Objective To reduce the amount of public hospital arrears,strengthen debt management,improve the over-all operational efficiency of the hospital,promote fine management of the hospital,and boost high-quality development of the hos-pital.Methods We analyzed relevant data collected from 3 000 inpatients,including 486 with outstanding debts,treated at a tertiary public hospital in Chongqing between 2019 and 2023.Single factor analysis and binary logistic regression analysis were performed to identify the causes of medical arrears,and subsequently propose effective debt management strategies.Results Uni-variate analysis revealed that factors such as medical insurance status,department,gender,age,and cause of arrears significantly influenced the occurrence of medical arrears(P＜0.05).The analysis based on the binary logistic model exhibited a good fit with the observed values,with the value of each classification factor's significance less than 0.05.The incidence of arrears was higher among self-funded patients compared to those with medical insurance.The surgical department had the highest rate of arrears,ne-cessitating specialized training for better debt management.The patients aged between 41 and 60 had the highest arrear rate,indi-cating the need for professionally trained nurses to pay close attention to this age group.The primary reasons for arrears included deliberate evasion,disputes,questionable sources(green passage),unforeseen public events,and economic difficulties.Conclusion To effectively manage medical arrears,hospitals should enhance their debt management systems,delineate depart-mental responsibilities and management processes,and implement stringent controls at key points from admission to discharge.

Third-party payments are widely used in public hospitals,bringing great convenience to hospitals and pa-tients.However,this also increases the difficulty and workload of financial reconciliation.In order to improve financial efficien-cy,many public hospitals have established or introduced unified payment reconciliation platforms to achieve automatic reconcilia-tion.However,in the actual operation process,there are risks such as system risks,fund management risks,refund risks,and information security risks.At the same time,there is currently limited research on internal control of unified payment reconcilia-tion platforms in China.Therefore,this paper uses literature analysis method and the COSO internal control framework to build an internal control system for the unified payment reconciliation platform,establish a sound organizational structure for platform man-agement,establish a risk assessment mechanism,control key control activities,enhance information communication,and promote the high-quality development of public hospitals.