Using technology to reveal true costs

Healthcare leaders should address three important questions as they prepare to implement new costing systems: Do all providers in their organizations' systems, networks, or partnerships share the same definitions of unit of care and of fixed, variable, incremental, direct, and indirect costs? What are the maintenance processes and protocols for cost center and period matching of revenues and costs? If some providers within a network or partnership are not using costing systems, can an enterprise derive surrogate cost per unit of care?     

Redefining competition in health care

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.     

Developing time-driven activity-based costing at the national level to support policy recommendations for radiation oncology in Belgium

We use time-driven activity-based costing (TDABC) to estimate the cost of radiation treatments at the national level. Although TDABC has mostly been applied at the hospital level, we demonstrate its potential to estimate costs at the national level, which can provide health policy recommendations. Contrary to work on reimbursement or charges representing the health care system perspective, we focus on resource costs from the perspective of health care service providers. Using the example of Belgian inputs and results, we discuss development of a TDABC model. We also present insights into the challenges that arose during model design and implementation. Finally, we discuss recent examples of policy implications in Belgium as well as some caveats that should be considered when developing resource allocation models at the national level.     

Managed care, consolidation among health care providers, and health care: evidence from mammography

We discuss the effects of managed care on the structure of the health care delivery system, focusing on managed-care-induced consolidation among health care providers. We empirically investigate the relationship between HMO market share and mammography providers. We find evidence of consolidation: increases in HMO activity are associated with reductions in the number of mammography providers and with increases in the number of services produced by remaining providers. We also find that increases in HMO market share are associated with reductions in costs for mammography and with increases in waiting times for appointments, but not with worse health outcomes.     

Health insurance and outcomes: comprehensive assessment of health system outputs

Outcomes analysis in health care has historically meant the examination of clinical results of inpatient hospitalization. In response to climbing health care and health insurance costs, the organization of health care providers, the location of service delivery and reimbursement mechanisms have changed. As the health care industry changes, so too must the definition of outcomes. This article presents a conceptual framework for the analysis of health outcomes as health industry outputs, with an emphasis on the ways in which such outputs are being assessed and improved.     

Let's put consumers in charge of health care

Businesses spend billions on health insurance. And what do they get for their money? A lot of unhappy employees. Workers fret about the quality of the care they receive, the burden of their out-of-pocket expenses, and the gaps in their coverage. For businesses, health care has become a lose-lose proposition: They pay way too much, and they get way too little. The problem is that the health care industry has been shielded from consumer pressure--by employers, insurers, and the government. As a result, costs have exploded even as choices have narrowed. But if companies embrace a new model of health coverage--one that places control over both costs and care directly into the hands of employees--the competitive forces that spur productivity and innovation in consumer markets can be loosed upon the inefficient, tradition-bound health care system. Moving to consumer-driven health care requires that companies revamp their health benefits in six ways: Give employees incentives to shop intelligently; offer a real choice of insurance plans; charge employees prices that accurately reflect the company's costs; let providers set their own prices; adjust payments for each enrollee based on need; and provide relevant information. Putting consumers in charge of health care may seem like a radical approach. But individuals are highly motivated to educate themselves about their health, their insurance, and their care, and they want to seek the most value for their money. Promoting that economic dynamic--the same that fuels consumer markets everywhere--is the best way to enhance the health care industry's productivity and quality.     

基于作业成本法的高校学生培养成本计量研究

本文采用作业成本法的基本原理,将学校各单位之功能加以区别,依作业活动分摊各项成本。通过构建多阶段的作业成本模型,来辨别、测算各种教育投入要素成本,了解成本发生之原因,最终提供学校、政府、家长等社会各有关方面进行教育决策所需要的教育成本信息。     

COSTING NEEDS AND PRACTICES IN A CHANGING ENVIRONMENT: THE POTENTIAL FOR ABC IN THE NHS

This pisper explores the potential application of ABC in a situation of rapid change - the introduction of markets for health care in the UK. This changing environment places pressures on hospital units to refine their costing methods for product costing, budget construction and the pursuit of efficiency. These are areas of management accounting for which activity-based costing (ABC) has been proposed as a refinement to traditional costings. The merits of the ABC approach were examined by conducting four case studies of acute hospitatls. The results cast doubt on the benefits to be gained from ABC in product costing, but revealed potential applications in its wider roles of cost reduction and budget construction.     

