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0 MINISTRY OF EDUCATION 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 Specialty : Accounting Code : 9.34.03.01 SUMMARY OF DOCTORAL THESIS HA NOI - 2020 The thesis is finished at Academy of Finance Scientific supervisors: Assoc Prof Dr Pham Van Dang Dr Hoang Van Ninh Opponent 1: Opponent 2: Opponent 3: The thesis will be defended at Doctoral Thesis Committee for Academy Level, ………………Location: ………………….Time: After the publication, the thesis will be stored at: - National Library of Vietnam and - Academy of Finance Library INTRODUCTION 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 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 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" 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 10 11 - 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 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 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 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 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 Outline of the thesis In addition to the introduction, conclusion, list of reference and appendices, the thesis is divided into 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 Chapter 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 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 12 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 13 14 15 16 51 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 52 53 17 18 54 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 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 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 55 56 57 12 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 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 27 13 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 14 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 28 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 29 15 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; 30 31 32 33 34 35 36 16 - 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 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 37 17 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 38 39 40 18 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 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 41 42 CONCLUSION OF CHAPTER In chapter 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 19 Chapter 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 20 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 21 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 43 44 45 46 47 22 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 48 49 50 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 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 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 24 CONCLUSION The financial autonomy mechanism has brought about many opportunities, but also many challenges for public hospitals in general and central general hospitals in Hanoi in particular To seize opportunities and proactively face and respond to challenges, financial management in order to improve the operational efficiency of the units is the key to success Improving the organization of accounting work is a necessary and sufficient condition to perfect the financial management of the unit in terms of financial autonomy With such importance, the thesis "Organizing the accounting work in central general hospitals in Hanoi in terms of financial autonomy" has studied and obtained the following results: Firstly, by analyzing the innovation process and urgent needs from practice, the thesis states the necessity of the thesis topic to proceed to clearly define the purpose, object, and scope and research tasks of the thesis Secondly, the thesis points out research gaps of domestic and foreign researches related to financial autonomy and organization of accounting work in public nonbusiness units in general and public hospital in particular Thereby, it can confirm the novelty and non-duplication of the thesis - research on organization of accounting work in public health non-business units in terms of financial autonomy Thirdly, the thesis systematizes and clarifies some basic theories about organizing the accounting work in public health non-business units according to the process of receiving, processing and providing information on the basis of generalizing theory 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 public health non-business units in the condition of financial autonomy, and at the same time points out the requirements posed to the organization of accounting work in these units in terms of financial autonomy Fourthly, the thesis analyzes and clarifies the current state of the accounting work in 03 central general hospitals under the Ministry of Health in Hanoi, including: Bach Mai Hospital, E Hospital and Huu Nghi hospital since the application of accounting according to the Circular 107/2017/TT-BTC in the context of implementing financial autonomy from 2014 to 2018 Fifthly, the thesis evaluates the achieved results and points out a number of limitations from the current state of the accounting work in information procedures in all the three hospitals, from information gathering to processing and providing accounting information Also the thesis analyzes and clarifies the causes of the limitations Sixthly, the thesis gives the point of views of perfecting accounting work organization in the condition of financial autonomy, and proposes 06 groups of solutions 25 to improve accounting work organization at central general hospitals in Hanoi The solution groups are built closely with the requirements for the accounting work organization in the units in terms of financial autonomy, which can be flexibly applied in the hospitals At the same time, the thesis points out the conditions for implementing solutions and recommendations for related subjects, creating a basis and framework for implementing these groups of solutions in practice In summary, organization of accounting work in public health non-business units in general and at central general hospitals in Hanoi in particular in the context of financial autonomy is a necessary issue for in-depth studies, especially in the period when the autonomy mechanism of public non-business units is gradually being completed synchronously The entire content of the thesis shows the theoretical and practical generalization about the organization of the accounting work in 03 central general hospitals under the Ministry of Health in Hanoi Despite great efforts, due to limited personal knowledge, the thesis cannot avoid the limitations and shortcomings The author hopes to receive comments and supplements from experts and scientists to the complete the thesis LIST OF WORKS PUBLISHED BY THE AUTHOR RELATING TO THE THESIS Hy Thi Hai Yen (2014), Correlation between GFS & IPSAS and the direction for Vietnam, Journal of Finance and Accounting Research, 12 (137), p.71 Hy Thi Hai Yen (2015), Public service prices in Vietnam through the lens of the revenue standards in IPSAS, Journal of Finance and Accounting Research, 06 (143), p.26 Hy Thi Hai Yen (2018), Accounting of revenues and revenues in public non-business units - step by step approach to international public accounting standards, Journal of Finance and Accounting Research, 06 (179), p.13 Hy Thi Hai Yen (2018), The impact of factors on public healthcare entities’ revenue in Bac Giang province via panel data regression, Proceedings of the sustainable economic development and business management in the context of globalization (SEDBM) - International conference 2018 ISBN 13 Un - Hyphenated: 9780900822070, p.81 Hy Thi Hai Yen (2018), Studying the effects of some factors on the degree of autonomy of public non-business units in the education sector in Bac Giang province, Proceeding of international conference “The sustainable economic development and business management in the context of globalization (SEDBM) 2018”, p.957 Hy Thi Hai Yen (2019), The problem of human resources at public hospitals in the process of autonomy in public non-business units in Ho Chi Minh city, Journal of Finance and Accounting Research, 10(195), p.5 Hy Thi Hai Yen (2020), Organizing the accounting work in public hospitals in terms of financial autonomy - requirements and problems, Journal of Finance and Accounting Research, 01 (198), p.37 Hy Thi Hai Yen (2020), General assessment of the implementation of financial autonomy mechanism for public non-business units under the Department of Education and Training of Thai Binh in the period 2013 2018, Journal of Finance and Accounting Research, 01 (198), p.40 ... 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... 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... 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