial statements and finalized financial
statements, management accounting reports to provide accounting information in public
health non-business units
* Organizing analysis of accounting information in public health nonbusiness units
2.3.5. Organizing accounting examination
2.3.6. Organizing the application of information technology to the accounting
work organization
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 information. This is an important premise for in-depth research in
the next chapters of the thesis.
Chapter 3
CURRENT SITUATION OF ORGANIZING
ACCOUNTING WORK IN CENTRAL GENERAL HOSPITALS IN HANOI
IN TERMS OF FINANCIAL AUTONOMY
3.1. CURRENT SITUATION OF FINANCIAL AUTONOMY IN CENTRAL
GENERAL 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 considered as typical and highly representative among all central general
hospitals in Hanoi.
3.1.1. Overview of central general hospitals in Hanoi
3.1.1.1. 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
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disadvantages compared to other central specialized hospitals in the process of
implementing financial autonomy mechanism.
3.1.1.2. 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 qualifications. Their expertise and reputation are very high, these hospitals have
strong 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 in the period from 2014 to 2018
3.1.2.1. 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 nonbusiness units that ensure all regular operating costs since 2018. Particularly in Bach Mai
Hospital, on May 19, 2019, the Resolution 33/NQ-CP on the pilot implementation of
comprehensive autonomy and self-responsibility mechanism of 04 hospitals under the
Ministry of Health.
Thereby, organization of accounting work in three hospitals has also shifted
towards 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. The autonomy
mechanism has created conditions to help revenues from health services increase rapidly

both 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 20% of total
recurrent expenses. Therefore, in organizing accounting work, good control of
information about these two expenditures plays an important role in quality.
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3.1.2.4. Results of financial autonomy implementation
The difference between recurrent revenues and recurrent expenditures in hospitals
has tended to increase but not evenly
3.1.2.5. Situation of settling and using funds
Settlement and use of funds, especially non-business operation development
funds, have been a great financial source to invest in medical equipment, expand and
develop the infrastructure system, develop activities joint venture, associate as well as
improve professional qualifications and skills for the team of medical doctors through
training programs.
3.1.2.6. Situation of additional income payment
The content of additional income spending is specified in the internal spending
regulations of the hospitals and the payment of additional income is implemented on the
principle: Departments, provisions and individuals having high working efficiency and
considerable contribution in increasing revenue and saving expenditure, receive higher
payment and vice versa.
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3.2. THE CURRENT SITUATION OF ORGANIZING ACCOUNTING WORK
IN CENTRAL GENERAL HOSPITALS IN HANOI

3.2.1. Situation of the accounting apparatus organization and accounting
policy applied in central general hospitals in Hanoi
3.2.1.1. 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 accounting, especially accounting in the public sector, hospitals
have implemented and applied these new regulations into practice. The Circular
No.107/2017/TT-BTC on guiding the public sector accounting has been applied by
hospitals since January 1, 2018.
3.2.1.2. 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 found that the accounting staff's qualifications have improved significantly, in
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
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operations. Although there is no proper management accounting department, the
hospitals have incorporated some contents of management accounting in their
accounting 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 funds. For the accountants who are facilitated by the directors of the
hospital to participate domestic training courses to improve their professional
qualifications and skills or civil servant rank-promotion exam, the hospitals only support
in terms 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 regime to build their systems of accounting vouchers in accordance with the
characteristics, operational scale and accounting apparatus of the units. Except for Huu
Nghi Hospital, the other 2 hospital have used electronic invoices directly extracted from
the software.
Step 2: Organizing accounting voucher checking
The survey results shows that most hospitals have organized to check accounting
vouchers before using them, especially for electronic documents related to hospital fee

collection.
Step 3: Organizing the use of accounting vouchers for recording account books
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 comparison. At the end of the annual accounting
period, accounting vouchers will be archived according to regulations.
3.2.3. Situation of systematizing and processing accounting information in
central general hospitals in Hanoi
3.2.3.1. Situation of organizing the accounting account system
Regarding building the systematic list of accounting accounts
The survey shows that the hospitals are currently applying the Circular
No.107/2017/TT-BTC. Particularly, depending on the specific operational characteristics
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of each hospital, the detailed account systems have different contents, which has led to
the inconsistency between the hospitals
Regarding the determination of the reflected contents of the accounting accounts
and the accounting methods of some key operations of the hospitals
- Processing accounting information in the accounting section of raw materials,
materials and tools, tools - accounting process for importing - exporting drugs and
medical supplies
- Processing accounting information on accounting of hospital fees and health
insurance
- Accounting for collection of hospital fees and health insurance
- Regarding the current status of expense recognition related to medical
examination and treatment

