关于医院成本核算与控制问题的探讨

分析了医院成本核算现状和医院成本核算特征,揭示了医院成本核算对象的多样性、方法的复杂性以及成本分摊和控制的特殊性与内生性.提出了按照可控性原则、全面性原则、例外管理原则、考核原则,实行成本目标分解、分级归口管理,推进全院、全员、全过程的医院经济核算的思路.     

The role of physician education in cost containment.

As the cost of health care in the United States has increased to consume an ever greater portion of the gross national product, various strategies for cost containment have been advanced. Too little attention has been paid to the education of physicians for more responsible use of expensive resources. Current data on the role of physician knowledge, attitudes, and behavior in cost containment are reviewed; several intervention strategies are presented; and recommendations are proposed for increasing the sensitivity of physicians to the financial implications of their clinical decisions.     

The cost containment—Quality of care issue

Continual emphasis on health care cost containment has reopened the issue of cost containment's relationship to quality of care and has created a need to understand the basic composition and nature of that relationship. For unless a new general approach is taken toward cost containment, continual emphasis could disrupt the delicate balance of the components that constitute quality of care and result in a deterioration of a standard level of care that the population has come to expect and that has taken decades to obtain.     

Design and behavioral strategies for cost containment and quality assurance

The design and behavioral strategies for cost containment and quality assurance in hospitals are related closely to similar issues in larger organizations. Using a taxonomy developed by Georgopoulos it is possible to develop a research outline examining design and behavioral strategies. The most important determinant of the shape and direction of these strategies in the VA medical care system appears to be its environmental constraints. For each of the seven categories presented by Georgopoulos, the nature of the VA is discussed and specific research questions are proposed. The seven categories include adaptation, allocation, coordination, integration, strain, output, and maintenance.     

Life, death, and the dollar sign. Medical ethics and cost containment

The development of strategies to contain rising medical costs has the potential to alter the physician's ability to decide on the use of life-support technology. The question of whether to provide maximum life-sustaining measures may become subject to financial considerations. The intrusion of diagnosis related groups, health maintenance organizations, and preferred provider organizations into the physician patient relationship is compounded by legal liability for decisions where cost appears to have been a consideration. Physicians and hospitals may no longer be able to be unbiased patient advocates. Johnson suggests the use of review committees and other knowledgeable but disinterested parties to share responsibility and act solely in the patient's best interests.     

Japanese anesthesiologists’ knowledge of the cost of medicines and their attitudes toward cost containment: a cross-sectional survey

Objectives: This study surveyed Japanese anesthesiologists’ knowledge of the cost of medicine and their attitudes toward cost containment to determine how these factors may affect their choice of medication and provide insight into reducing healthcare expenditures.Materials and Methods: In this cross-sectional study, Japanese anesthesiologists’ knowledge of medicine prices and their attitudes toward cost containment were surveyed to identify barriers in lowering the cost of anesthesia. The proportion of participants who correctly guessed the cost of the five most frequently used types of drugs within 25% of the actual price was determined, and their attitudes regarding drug prices and barriers to achieving cost containment were analyzed.Results: In total, responses to 60 questionnaires were analyzed. The proportion of participants correctly guessing the price within 25% of the actual price for each of the five drug categories, including neuromuscular blocking agents, inhaled anesthetics, intravenous anesthetics, opioids, and neuromuscular blockade reversal agents, was 30% (n=18), 18.3% (n=11), 6.67% (n=4), 30.0% (n=18), and 63.3% (n=38), respectively. Participants believed they had adequate access to information on prices, that the cost of a product influenced their decisions regarding product use, and that more information about cost might change their use of the drugs but did not believe that they had adequate knowledge about product prices.Conclusion: The proportion of participants with acceptable price estimates is small. Educating anesthesiologists about the cost of anesthetic agents may be required to encourage cost-containing behaviors. This study is the first survey to assess Japanese anesthologists’ knowledge of the cost of medicines.     

Medical practice, case mix, and cost containment. A new role for the attending physician

Present political pressures for hospital cost containment appear to make some form of case-specific reimbursement system inevitable. For such a system to be able to control hospital costs effectively, however, its design must reflect the fundamental and traditional principles of management control systems. Although the diagnostic-related group (DRG) approach is the most frequently discussed form of case-mix-sensitive reimbursement, DRGs do not satisfy basic management control principles. Under a more appropriate hospital control system, however, physicians would be incorporated directly into the hospital's management structure. Consequently, to ensure that this new control system is medically as well as financially appropriate, physicians should seize the initiative in determining the standards against which their performance will be measured.