Medical equipment is a vital state asset for the operation and development of public hospitals, the operation of the hospital's clinical units, the healing of medical pains and the contribution of medical equipment to doctors, patients and scientific research. However, there are many irregularities in the day-to-day management of medical equipment, and this paper analyses common problems in equipment management accounting from a financial point of view in terms of the lack of control over the use of equipment, the need for improved internal controls and the lack of strict procedures for end-of-life procedures, and provides responses on issues such as sound management, clarification of functions, strengthening of internal controls, large-scale equipment management, equipment inventory and rigorous end-of-life management。
Medical equipment is a vital state asset for the operation and development of public hospitals. It represents more than 60 per cent of the value of the hospital assets and is an important asset for medical, scientific, teaching, etc. Effective and dynamic monitoring of the life cycle of medical equipment must therefore be strengthened in practice, to the full extent of its effectiveness, which is crucial for improving the economic and social efficiency of public hospitals and enhancing their core competitiveness。
I. Common problems in operating public hospital equipment
(i) the use of sectoral ownership in equipment management is unclear and accounting methods should be strengthened
As a rule, the general services section of the hospital is responsible for the management of assets valued at over $1,000 per unit, such as building buildings, furniture and transport equipment, while the armaments section is responsible for the management of specialized equipment, valued at over $1,500 per unit. Information centres are responsible for the maintenance of networks, computers, software, etc. In reality, however, the management of hospitals varies, with the general services section and the medical equipment section having cross-management areas such as disinfectant cabinets, printers, washing machines, etc., and the medical equipment section and the information centre having unclear responsibilities such as computer and printer installation maintenance. As a result, network information centres often push computer installation and maintenance work to the instruments section. Multiple management and cross-management lead to a situation of lack of authority and responsibility, a lack of dedicated medical equipment managers in the use of sections and a lack of accountability, leading to mismanagement and even disruption of work。
While medical equipment is of high value, highly technical and up-to-date, its qualifications are rigorously reviewed, it must have a product registration and the relevant qualifications are complete and traceable, and the new accounting system uses the historical cost method to account for its original value, medical equipment is generally depreciated on a six-year straight-line basis, unlike the enterprise accounting system, which requires that accumulated depreciation and asset impairment be prepared using the sum of years or double-balance reduction, which results in a discrepancy between the book value of the equipment and the actual value and does not reflect the net value of the medical equipment。
(ii) insufficient justification of equipment acquisition and improvement of internal control systems for hospital assets
Some hospitals do not strictly follow the acquisition process for specialized equipment, do not demonstrate the feasibility of social and economic benefits, or, despite the expert opinion of the organization, are insufficiently demonstrated in all respects, or do so in an inaccurate manner, resulting in the blind acquisition of low-tech and poor-quality equipment, the increased cost of use, maintenance and even idleness, which reduces the value and efficiency of medical equipment。
Business processes for the management of medical equipment are generally divided into four stages of acquisition, acceptance, routine maintenance and disposal of assets, with higher risks, such as receiving and inspection of aerobics resulting in a lack of quality of medical equipment and an impact on its use; inappropriate operations resulting in an increase in equipment malfunctions and maintenance costs; and lack of effective control measures for the acquisition, custody, use, maintenance, redeployment, end-of-life, inventory, etc. Of medical equipment, causing confusion in the management of medical equipment and waste of equipment resources。
(iii) irregular inventory of medical equipment and poor procedures for end of life
Some hospitals do not require a full inventory of equipment at least once a year, in accordance with the state-owned asset management system and the new accounting system, but only when the audit needs to be performed by a firm of accountants, which is concerned only with the availability of equipment and inadequate monitoring of the storage, use, regular maintenance, maintenance, redeployment and utilization of equipment。
In practice, equipment is lost owing to the negligence of equipment managers, lack of accountability, unclear identification of storage sites, random disposal and, at times, irregular damage to equipment that should not be disposed of. At the same time, there have been instances in which assets have not been disposed of in a timely manner for equipment that has reached the end of its useful life, is normally scrapped and has completed its end-of-life clearance, and the proceeds of disposal have not been handed over to the state treasury in a timely manner, and some medical equipment has not been found owing to the lack of personal custody by the equipment user department, which has left the equipment unrecoverable。
Response to the management of medical equipment
(i) sound management, with clear management responsibilities and full participation in management
The management of medical equipment requires the implementation of a full-time process, and the importance of hospital leadership is key to the proper management of medical equipment. It strengthens the learning of the staff of the entire institution in terms of laws and regulations, operational knowledge, management knowledge, medical knowledge, etc., in order to create a favourable learning environment in which employees can use the equipment well, make every medical equipment available and provide material security for the economic development of the hospital。
State-owned assets shall be subject to the principles of "unional leadership, portfolio management, classification, responsibility and responsibility", the establishment of an asset management system, the organization of clean-up funds, etc.; the medical equipment section shall be responsible for the approval, acquisition, acceptance, transfer, maintenance, repair and recording of desk accounts of products and related medical equipment of sufficient qualifications, the validation of end-of-life claims by technical engineers, and the collective decision on the acquisition of large equipment; the use of the section shall identify those responsible, who shall generally be the heads of sections or nurses; the treasury shall be responsible for the general accounting of equipment section assets and for the financing of procurement requirements; the departments shall be clearly divided and accountable, avoiding cross-cutting or multi-head management and facilitating the return and efficient use of state-owned assets。
