Methods for cost analysis,cost recovery,and cost control for a public hospital in a developing country: Victoria Hospital,St. Lucia

International attention has focused in recent years on methods for analysing costs of public hospitals in developing countries, with the goal of reducing the financial burden on governments by enabling improved resource allocation, by identifying areas for cost recovery and cost control, and by developing management systems to facilitate these efforts. A range of methods for cost analysis, cost recovery, and cost control are reviewed in this article, with illustrations of applications of the methods at Victoria Hospital, the national hospital in St. Lucia. Comparisons are made to similar studies in Belize, Lesotho, and the Dominican Republic. Cost-analysis methods focus on a detailed cost accounting effort which identifies the full financial costs of hospital operations and the unit costs of individual hospital services. Cost-recovery methods include an analysis of cost-related and other issues involved in setting fee levels for hospital services, determination of exemptions for certain population groups, and management of fee collection systems. Cost-control methods include analysing the degree of managerial authority exercised by hospital managers in relation to the central Ministry of Health and other government departments, identifying opportunities and incentives for cost control by individual departments within the hospital, and evaluating methods for involving physicians and other clinical decision-makers in cost control efforts. A diagnosis-independent method for utilization review of clinical decisions, the Appropriateness Evaluation Protocol, is pilot-tested and alternatives, including Diagnosis Related Groups, are discussed. Implementation issues related to long-term systems development efforts are reviewed.     

Managing the unmanageable: public hospital systems

There are significant challenges to those who work in large public health care delivery systems: political imperatives; resource constraints; sometimes rigid personnel systems; and, the reality that everything occurs in a public forum. The fact that many nations are reviewing and, in some instances, restructuring their national health care systems, has added to the complexity and feeling of continual turbulence experienced by their managers. State run systems like that in the United Kingdom are introducing market forces to increase effectiveness and value for money; while market systems, like that in the United States, are increasing regulatory interventions to achieve the kind of cost control available to countries with large public systems which operate with global budgets. Public hospitals in the United States offer examples of public institutions operating in a highly competitive market environment. A decade of management changes undertaken to enhance the efficiency and effectiveness of the New York City Health and Hospitals Corporation (HHC), the largest public hospital system in the United States, is presented as a case study of public health services and public management in a market environment.     

Determinants of the cost of capital for privately financed hospital projects in the UK

Many governments make use of private finance contracts to deliver healthcare infrastructure. Previous work has shown that the rate of return to investors in these markets often exceeds the efficient level. Our focus is on the factors that influence that return. We examine the effect of macroeconomic, project- and firm-level variables using a detailed sample of 84 UK private finance initiative (PFI) contracts signed between 1997 and 2010. Of the above variables, macroeconomic conditions and lead sponsor size are related to the investor return. However, our results show a remarkable degree of stability in the return to investors over the 14-year period. We find evidence of a ‘prevailing norm’ that is robust to project- and firm-level variation. The sustainability of excess returns over a long period is indicative of a concentrated market structure. We argue that policymakers should consider new mechanisms for increasing competition in the equity market, while ensuring that authorities have the specialist resources required to negotiate efficient contract prices.     

医院科研项目信息服务模式的研究与实践

如何能够满足医院科研人员的信息需求,为其提供更好的信息服务是信息服务部门所致力研究的课题。本文通过对医院科研项目信息需求的特点以及目前信息服务的现状进行分析,对信息供给与需求的匹配模式进行研究,试图找出一种更加合理的信息供需匹配模式,以便更好地服务于医院医学科研项目,并为国内其他文献服务机构的发展提供参考。     

构建医院信息管理系统（HIS）探讨

本文根据实践经验，阐述了中小医疗机构建设医院信息管理系统的主要过程步骤，以及在具体实施过程中该注意的一些问题与解决方法。     

Comparing methodologies for the cost estimation of hospital services

The aim of the study was to determine whether the total cost estimate of a hospital service remains reliable when the cost components of bottom-up microcosting were replaced by the cost components of top-down microcosting or gross costing. Total cost estimates were determined in representative general hospitals in the Netherlands for appendectomy, normal delivery, stroke and acute myocardial infarction for 2005. It was concluded that restricting the use of bottom-up microcosting to those cost components that have a great impact on the total costs (i.e., labour and inpatient stay) would likely result in reliable cost estimates. Partly supported by the European Commission within the Sixth Framework Research Programme (grant no. SP21-CT-2004-501588).     

