伴随社会的快速发展，人们的生活质量也逐步提升，对医疗服务的需求也明显 增加。人们需求的变动对我国的医药改革起到了很强的推动作用，医院为更好的应 对时代发展趋势，开始向企业借鉴经验。公立医院在我国医疗欧亿·体育（中国）有限公司中一直位居重要 位置，具备实力强、竞争力强的特点，然而在当前的时代背景下，想要持续的保持 自身优势，就必须要进行改革，努力提升管理水平。结合我国公立医院的现实情况 进行分析，发现医院在发展过程中还存在着较多的问题，比如管理水平不高、管理 模式不合理、内部控制力度不足等，这直接导致了决策上的不合理，影响医院整体 的发展。因此对于公立医院来说，必须要重视构建内部控制制度，以强大的控制力 约束好内部主体的行为，保障公立医院向着正确的方向发展。 本文主要结合公立医院在内部控制上存在的问题进行研究。在研究时采用了理 论与实践相结合的方式，结合特殊的角度来分析问题，并帮助A大学附属医院解决 现实问题。其次，针对本文研究的内部控制进行分析，介绍了内部控制的定义、内 容、理论成果等，比如控制论等；然后，结合公立医院在实施内部控制时应该偏重 的重点进行分析，以A大学附属医院为研究案例，对我国公立医院在内部控制中存 在的问题进行阐述。首先，参考国家卫生部门发布的要求以及A大学附属医院的实 际情况，构建评价指标体系。在选择指标时综合考虑了各大要素，共设置了5个一 级评价指标，15个二级指标以及65个三级指标，通过这种指标细分的模式保障评 价的全面性。其次，考虑到各指标重要性的不同，利用层次分析法分配权重，然后 借助于模糊综合评价法评价该医院在内部控制上的实际效果，并分析评价结果，查 找分析工作中存在的问题，并对问题产生的原因进行分析，最后提出改进方案。期 望为A大学附属医院的内部控制完善提供可参考建议。 关键词：内部控制；公立医院；模糊评价 II ABSTRACT With the rapid development of the society, people's quality of life has gradually improved, and the demand for medical services has also increased significantly. The change of people's demand has played a strong role in promoting the medical reform in China. In order to better cope with the development trend of The Times, hospitals began to learn from the experience of enterprises. Public hospitals have always occupied an important position in China's medical industry, with the characteristics of strong strength and competitiveness. However, in the current background of The Times, in order to continue to maintain its own advantages, it is necessary to carry out reform and improve the management level. Based on the analysis of the actual situation of public hospitals in China, it is found that there are still many problems in the development process of hospitals, such as low management level, unreasonable management mode and insufficient internal control, which directly lead to unreasonable decision-making and affect the overall development of hospitals. Therefore, for public hospitals, it is necessary to attach importance to the construction of internal control system, restrict the behavior of internal subjects with strong control force, and ensure that public hospitals develop in the right direction. This paper studies the problems existing in the internal control of public hospitals. In the study, the author combined theory with practice to analyze problems from A special perspective and help the affiliated hospital of A university solve practical problems. Secondly, it analyzes the internal control studied in this paper and introduces the definition, content and theoretical results of internal control, such as cybernetics. Then, combined with the emphasis of public hospitals in the implementation of internal control, this paper analyzes the problems existing in the internal control of public hospitals in China, taking the affiliated hospital of A university as A case study. First, the evaluation index system was constructed by referring to the requirements issued by the national health department and the actual situation of the affiliated hospital of A university. In the selection of indicators, all major factors were considered comprehensively, and a total of 5 first-level evaluation indicators, 15 second-level indicators and 65 third-level indicators were set. The model of subdivision