Challenges in Distinguishing the Concepts of “Costs” and “Expenses” in State (Municipal) Healthcare Institutions

This article addresses the problem of distinguishing between the economic categories of “costs” and “expenses” in the accounting (budget) records of public (municipal) healthcare institutions. Limited financial resources in the healthcare system necessitates the formation of reliable accounting data to analyze the effectiveness of their use. The revealed regulatory ambiguity leads to contradictory accounting practices and complicates the process of calculating the cost of medical care (medical services). Based on a comprehensive analysis of the legislation of the Russian Federation, an assessment of accounting practices, and a survey of chief accountants of medical organizations, it was revealed that a significant number of institutions primarily reflect accounting records as part of expenses for financial security codes, with the exception of income-generating activities. The paper proposes an author’s algorithm for correlating the facts of economic life, which determines the primary reflection on cost accounting accounts. The implementation of this approach will increase the transparency of data for control procedures and ensure the correlation of actual indicators with the state tariff policy in the field of healthcare.