RFID技术在医院信息系统中的应用

目的：为了客观实时地监控医疗信息的全过程,预防和避免医疗差错的发生,进一步提高医疗工作的安全性。方法：在防止医疗差错的需求牵引下,考虑医院环境,具体应用射频识别技术（RFID）与无线网络技术,实现系统架构和软件设计。结果：对医院信息管理的每一步实时检查和确认,包括患者身份、药品、血液等唯一识别。结论：系统对保证医疗信息的完整性和安全性,切实提高医疗质量、减少医疗差错发挥了巨大作用。     

试论医院的战略成本管理

医院战略成本管理是指将医院成本管理置身于战略管理的空间,从战略高度对医院及其与之关联的成本行为和成本结构进行分析,从而创造竞争优势,以达到医院有效地适应外部持续变化环境的目的,为战略管理服务。战略成本管理有长期性、全局性、外延性和创新性特点。战略成本管理有价值链分析、战略定位分析、成本动因分析等多种方法。明确战略成本管理的目标、依据战略成本信息选择不同战略、完善医院的成本管理和提高成本意识、发挥经济管理人员的职能作用是医院实施战略成本管理的前提。     

医院成本目标管理探析

成本目标管理是医院管理的重要组成部分。文章通过对某院近2年来在医院管理中推行成本目标管理方法进行回顾分析,从成本目标管理的概念、具体措施和作用三方面进行讨论,认为推行成本目标管理对提高医院管理水平和经济效益都具有重要意义。     

Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level

Promoting the improvement of standardized cost systems (CS) is one of the measures available to health policy makers for the purpose of improving efficiency in hospitals over the long-term. Nevertheless, very few studies evaluate the relationship between alternative CS and the costs really incurred. We use data from 242 hospitals of the Spanish National Health Service (NHS) between 2010 and 2013 in order to explore the determinants of the cost per adjusted patient day, using a difference-in-differences approach where the treatment is the implementation of an advanced CS. We also investigate if the association between advanced CS and unit cost is different depending upon the technological level of the hospital. Results show that hospitals with more advanced CS contained their costs better. However, the latter effect of advanced CS is lower in hospitals with a greater endowment of high technology. Results suggest that health authorities should support the development of CS, particularly in high-tech hospitals, which are usually larger and more complex hospitals that tend to accumulate a greater portion of NHS hospital sector expenditure.     

影像数据传输及储存系统与放射学信息系统在医院信息化管理中的应用

目的：介绍影像数据传输及储存系统（PACS）和放射学信息系统（RIS）技术在医院信息化管理中的应用.方法：应用PACS及RIS对医院信息进行管理与共享.结果：医院PACS及RIS的实施提高了医疗质量及管理水平;PACS全面解决了医学影像的获取、显示、处理、贮存以及管理等问题;RIS解决了医院普遍出现的病历档案大容量存储的难题.结论：PACS及RIS是医院信息系统重要组成部分,PACS及RIS的应用可有效提高医院信息化管理水平.     

