随着我国医保基金规模扩大、结构复杂化和功能延展,现行收付实现制会计制度难以充分回应公共受托责任的治理需求。本研究以公共受托责任理论为框架,构建报告责任、行为责任与结果责任三维结构,将医保基金会计制度功能界定为信息揭示、合规控制与风险预警、绩效与可持续性评价,结合各险种的受托责任差异,分析其信息需求与核算基础选择。研究认为,收付实现制在预算控制方面具有优势,但难以反映跨期义务和长期偿付压力;权责发生制既能客观反映当期收支状况,也可展现远期财务承载能力,但不宜照搬商业保险的会计模式。本研究主张构建收付实现制与权责发生制混合的核算体系,坚持功能导向、分类适用和分层推进原则,为医保基金会计制度改革提供理论依据。
Abstract
With the expansion, structural complexity, and functional extension of China's medical insurance fund, the existing cash basis accounting system can no longer adequately respond to the governance demands of accountability. Drawing on public accountability theory, this paper constructs a three-dimensional framework comprising reporting responsibility, behavioral responsibility, and outcome responsibility. It defines the accounting functions of medical insurance funds as information disclosure, compliance control and risk warning, performance and sustainability assessment. By examining the accountability differences among employees’ medical insurance, residents’ medical insurance, long-term care insurance and maternity insurance, the paper analyzes their information needs and accounting basis choices. The study argues that while the cash basis retains advantages in budgetary control, it fails to reflect incurred but unsettled obligations, cross-period rights and duties, and long-term solvency pressures. The accrual basis not only objectively reflects the current revenue and expenditure situation, but also demonstrates long-term financial sustainability, yet its application should not mechanically replicate commercial insurance accounting models. This paper proposes a hybrid accounting system with cash basis and accrual basis, guided by the principles of function-orientation, category-specific application, and phased implementation, thereby providing theoretical foundations for deepening accounting system reform.
关键词
公共受托责任 /
医保基金会计 /
收付实现制 /
权责发生制
Key words
public accountability /
medical insurance fund accounting /
cash basis /
accrual basis
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基金
国家医疗保障局立项课题“医疗保险基金财务会计制度修订和权责发生制核算改革研究”（202507）