(ii) regulate the medical equipment acquisition process and focus on large equipment management
The procurement of all types of equipment in accordance with the government procurement act requires the performance of such processes as requisitions, justifications, requests for quotations and open tendering. The medical equipment section prepares, at the end of the year, a plan for the acquisition of medical equipment for discussion by the medical equipment management board, which is reviewed by the director-general and approved by the director-general. The medical equipment management board, which normally consists of the head of the compound and the heads of the sections, shall, prior to acquisition, submit a request for equipment based on the budget and conduct a feasibility analysis, submit it to the head of the hospital for approval, ensure the necessity and economy of the acquisition of medical equipment, ensure that the hospital is carried out strictly in accordance with the medical equipment procurement process, and implement a collective decision by the unit's leadership to prevent corruption。
The introduction of large-scale medical equipment not only focuses on pre-scientific assessment, but also on the establishment of a system of accounting and control at a later stage, rigorous monitoring and management control of the full life cycle of medical equipment, clear management and use of those responsible, training of operators by plant engineers, contracts for repair and maintenance with quality third parties, such important matters as routine maintenance of ct, stratification of operating theatres, etc., to ensure that large-scale medical equipment works well and to ensure the accuracy of operational data for large-scale medical equipment. Each year, a single cost-benefit assessment of large medical equipment is performed, an annual quality assessment of the use of a single machine is performed to ensure the number, application rate, operating income and patient satisfaction of individual equipment. Ensuring the proper functioning of large-scale medical equipment effectively increases the economic and social benefits of hospitals。
(iii) strengthened medical equipment inventory system to improve end-of-life management of fixed assets
As the hospital continues to evolve, the operations are constantly adjusted, with the addition of new sections and the dismantling and reorganization of sections, as well as the reprogramming of sections. It is proposed that the hospital notify the medical equipment section and adjust the medical equipment section to process the transfer procedures for the related medical equipment, adjust the medical equipment billings in a timely manner and ensure that the medical equipment billing is consistent with the use of the medical equipment in the section. Hospitals should strictly implement the property inventory and inventory system, organize a comprehensive inventory of medical equipment by the relevant personnel at least once a year, identify the profit and loss equipment and submit the approvals required and in accordance with established procedures to ensure that the books are kept and the accounts are kept in line。
Due to, inter alia, the length of service, medical equipment that has been retired from service in each section should be filled out in the application form. Under the state-owned management system of hospitals, medical equipment is not allowed to be scrapped for up to six years. Medical equipment in excess of its useful life is requested by the user office, certified signature by the maintenance staff of the medical equipment section, written by the equipment section and the finance section, studied by the medical equipment management board, submitted to the medical equipment section with the approval of the head of the hospital for consolidation, registration of the name, specifications, place of production, date of purchase, unit price, amount and place of storage of the medical equipment in excess of its useful life, and arrangements for the person concerned to take photographs and to keep files in separate categories, and then report to the finance section for processing the process related to the liquidation of fixed assets. Prior to the issuance of a higher-level financial authority, the end-of-life medical equipment should be managed by a dedicated person who will not allow the private disposal of the equipment for sale; after the financial authority's approval, the net proceeds from the sale of the end-of-life medical equipment should be transferred to the hospital, and the finance and equipment section should perform the write-down and reduction of the financial ledger and the medical equipment desk on the basis of the recovery, thus ensuring the true integrity of the hospital assets。
(iv) strengthened medical equipment management information system and use of software to inform the management of medical equipment
With the advent of an era of intelligence, it is expected that by 2025 basic finance will be replaced by robotics, and the introduction of intelligence will be a trend that will not only reduce the basic work of finance staff, but also enhance the self-value of finance staff in all respects, shift from accounting to accounting for management, and help open up hospitals and widen their profit channels. The medical equipment section has a heavy and extensive workload, building a platform where all sections can share information resources, effectively linking the procurement, warehousing, access, redeployment, maintenance, end-of-life, clean-up of hospital medical equipment to the use sections, finance and state-owned asset management, regulating processes, and fully implementing dynamic management and overall control over the life cycle of medical equipment。
(v) improvement of hospital controls and accountability
Hospitals should establish appropriate internal controls, strengthen internal control of medical equipment, establish job responsibility, reasonably ensure the proper operation of public hospitals, separate incompatible functions such as application and approval, approval and execution, execution and supervision, separate procurement, custody and accounting records, conduct regular audits of the safety and integrity of medical equipment, its economic efficiency and the handling of accounts, and improve the profitability of the equipment。
Hospitals rent or guarantee equipment for financial approval at the same level and establish accountability systems. Those responsible should also be held legally responsible for the serious damage caused to hospitals as a result of malicious acts of appropriation, misappropriation, the sale and sale of loans in their personal name, unauthorized disposal and deliberate destruction of medical equipment。
To sum up, strengthening the management of medical equipment from the perspective of financial management will increase the efficiency of the use of assets, guarantee medical services and save patient costs, thereby ensuring that medical equipment is used to its full potential, reducing the loss of state assets and promoting the rapid and healthy development of hospitals。
Concluding remarks
In the light of the above, efforts have been made to improve the dynamic management of hospital medical equipment, to improve the efficiency of its use, to strengthen the information system for the management of medical equipment, to use software to inform the management of medical equipment, to gradually improve the management of state-owned assets and to improve the core competitiveness of hospitals in practice。