- Processing accounting information on accounting of fixed assets - realization of
depreciation of fixed assets
- Processing accounting information on accounting of salary and additional
income payment
- Processing accounting information in the accounting practice related to joint
venture, 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, recording and closing accounting books
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 perform bookkeeping on computers, so in the bookkeeping
department, all accounting books are stored on computers and bookkeepers are mainly
responsible for the direct entry in the accounting books. At the end of an accounting
year, accounting books are printed, arranged and preserved in the archive department
with accounting vouchers.
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

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according to the public accounting regime issued under the Decision No. 19/2006/QDBTC 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.
3.2.4.2. Situation of the organizing information provision according to the
requirements of internal management and governance in hospitals
In addition to the systems of financial statements and finalized financial reports
in accordance with the Circular 107/2017/TT-BTC, the hospitals have developed the
number of reports to serve the management and governance needs of the hospital.
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 accounting software such
as DAS or MISA and some software to support the hospitals' professional operations
such as hospital fee software, pharmacy management software, health insurance
assessment software, human resource management software, etc. This shows that the

application of IT in accounting has been focused on by public hospitals.
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3.3. ASSESSING THE CURRENT SITUATION OF ACCOUNTING WORK IN
CENTRAL GENERAL HOSPITALS IN HANOI

3.3.1. Results achieved in the process of organizing the accounting work in
the central general hospitals in Hanoi
3.3.1.1. Organizing accounting apparatus
The centralized form of accounting is generally suitable for the current scale and
characteristics of the hospital operations.
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3.3.1.2. Organizing accounting information acquisition
The hospital has performed quite well in organizing the information acquisition
through the accounting voucher system.
3.3.1.3. Organization of systematizing and processing accounting information
The current accounting account system of the hospitals is relatively consistent
with the 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 need to retrieve detailed information, as well as collate and
check data on financial statements.
3.3.1.4. Organizing provision of accounting information
Thanks to the application of accounting software, the hospitals have prepared
relatively complete reports in regulated forms and in accordance with the
requirements of providing information for the users of financial statements and
finalized financial reports.

3.3.1.5. Organizing accounting examination
The accounting examination in the hospitals has been carried out relatively
regularly and continuously. Checking has been also implemented in all stages and all
accounting processes.
3.3.1.6. Organizing the application of information technology to accounting
work
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 are different.
3.3.2. Limitations in organizing accounting work in central general hospitals
in Hanoi
3.3.2.1. Organizing accounting apparatus
Firstly, the centralized accounting system organization is only suitable at the
present time, but not suitable for the development in the scale and types of operations of
the hospitals in the future.
Second, there has been no management accounting department in the accounting
apparatus of the hospitals. Hence, the financial management of the hospitals has not been
paid attention, 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.
3.3.2.2. Organizing accounting information acquisition
- The recording of factors related to the contents of the accounting vouchers is
sometimes not complete and timely;
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- The acquisition of accounting information in the process of importing exporting drugs are still passive, depending on other departments, especially the
pharmacy 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 einvoices has not yet been optimized
- The accounting voucher system for accounting management does not exist or
exists but still has many limitations
- The checking of accounting vouchers is only in the first stage, but after entering
vouchers into the machine, the accountants do not check or omit the inspection.
- Storing and preserving documents in the hospitals has not been scientifically,
leading to difficulties in checking
3.3.2.3. 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 of management and administration of each hospital, this
creates inconsistencies between hospitals, causing difficulties for other users of reports,
especially governing agencies.

