It is reported that many hospital construction projects have the problem of over-investment budget estimates. The investment estimate is an important basis for controlling the cost standard of investment projects. The reasons are mainly divided into two aspects: one is subjective factors, including expanding the scale of construction, changing the design scheme, improving the standards and grades of construction and equipment, the other is objective reasons, mainly including the low budget estimate and tender list. Leak items and so on. Let's get to know them together.
Problems in cost control and management of hospital construction
1. Do not attach importance to the pre-management of hospital construction projects
At present, the common problem is that the hospital does not pay enough attention to the project proposal and feasibility study. In some over-budgeted government investment projects, project proposals and feasibility studies are usually used only for obtaining approval documents.
2. Design Leakages and Imperfect Design Change Control
Hospital architecture has strong specialty and involves a wide range of fields. It requires design units to have rich experience in medical architectural design and design in combination with the characteristics of hospital projects.
3. Construction units should raise construction standards and increase construction contents by themselves.
Hospital construction projects mainly undertake the tasks of medical treatment, teaching and research. They should meet the functional needs first, and then create a harmonious and orderly diagnostic and therapeutic environment. Some hospital buildings blindly pursue high-end, use high-grade materials for luxury decoration and face-saving projects, resulting in overinvestment and cost.
4. Hidden dangers of cost management in project bidding process
The whole hospital construction project is divided into many single projects, and the single project is composed of many unit projects, and the unit project can also be subdivided into many professional projects.
5. Low investment estimates
The construction standards in some project approval budget estimates are too low. In order to control the total amount of investment, there is often a mismatch between the construction standard formulated in the approving budget and the function orientation of the construction project. As a result, in order to satisfy the development and function orientation of the hospital, it is difficult for the construction unit to implement the approving budget standard, resulting in the actual investment exceeding the estimate.
The price of manpower and materials keeps rising. Because of the large interval between the time of budget preparation and the actual start-up time of the project, the price of manpower and materials in the budget estimate can not accurately reflect the market situation. As a result, the actual price of manpower and materials in the construction of the project exceeds the approved price of the budget estimate, resulting in the actual investment exceeding the budget estimate.

Budget estimates are prepared without considering the unique characteristics of each project. Each hospital has its own unique personality, such as outpatient service, average length of stay, development of dominant disciplines, size of hospital beds, etc. It is reflected in the building itself, which involves many aspects such as structural form, functional positioning, number and level of operating rooms, configuration of large medical equipment, etc. According to different individualized needs, the cost of each square meter is also quite different. However, when making and auditing the budget estimates of hospital projects, the unified standard of general hospital construction is often used as the basis, and the individualized needs of each hospital or even each department are not fully considered, which eventually leads to the occurrence of overestimation.

Solutions
1. Cost control in design stage
Cost control in design stage belongs to pre-control. Relevant research data at home and abroad show that the cost in design stage only accounts for about 1%~2% of the total cost of the project, but its impact on the project cost is as high as 75%. Therefore, we should focus on controlling the design work in the early stage, improve the design quality, and make the design drawings meet the requirements of the design depth.
Quota design is based on the investment or cost quota to meet the technical requirements of the design, requiring the close cooperation of hospital users, designers and budget estimators, reasonable and clear objectives, to put forward opinions on unreasonable design, so as to achieve the role of effective control of investment.
We should strengthen the review of the previous design drawings and budget estimates, ensure that the budget estimates truly reflect the content and standards of the design drawings, and make the total investment of the budget estimates more complete, reasonable and close to reality. To improve the quality of design estimates, we should start with strengthening the review of preliminary design estimates, so as to avoid overshoots caused by design and budget errors.
Strengthen the evaluation of design units, and make multi-scheme comparison and selection in the stage of scheme design and preliminary design, so as to effectively promote the competition of design units. In order to improve the enthusiasm and initiative of designers, we should increase the requirement of encouraging assessment standards for design units in controlling budget estimates, optimizing design and improving technical measures. In order to reduce design errors, improve the accuracy of budget estimates and control the cost, special clauses are added to the design contract, and penalties for design errors and omissions are stipulated to varying degrees, and effective constraints are imposed.
2. Reduce the influence of human factors and strengthen the management of cost control
Construction should be carried out in strict accordance with the approved project budget estimates, and original design, scale expansion, content increase and construction standards should not be modified without authorization. At the same time, we should strengthen the management of project decision makers, strengthen the concept of cost control, refuse willfulness and firmly implement the principle of "drawing a blueprint to the end". Continuously strengthen and improve the professional ability and coordination ability of capital construction managers of construction units, and effectively control budget estimates.
In the bidding stage, we should mainly control the bill of quantities, the rationality and comprehensiveness of the compilation of control price, avoid the situation of low-price winning bid and unbalanced quotation, and lay a good foundation for signing the contract.
Design changes and site visas should be strictly controlled during construction. In the examination of design changes and visas, the necessity, rationality and authenticity of engineering changes should be determined in accordance with the guidelines of ensuring safety, controlling investment, ensuring quality and speeding up progress, as well as the basic principles of reasonable pricing and effective control.
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