价值链引导下的医院成本管理探讨

医疗卫生体制改革把医疗卫生机构推向市场,在市场的大浪淘沙下,医院步履艰难。该文通过分析医院战略发展的背景、医院成本管理理念的转变,提出价值链引导下的医院成本管理方法,该方法从时间、空间、多维度为适应市场环境,谋求战略发展对医院进行内部成本管理,其结果就是达到优化成本管理流程,最大限度地降低医疗成本和促进医疗活动价值的增值,它是一种全新的具有时代价值的成本管理方法。     

Measuring the cost of hospital adverse patient safety events

This paper estimates the excess cost of hospital inpatient care due to adverse safety events in the U.S. Department of Veterans Affairs (VA) hospitals during fiscal year 2007. We measured adverse events according to the Patient Safety Indicator (PSI) algorithms of the Agency for Healthcare Research and Quality. Patient level cost regression analyses were performed using generalized linear modeling techniques. Accounting for the heavily skewed distribution of costs among patients having adverse safety events, results suggested that the excess cost of nine different PSIs for VA patients are much higher than previously estimated. We tested sensitivity of results to whether costs were measured by VA's Decision Support System (DSS) that uses local costs of specific inputs, or by the average costing system developed by VA's Health Economics Resource Center. DSS costing appeared to better characterize the high cost patients.     

资源利用视角下的公立医院成本分析与管理策略实践——以XH医院为例

随着医疗卫生体制改革的纵深推进,公立医院的成本管控水平对医院的发展显得越来越重要。本文以上海XH医院的管理实践为基础,从资源利用视角探讨公立医院的成本管理策略及具体措施,其中,资源投入合理性策略包括全面预算管理和资源效益分析,资源使用高效性策略包括人员成本、药耗成本、设备成本、后勤成本的管控,业务运行高效率策略包括业务流程、信息服务和学科间协作的高效运转。     

谈医院信息系统中的网络建设

医院信息管理系统中计算机网络的建设是整个应用系统运行的高速路,为使医院整个系统运行在稳定可靠、安全高效的健康网络环境中,必须对网络建设进行合理的规划,拟订出科学的方案。     

山东省社区卫生服务信息系统需求与对策研究

目的了解山东省社区卫生服务信息系统建设需求情况,为优化山东省社区卫生信息系统提供依据。方法采用多阶段分层系统抽样的方法进行有关社区卫生服务信息化建设需求情况的问卷调查。结果社区卫生服务中心(站)对社区卫生服务信息系统使用需求高,对实现社区卫生服务信息系统管理的迫切程度和硬件设备更新、升级的迫切程度呈现为欠发达地区明显高于发达地区和中等发达地区,对公共卫生、医疗、医保、药品以及财务监管社区卫生服务信息系统功能模块需要完善的迫切程度呈现为公共卫生模块需要完善的迫切程度最高。结论不同地区社区卫生服务信息系统需求程度不同,社区卫生服务机构应根据信息系统建设规划要求和需求程度,优化社区卫生服务信息系统,提高社区卫生服务信息系统的建设和使用水平。     

上海市产前检查和住院分娩费用调查

为了解上海市产前检查和住院分娩实际费用 ,制定出适宜的生育保险标准 ,抽取全市 19个区 (县 ) 5 4家医院进行现况调查。结果显示 :1产前检查、正常产、剖宫产的平均费用分别约为 90 0、 2 0 0 0和 40 0 0元人民币 ,市区和郊县之间存在着差别 ,不同级别医院的产前检查费用和住院分娩费用也有所不同 ,但同级别的综合性医院和专科医院之间基本无差别 ;2产前检查初、复诊的检查项目各家医院各不相同 ,除了血、尿常规外 ,其他项目差别较大 ,存在着许多不规范之处 ;3分别有 6 6 .6 7%和 70 .71%的孕妇希望在三级医院进行产前检查和住院分娩。提示生育津贴的标准应以目前的费用为基线 ,但项目需规范 ,技术要提高 ,质量要保证。     

国有医院成本核算与确定职工收入分配总量的研究

该着重研究国有医院成本核算与确定职工收入分配总量的问题。通过阐述国有医院财务管理与会计核算的目标、任务和要求，对国有医院业务经济管理现状作出性分析和客观性评价；重点介绍了有关国家和地区医院财务管理、成本控制做法和管理理念；在分析目前医院实施工资性支出管理办法的基础上，着重提出了确定国有医院职工收入分配总量的改革方案，以供探讨。