Secondly, in terms of determining the reflected content of accounting accounts
and accounting methods for a number of key operations in the hospitals
Limitations in processing accounting information in the accounting of
importing and exporting drugs
- Information on drug storage is manually entered into accounting software by the
hospitals, and there is no connection between pharmaceutical management software and
accounting software.
- Information on exporting drugs is recorded and reflected at the end of the month
in different ways between the hospitals.
- It is a risk of drug leakages that the cost has been accounted when drugs are
exported from the pharmacy departments to treatment departments and patient rooms,
but the patient has used or not used the drugs.
Limitations in processing accounting information in the accounting of medical
examination and treatment activities
- The recognition of health insurance revenues and expenses in the period are
inconsistent and not complying with the revenue recognition principles in international
public accounting standards.
- There have been no criteria for the allocation of general expenses to each
department
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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
There is no appropriate accounting treatment to harmoniously solve the problem
of developing high-quality human resources
Limitations in processing accounting information in the accounting of joint
venture and association activities
Accounting for this activity in hospitals does still not really reflect the nature of
LD, LK.
Third, limitations in the application of the accounting book system
The detailed accounting books are opened according to the subjectivity of the
hospitals, which is inconsistent and often spontaneous, not following a certain order and
principles.
3.3.2.4. Organizing provision of accounting information
First, the time to submit financial statements and finalized financial reports of
hospitals is often slower than the regulations.
Secondly, there are many difficulties and problems in making financial reports,
such as the hospitals are confused in checking, comparing and detecting errors on
reports.
Third, the preparation of financial statements and finalized financial reports at the
hospitals is still obedient,
Fourthly, most hospitals have not built up management accounting reporting
systems.
Fifth, hospitals have not analyzed financial statements to serve hospital internal
governance and warn the risk of imbalance in financial resources, which is extremely
important when hospitals implement financial autonomy.
3.3.2.5. Organizing accounting examination
Even though the hospitals have an internal control department, they directly
assign accountants to check the contents of their work.
3.3.2.6 Application of information technology to organizing accounting work
Data linkage between functional departments to share information, improve
information processing efficiency, and support daily management and operations has not

been concerned and implemented well in many public hospitals.
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3.3.3. Causes of the limitations
3.3.3.1. Objective reasons
The first reason is relatively large and incomplete changes in both financial
and accounting mechanisms in the public sector, especially in the public health
service sector.
The second one is that the Circular 107/2017/TT-BTC promulgating a new public
accounting regime, replacing the Decision 19/2006/QD-BTC and is applied after only 3
months, making the accounting work in the hospitals met many difficulties.
Thirdly, another cause is that the specificity and complexity of the health sector
where operates 24/24 hours and 7/7 days and is always in overload.
3.3.3.2. Subjective reasons
Firstly, the governance capacity of hospitals has not kept pace with the
requirements of development towards financial autonomy in the hospitals.
Secondly, due to the application of science and technology, especially the
information system in the hospitals, it has not really met the hospitals' needs for internal
management and administration, and reduces the pressure and workload for accountants.
Third, because of the limited expertise of some accountants, it leads to
dependence on the support of the software without really understanding the nature of the
profession, thereby incorrectly handling and reflecting accounting information.
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CONCLUSION OF CHAPTER 3

In chapter 3 of the thesis, the author outlines the operations of central general
hospitals in Hanoi as well as clearly analyzes the status of the process of implementing
autonomy mechanisms in the 03 hospital: Bach Mai Hospital, E Hospital and Huu
Nghi Hospital in the period from 2014 to 2018. At the same time, the author focuses on
in-depth analysis of the actual state of accounting work in these three hospitals
according to the procedure of receiving, processing and providing accounting
information, in which focusing on a number of key accounting operations that are
greatly affected by the autonomy mechanism. Thereby, the thesis offers advantages,
limitations and causes in the process of organizing the accounting work in the three
hospitals since the implementation of the Circular 107/2017/TT-BTC. This will be a
fundamental basis, playing a key role for the author to give appropriate and applicable
solutions in chapter 4.