of these indicators ensured the comprehensiveness of the evaluation. Secondly, considering the importance of every index is different, distribute the weights using the analytic hierarchy process (ahp), and then by means of fuzzy comprehensive evaluation method to evaluate the actual effect the hospital on the III internal control, and analyze the evaluation results, find the analysis of the problems existing in the work, and analyzes the causes of the problem, finally put forward the improvement plan. It is expected to provide referential Suggestions for the improvement of internal control of affiliated hospital of A university. Key words: Internal control; Public hospital; Fuzzy evaluation 目 录 摘要..I ABSTRACT..........................II 第1章 绪论..........................1 1.1 研究背景与意义.....1 1.1.1 研究背景......1 1.1.2 研究意义......3 1.2 国内外研究现状.....4 1.2.1 国外研究现状.............................4 1.2.2 国内研究现状.............................6 1.2.3 文献综述小结.............................8 1.3 研究方法、研究内容与技术路线........8 1.3.1 研究方法......8 1.3.2 研究内容......9 1.3.3技术路线.......9 第2章 内部控制概述........10 2.1 相关概念...............10 2.1.1 内部控制的概念.......................10 2.1.2 内部控制的构成要素...............10 2.1.3 医院集团内部控制的特点........11 2.2 相关理论................11 2.2.1 控制论.........11 2.2.2 代理理论....12 2.2.3 组织行为理论...........................13 第3章 A大学附属医院内部控制现状及评价指标体系构建......15 3.1 A大学附属医院概况...........................15 3.2 A大学附属医院内部控制调查...........15 3.3 A大学附属医院内部控制评价指标体系构建..................19 3.3.1 评价指标选取原则...................19 3.1.2内部控制评价的指标体系........20 第4章 A大学附属医院内部控制评价及结果分析......................23 4.1 分析方法...............23 4.1.1层次分析法.23 4.1.2模糊综合评价............................25 4.2基于层次分析法的评价指标权重.......27 4.2.1 建立递阶层次结构...................27 4.2.2 构造判断矩阵计算权重...........27 4.2.3 计算权向量33 4.3 基于模糊综合评价的内部控制评价..35 4.3.1 确定评价因素...........................35 4.3.2 确定评语等级...........................35 4.3.3 建立模糊关系矩阵...................35 4.4 评价结果分析.......39 4.4.1 采购内部控制活动...................39 4.4.2 药品管理内部控制活动...........40 4.4.3 固定资产管理内部控制活动...40 4.4.4 收入与支出内部控制活动.......40 4.4.5 债权与债务内部控制活动.......41 第5章 A大学附属医院内部控制存在的问题和成因分析..........42 5.1 A大学附属医院医院内部控制存在的问题.......................42 5.1.1 管理层风险控制意识薄弱，风控各节点工作人员人浮于事.............42 5.1.2 对固定资产的管控较混乱.......43 5.1.3对于医疗业务收入中的现金缺乏有效监管...........44 5.1.4药品采购环节风险点未能得到有效控制...............45 5.1.5 内部控制评价报告制度沦落为形式主义..............46 5.2 A大学附属医院内部控制问题形成的原因.......................46 5.2.1 管理层对内部控制不重视，内控相关工作人员敷衍了事.................46 5.2.2 没能充分认识到固定资产管理的重要性..............46 5.2.3 退费环节风险控制力度薄弱...48 5.2.4 药品采购环节内部控制制度不完善且监管不力..49 5.2.5 忽视内部控制报告的意义及作用..........................50 第6章 完善A大学附属医院内部控制的建议.............................52 6.1 提高管理层风险控制意识，构建强有力的风控组织架构............................52 6.1.1 善于借力使管理层理解风控重要性......................52 6.1.2 加强内控培训...........................52 6.1.3 规范内控岗位设置...................52 6.2 完善固定资产管理制度并将制度落到实处.....................52 6.2.1 核实固定资产台账...................53 6.2.2 严肃固定资产盘点工作...........53 6.2.3 资产采购科学化.......................53 6.2.4 落实固定资产归口管理...........55 6.3 加强现金的管理...55 6.3.1 在技术层面上解决退费难题...55 6.3.2 打通退费所需合作渠道...........56 6.3.3 严肃纪律杜绝舞弊...................56 6.4 完善药品采购内部控制制度和组织架构.........................57 6.4.1 确保不相容职务相分离...........57 6.4.2 依靠警示教育将问题消灭在初始