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.
Key words
public accountability /
medical insurance fund accounting /
cash basis /
accrual basis
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