19
Chapter 4
SOLUTIONS FOR COMPLETING THE ORGANIZATION OF ACCOUNTING
WORK IN CENTRAL GENERAL HOSPITALS IN HANOI IN TERMS OF
FINANCIAL AUTONOMY
4.1. THE VIEWS TO PERFECTING THE ORGANIZATION OF
ACCOUNTING WORK IN CENTRAL GENERAL HOSPITALS IN HANOI IN
TERMS OF OF PROMOTING FINANCIAL AUTONOMY OF PUBLIC NONBUSINESS UNITS

Starting from the context of reforming the organizational and management
system, improving the quality and efficiency of operations associated with promoting
financial autonomy in public health non-business units, perfecting the organization of

accounting work in public non-business units and in central general hospital in Hanoi is
an objective indispensable. With the aim of becoming an indispensable tool for the
success of the innovation process in public health non-business units, the accounting
work organization in these units should be completed according to the consistent
requirements and principles.
Firstly, it does not disrupt the consistency of the accounting system and at the
same time conform to the state financial policies and regimes prescribed for public nonbusiness units based on the inheritance principle.
Secondly, it is to ensure consistency, consistent with the characteristics of the
hospital's operations and management in response to requirements from the process of
promoting financial autonomy.
Thirdly, perfecting the accounting organization needs to thoroughly grasp the
spirit of thrift and efficiency
4.2. SOLUTIONS FOR COMPLETING THE ORGANIZATION OF
ACCOUNTING WORK IN CENTRAL GENERAL HOSPITALS IN HANOI IN
TERMS OF FINANCIAL AUTONOMY

4.2.1. Regarding organization of accounting apparatus
Firstly, applying the centralized and distributed accounting model or the
distributed accounting model in the organization of the accounting apparatus when the
hospitals have many facilities operating as independent hospitals
Second, setting up the management accounting department in parallel with the
financial accounting department in the hospital accounting apparatus
Third, organizing the accounting apparatus in a streamlined, compact direction,
suitable with hospital management software to easily control accounting information and
financial situation


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4.2.2. Regarding organization of accounting information acquisition
With the expanding scale of the hospital's operations, the requirement of

information processing is increasing rapidly, creating pressures on quickly and
accurately controlling and classifying information. Therefore, the organization that
receives accounting information must change qualitatively, not only in the accounting
department, but also in the sections related to the information. It is also necessary to
specify detailed regulations of the rights and responsibilities of the parts related to that
information, thereby defining the responsibilities of the parties if any error occurs.
Firstly, completing on the basis of fully supplementing the basic elements of
vouchers, in particular, fully and comprehensively reflecting the basic information
related to the professional contents recorded on the accounting vouchers, ensuring clarity
and accuracy, facilitating the recording, arrangement and classification of vouchers and
facilitating inspection and examination.
Second, completing the accounting process for the import and export of the drug
stores, in which the role of the accountant is at the center. There is a high connection
between the accounting department and other departments on the basis of consolidating
information from different departments, creating proactive and timely accounting for
drug import and export activities.
Third, regarding medical examination and treatment, it is necessary to comply
with regulations on financial invoicing in general and e-invoices in particular.
Fourthly, building and perfecting the voucher system, overcoming the limitations
of the current accounting voucher system, matching and responding to information
requirements, especially management accounting information in conditions for hospitals
to promote financial autonomy.
Fifth, completing the process of checking accounting vouchers at all stages on a
comprehensive, complete and timely perspective
Sixth, researching and improving the process and method of storing accounting
vouchers at the hospitals in the direction of increasing storage on electronic media
through different storage channels, limiting paper documents to avoid risks in the
process of archiving and preserving accounting vouchers. In addition, organizing the
arrangement and classification scientifically in the process of archiving and preserving
accounting vouchers to facilitate the later examination

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4.2.3. Regarding organization of systematizing and processing accounting
information
4.2.3.1. Building a combined system of public accounting accounts suitable to
the characteristics of the operation, meeting the management needs of hospitals and
the needs of synthesizing information of state management agencies
Proposing to develop a combined system of accounting accounts in the hospitals,
including 13 codes, prescribed by the Ministry of Health in coordination with the
Ministry of Finance for the detailed accounting of arising economic transactions
according to the management and administration requirements of hospitals as well as the
management and administration requirements of the State for hospitals.
4.2.3.2. Thoroughly applying accounting principles in international public
accounting standards to receive and process information
There should be specific and detailed guidance on the application of accounting
principles according to the content of international public accounting standards so that
these units can understand correctly and perform correctly.
4.2.3.3. Completing accounting for some key operations in hospitals
On the basis of applying accounting principles in accordance with international
public accounting standards, it is necessary to refine accounting contents, principles and
methods in a number of major hospital operations.
4.2.3.4. Perfecting the organization and application of the accounting book
system
With the accounting method based on a combined account system designed with
the above code, the hospitals need to define a list of detailed accounting books that must
be opened corresponding to the list of contents of financial management of the hospitals.
4.2.4. Regarding organization of accounting examination
Therefore, improving the organization to provide accounting information is not
only necessary, creating the quality of the entire accounting procedure, but also

