目的: 推动医保基金会计核算基础向权责发生制有序转型,构建精准、管理导向的医保基金会计核算体系,以提升医保管理效能与国家财会监督水平。方法: 梳理并剖析收付实现制会计基础的局限性,结合医保管理制度改革实践,从管理学视角系统分析引入权责发生制的必要性与可行性。结果: 现行收付实现制核算体系难以真实反映医保基金的财务状况、收支结余与潜在风险,也无法全面揭示医保管理活动的经济实质与管理绩效;权责发生制能够提供更公允的基金资产、负债、收入与费用信息,为规范医保管理行为、提升基金使用效率提供有效决策支撑。结论: 建议分步引入权责发生制并完善配套协同机制,构建适应我国医疗保障管理需求的基金会计核算制度,完善配套标准与协同机制,为医保精细化管理与基金可持续运行提供坚实的会计基础。

Objective: The paper attempts to promote the orderly transformation of the accounting basis of medical insurance funds towards the accrual basis, and establish an accurate, management-oriented accounting system for medical insurance funds, so as to improve the efficiency of medical insurance management and the level of national financial supervision. Methods: The limitations of the cash basis accounting system were reviewed and analyzed, and in combination with the practice of medical insurance management system reform, the necessity and feasibility of introducing the accrual basis were systematically analyzed from a management perspective. Results: The current cash basis accounting system is difficult to truly reflect the financial status, revenue-expenditure balance, and potential risk of medical insurance funds, and it cannot comprehensively reveal the economic substance and management performance of medical insurance activities. The accrual basis can provide more equitable information on fund assets, liabilities, income, and expenses, offering effective decision-making support for regulating medical insurance management and improving fund utilization efficiency. Conclusion: It is recommended to introduce the accrual basis step by step and improve the supporting coordination mechanisms, build a fund accounting system that meets China's medical insurance management needs, improve supporting standards and coordination mechanisms, and provide a solid accounting foundation for refined medical insurance management and sustainable fund operation.