Applying activity-based costing to the nuclear medicine unit.

Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.     

ABC estimation of unit costs for emergency department services

Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.     

Using computerised patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies

Casemix-funding systems for hospital inpatient care require a set of resource weights which will not inadvertently distort patterns of patient care. Few health systems have very good sources of cost information, and specific studies to derive empirical cost relativities are themselves costly. This paper reports a 5 year program of research into the use of data from hospital management information systems (clinical costing systems) to estimate resource relativities for inpatient hospital care used in Victoria's DRG-based payment system. The paper briefly describes international approaches to cost weight estimation. It describes the architecture of clinical costing systems, and contrasts process and job costing approaches to cost estimation. Techniques of data validation and reliability testing developed in the conduct of four of the first five of the Victorian Cost Weight Studies (1993-1998) are described. Improvement in sampling, data validity and reliability are documented over the course of the research program, the advantages of patient-level data are highlighted. The usefulness of these byproduct data for estimation of relative resource weights and other policy applications may be an important factor in hospital and health system decisions to invest in clinical costing technology.     

Adoption of costing systems by U.S. hospitals

This article re-examines the use of costing information in hospitals. While previous research reports that hospitals are increasingly adopting costing methodologies, survey results indicate that costing systems and cost methodologies have not been widely implemented. A telephone survey of 94 hospital executives revealed only 26 percent routinely collect procedure-level costs and only 12 percent apply basic costing techniques described in prior health care management literature. It appears that despite cost accounting's benefits, immediate cost-control problems are answered with short-term, focused cost-cutting solutions. While these short-term measures allow hospitals to survive in the current environment, health care reform and other pressures to control revenue growth will make sophisticated cost management a necessity for hospitals in the near future.     

作业成本法在医院成本核算中的应用探讨(上)

分3部分对作业成本法在医院的应用进行了探讨,从理论上提出了包括划分作业、确定作业代表动因、分摊作业成本、计算单元成本、建立成本账户、制定账务处理程序和编制成本表等步骤在内的一整套具体的、可操作的成本核算方法,该方法集科室成本核算和医疗服务单元成本核算于一体,能够为医院管理和宏观决策提供丰富翔实的成本核算资料。该方法较好地解决了目前医院成本核算中对间接成本分摊不合理的问题以及医疗服务成本核算对象过于笼统的问题。     

Comparing systems for costing hospital treatments. The case of stable angina pectoris

This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.     

作业成本模式的运用——以中国台湾某医学中心手术室为例

随着作业成本法（Activity-based costing，简称ABC）在企业的普及，ABC被引入作为医院财务管理．这种制度能更加精确地计算医院成本。以中国台湾某医学中心手术室为例，实证作业成本法对医院财务管理的帮助。结果显示作业成本法除可由作业活动的归纳计算出更精彩的成本之外，还可为许多管理决策提供帮助。     

Study of cost by type of diagnosis in Switzerland.

Lengths of stay, for a given diagnosis, are poorly correlated between Switzerland, the USA., and Australia; and between 5 hospitals within Switzerland. Three different sets of DRG cost weightings (U.S., French A, French B) are also poorly correlated. Hospital operating efficiencies, standardized by DRG, were estimated and compared. The three sets of cost weightings used all yielded very similar estimates of hospital operating efficiency. The use of current existing systems of cost weightings may, therefore, provide a rapid and cheap means of comparing hospital operating efficiency. In the long run, more precise and detailed cost data will enable national cost weightings to be obtained. Associated issues, such as costing methodologies and perspectives on utilization, are also discussed.     

作业成本法的基本原理及其在医疗服务成本测算中的应用前景

国外已有较多医院采用作业成本法方法进行成本控制和成本管理，收到了良好的效果。与传统的成本核算方法相比，作业成本法能够提高服务成本核算的准确性和合理性。本文对作业成本法的产生背景，基本概念，基本原理及医疗服务成本测算中的应用前景作一介绍。     

应用作业成本法管理医院成本的实践

目的:将作业成本法应用于医院成本管理实践.方法:以某医院血液透析中心为研究对象,结合医院及医疗服务流程特点,划分医院作业及血液透析中心作业,确定作业成本动因.结果:根据作业成本法原理,测算科室及医疗服务项目成本.结论:应用作业成本法于医院内部管理是一个新的发展方向.     

Investigating DRG cost weights for hospitals in middle income countries

Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done through different costing approaches depending on availability of information and time and budget. This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of stay (LOS).We concluded that calculation of DRG cost weights (CWs) using Australian service weights provides a sensible starting place for DRG-based hospital management; but restructuring hospital accounting systems, designing computerized feeder systems, using appropriate software, and development of national service weights that reflect local practice patterns will enhance the accuracy of DRG CWs.     

