价值医疗下公立医院需转变运营管理模式,建设专门运营管理部门对满足外部政策要求和改善内部运营管理十分必要。通过梳理公立医院开展运营管理的主要任务,确定公立医院专门运营管理部门的职责,设计与承担职责相适应的组织架构,保证专门运营管理部门的职能充分发挥。

Public hospitals need to change the operation management mode under value-based healthcare．It is necessary to build a special operation management department to meet the requirements of external policies and improve internal operation management．By sorting out the operation and management tasks of public hospitals,the responsibilities of the operation management department are determined,and the organizational structure suitable for the responsibilities is designed,so that the construction of specialized operation management department can be effectively implemented．

目的 从社会组织网络嵌入性的角度,探讨公立医院医务人员工作内外匹配（包括组织匹配和区域匹配）在人际信任与隐性医学知识共享行为之间的中介效应,完善公立医院医务人员隐性医学知识共享机制的研究。方法 采用问卷调查方式对公立医院医务人员进行调查,运用SPSS 17.0软件进行数据分析,采用AMOS 22.0建立公立医院医务人员工作内外匹配在人际信任与隐性医学知识共享行为之间的中介效应回归方程。结果 公立医院医务人员人际信任与隐性医学知识共享行为之间有显著的正相关关系,标准化回归系数为0.446（P <0.001）。加入工作内外匹配变量后,公立医务人员人际信任对隐性医学知识共享行为的标准化回归系数由0.446（P <0.001）降到0.189（P<0.01）。结论 公立医务人员人际信任正向预测隐性医学知识共享行为;组织匹配、区域匹配在公立医务人员人际信任与隐性医学知识共享行为之间具有部分中介效应。

Objective To explore a new path of interpersonal trust impact on knowledge sharing behavior-being from the perspective of job embeddedness．Methods Questionnaire survey was used to investigate the medical staff in public hospitals．SPSS 17.0 software was used to analyze the data．AMOS 22.0 was used to establish the regression equation of intermediary effect between interpersonal trust and tacit medical knowledge sharing behavior of medical staff in public hospitals．Results There was a significant positive correlation between interpersonal trust and tacit medical knowledge sharing behavior．The standardized regression coefficient was 0.446（P <0.001）．When added the fitting to organization and community,the standardized regression coefficient decreased from 0.446（P <0.001）to 0.189（P <0.01）．Conclusions The interpersonal trust of public medical staffs positively predicts the tacit medical knowledge sharing behavior．Organizational matching and regional matching have partial mediating effect between interpersonal trust and tacit medical knowledge sharing behavior of public medical staff.

        随着信息技术发展，传统报账模式难以满足现代医院精细化管理与内部控制要求，公立医院报账现状存在财务定位不准确、重核算轻管理，顶层规划不足、信息孤岛现象严重，内部控制不完善、运营风险高，核算效率不高、职工满意度低等诸多问题。如何有效应对传统报账弊端，推动医院管理模式转变并实现高质量发展是公立医院面临的课题。公立医院智慧报账体系建设需重视顶层设计，基于内部控制要求结合智慧化手段优化流程，以达成提升财务战略地位、系统互通、效率提升、提高职工满意度和内控风险可控的目标，案例医院的智慧报账系统建设实践可为其他医院提供参考借鉴。

        As information technology advances，traditional accounting models are increasingly inadequate for the refined management and internal control needs of modern hospitals．Public hospitals encounter several challengesincluding inaccurate financial positioning，an emphasis on accounting over management，insufficient top-level planning，seriousinformation silos，weak internal controls，high operational risks，low accounting efficiency，and low employee satisfaction．Effectivelyaddressing 

the shortcomings of traditional accounting practices and transforming hospital management models for high-quality development is 

a pressing challenge．The development of an intelligent accounting system in public hospitals should prioritize top-level design，

optimize processes in line with internal control requirements，and integrate intelligent technologies．This approach aims to enhance 

the strategic role of finance，improve system interoperability，increase efficiency，boost employee satisfaction，and ensure 

manageable internal control risks．The practical implementation of the intelligent accounting system in the case hospital can provide 

valuable insights for other hospitals．

        当前公立医院面临的内外部环境十分复杂，各种不确定因素影响公立医院健康运营。引入内部控制理念，建立健全采购与付款环节是必要的。文章对目前公立医院采购与付款业务管理中存在的问题进行分析，从改善内部环境建设、建立起有效的风险评估体系、加强采购与付款业务控制活动、巩固监督检查体系、加强信息沟通建设五个方面提出相应策略，优化公立医院采购与付款环节内部控制，从而减少风险带来的不确定性，保障医院运行的效率效益，助力医院高质量持续发展。

      Public hospitals are currently navigating a complex internal and external environment，where  various uncertainties can impact their effective operation．The introduction of internal control concepts and the establishment of  robust procurement and payment processes are essential．This paper analyzes the issues present in the management of procurement and payment operations within public hospitals．It proposes strategies across five key areas：enhancing the internal environment，establishing an effective risk assessment framework，strengthening control activities in procurement and payment processes，reinforcing the supervision and inspection system，and improving information communication．These  strategies aim to optimize internal controls，reduce uncertainty associated with risks，ensure operational efficiency，and support the sustainable，high-quality development of public hospitals．