contributes to building the reputation and branding of the hospitals when the information
is announced to not only internal users, but also external users such as industry
regulators, domestic and foreign organizations, joint ventures and development
cooperation organization, etc.
4.2.4.1. Completing the manner, method and procedure of preparing financial
statements and finalized financial reports according to the Circular 107/2017/TT-BTC
First, it is necessary to change the mindset of making and using financial
statements and finalized financial reports of accountants: the preparation of financial
statements and finalized financial reports needs to be identified as the central task,
assigned to competent and highly qualified staff and accountants.
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Second, it is necessary to improve the accounting capacity and level of knowledge
in preparing and analyzing financial statements and finalized financial reports.
Third, it is necessary to accelerate the process of reporting and submitting
financial statements and finalized financial reports in accordance with the Law on
Accounting 2015 and the Circular 107/2017/TT-BTC.
4.2.4.2. Unifying and completing forms and detailed content on the items in the
reports in the financial statement system
It is necessary to unify the form and detailed content on the operational

performance reports and financial disclosure reports to create a unity for the synthesis
and consolidation process.
4.2.4.3. Building and designing management accounting reporting system
Proposing to develop and design a management reporting system based on the
activities of the unit to serve the internal governance of the hospitals.
4.2.4.4. Performing analysis of financial statements and finalized financial
reports
Proposing to perform analysis of financial statements and finalized financial
reports through the use of financial analysis methods
4.2.5. Regarding organization of accounting examination in central general
hospitals in Hanoi
It is necessary to set up internal audit department in hospitals. By analyzing,
examining, and monitoring the operational processes of the departments in the
organizational apparatus, internal audit will provide advices to help the hospitals operate
more efficiently and effectively.
4.2.6. Regarding organization of applying information technology to
accounting work in central general hospitals in Hanoi
Firstly, applying general hospital management software, which directly connects
this software with accounting software and other software’s in the hospitals
Secondly, reducing cash collection and payment of hospital fees through
promoting and developing methods of paying hospital fees through banks
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4.3. CONDITIONS FOR SOLUTION IMPLEMENTATION

4.3.1. Conditions for implementing the solutions

4.3.1.1. Improving governance capacity to meet the needs of hospital
development in the process of financial autonomy
4.3.1.2. Promoting computerization in accounting work
4.3.1.3. Improving professional qualifications of accounting teams
4.3.1.4. Improving connectivity between departments in hospitals
4.3.2. Proposals
4.3.2.1. For the National Assembly and the Government
4.3.2.2. For ministries and ministerial-level agencies


23
CONCLUSION OF CHAPTER 4

On the basis of analyzing the current situation, assessing the advantages and
disadvantages in Chapter 3, the author finds a common situation in the accounting
organization in all the three hospitals that although there have been changes to respond
to requirements in the process of implementing the financial autonomy mechanism,
there are certain limitations in the process of financial autonomy regarding both aspects
of financial accounting and management accounting at each stage in the procedure of
receiving, systematizing, processing and providing accounting information. Especially,
the content of management accounting is still weak in the accounting work organization
in these three hospitals. Therefore, chapter 4 of the thesis gives a view to perfecting the
accounting work organization in the central general hospitals in Hanoi in terms of
financial autonomy and proposes 06 main solution groups. The solution groups are built
closely with the requirements set out for the accounting organization in the units in terms
of financial autonomy. And in each group of solutions, the author not only gives
recommendations for orientation, but also recommendations with specific illustrations,
which can be applied in harmony and suitable with hospitals. At the same time, the
thesis has also pointed out the conditions for implementing solutions and
recommendations for related subjects, creating a basis and framework for implementing

these groups of solutions in practice.