我国与美国公立医院成本管理的比较及启示

新医改方案强调,公立医院要严格预算管理,加强成本核算与控制,定期开展医疗服务成本测算,科学考评医疗服务效率。本文从成本管理起因、核算对象和控制手段等方面对我国与美国的公立医院成本管理进行了比较,美国公立医院成本管理有值得我国借鉴的地方,对我国公立医院具有启示作用,例如积极开展以作业成本法为基础的医疗项目成本核算和按病种分组付费试点,进行全方位的成本分析与控制,调整不合理支出结构等。     

医改背景下项目成本核算问题研究

作业成本法由于在分配间接费用方面的优势而被引入项目成本核算中.通过实证分析,进一步揭示了作业成本法下的项目成本核算在解决医院成本控制、医改财政补偿、医疗服务定价改革中将发挥的积极作用及重大现实意义.     

Evaluation of activity-based costing versus resource-based relative value costing

Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided.     

DRG改革背景下医院卫生技术评估的功能与推行策略

医院卫生技术评估(HB-HTA)是专门针对医院实际情况进行评估的方法学工具,可辅助医院进行卫生技术管理与决策。HB-HTA与DRG均是医院管理的工具,二者价值理念相同、现实作用相近,可推动医院向精细化管理和高质量服务提供的发展方向迈进。在DRG改革中,HB-HTA可通过对卫生技术安全性、有效性和经济性评估,对同一病种的不同诊疗过程、技术和相应的配套措施进行分析和比较,帮助医院进行成本核算,优化"服务包"的安全有效性和成本效益,促进医院对DRG改革进行战略性回应。此外,HB-HTA还可覆盖到DRG短时间无法覆盖和不适宜以DRG支付的医疗服务,辅助医院对多元复合式医保支付方式进行整体性探索。未来,应在医院内部重点打造"HB-HTA+DRG"式医院精细化管理模式,同时要理顺组织体制、注重大数据开发和使用、加快HB-HTA试点工作并建立动态监管机制。     

Determinants of variation in the cost of inpatient stays versus outpatient visits in hospitals: a multi-country analysis

Information on hospital costs is key to many types of economic and financial analyses, yet many countries lack reliable estimates due partly to the time and resources required to undertake detailed costing studies. Accordingly, some analysts have used simple rules of thumb to estimate hospital unit costs, e.g., total hospital costs are allocated between departments assuming that the cost of an inpatient day equals a fixed number of outpatient visits. This paper first explores the extent to which these simple rules apply within and across countries. It then identifies determinants of variation in the relationship between the cost of outpatient visits and inpatient days, then uses the estimated relationship to calculate average costs of inpatient and outpatient stays for countries where data are not yet available. Cost information from 832 hospitals in 28 countries are used. We show that simple rules of thumb do not prove to be an accurate basis for cost estimates. The ratio of inpatient to outpatient unit costs varies with GDP per capita, hospital size, ownership, and occupancy rate. We show how the estimated relationship can be used to calculate a mean cost of inpatient stays and outpatient visits, taking into account differences in the levels of key determinants, and argue that, in the absence of a representative sample of hospital costing studies, this method can be used to estimate unit costs in the interim. Moreover, we suggest that the observed great variation in unit costs for similar hospitals in the same country means that this method might well be preferable to basing policy advice on the results of costing studies that cover only one, or a few hospitals, which might well be outliers.     

Costes de las terapias de las enfermedades neurodegenerativas: aplicación de un sistema de costes basado en las actividades

Objective

To apply the activity based costing (ABC) model to calculate the cost of therapy for neurodegenerative disorders in order to improve hospital management and allocate resources more efficiently.

Method

We used the case study method in the Francolí long-term care day center. We applied all phases of an ABC system to quantify the cost of the activities developed in the center. We identified 60 activities; the information was collected in June 2009.

Results

The ABC system allowed us to calculate the average cost per patient with respect to the therapies received. The most costly and commonly applied technique was psycho-stimulation therapy. Focusing on this therapy and on others related to the admissions process could lead to significant cost savings.

Conclusions

ABC costing is a viable method for costing activities and therapies in long-term day care centers because it can be adapted to their structure and standard practice. This type of costing allows the costs of each activity and therapy, or combination of therapies, to be determined and aids measures to improve management.     

作业成本法在医院流程管理中的应用研究

流程成本管理是医院流程管理的重要内容之一,主要包括流程成本的汇集及成本分析.作者对作业成本法应用于医院流程管理进行了理论探讨,并基于医院组织结构建立了医院流程作业成本模型,对医院医疗服务项目及其活动成本归集进行了论述.之后,通过实例分析,验证了医院业务流程成本分析和计算方法具有一定的实践意义.