ABC: The Pathway to Comparison of the Costs of Integrated Care

In recent years, health care demand has become increasingly complicated and care has had to be integrated. The main reasons for this are a rising number of chronically ill patients and ageing of populations. Integrated health care is processual so there are continuous changes in care delivery; it incorporates many co–ordinating and co–operative activities which can produce uncertain outcomes; and activities are directed at delivering tailor–made care so there are no standardized or generalized outcomes. These characteristics mean that it is difficult to determine and compare the costs of different integrated care structures. This article argues that using Activity Based Costing (ABC) and integrated care pathways provides the best information possible for decision–making by health care managers, insurers, care suppliers and governments.     

Strategies for survival in the hospital industry.

Hospitals, besieged by new competitors and pressured to cut costs, are entering a new and unfamiliar environment. As usage declines and the government's new prospective payment system makes itself felt, hospitals are feeling the pinch. Nonprofit hospitals face competition from newer, for-profit providers of health care. These authors discuss the factors that have led some hospitals to close and forced most others to consider how they can lower costs while maintaining high-quality care. Several strategies exist to help hospitals cope with their new problems. The authors point out the advantages and disadvantages of downsizing, diversification, and joint ventures, among other practical measures that hospitals can take.     

Health and the welfare of U.S. business

Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Modern Costing Innovations and Legitimation: A Health Care Study

This article is a study of the introduction of a modern costing technology—activity based costing (ABC)—into a health care organization which is undergoing change. The transformation of this organization is of particular interest as it focused on the experience of a service which had always existed by collecting blood, which is given as a free donation (the gift), and which is then converted into a variety of health care products. Typically, accounting innovations in the U.K.'s National Health Service are at the behest of central government: In this case, the adoption of ABC is on the initiative of the health care organization itself. The attractiveness of the specific costing approach from the perspective of the management of this health care organization is as an ingredient in legitimation—the portrayal of this entity as a 'complete organization'.     

How companies tackle health care costs: Part III.

As corporations look for ways to cut the rising costs of health care, they direct most of their efforts at modifying the demand for services. Some have attempted to effect changes in the health care system as a whole, and a smaller number have instituted programs to attack the problem at its source by improving the health of their employees. This article explores and evaluates existing corporate health promotion activities and concludes that such programs should form the third part of a three-pronged attack on health care costs.     

Frequent-user patients: reducing costs while making appropriate discharges

Homeless patients who lack access to the health resources they need to maintain their health on their own pose a challenge for hospitals: Premature discharge of such patients can result in their being readmitted to the hospital in a short time, leading to higher costs for the hospital. Hospitals can address this problem by developing clear, effective homeless discharge policies and by developing ongoing relationships with appropriate medical respite care providers. A hospital also can benefit from spearheading an initiative to develop a medical respite program, enlisting the assistance of other community stakeholders.     

Das Geschäftsmodell des selektiven Kontrahierens — Eine Analyse wertschöpfender Aktivitäten gesetzlicher Krankenkassen

By establishing Integrated Care sickness funds are introduced the possibilities of signing individual contracts with single or a group of health care providers (selective contracting). So far, this topic has been discussed a lot from the health care system’s point of view. The research presented in this paper however focuses on business aspects from a single sickness fund’s point of view. By selective contracting of providers a sickness fund creates additional value for insurants. Besides the traditional payer function this is especially done by pre-selecting quality-proved providers, stipulating diagnosis and therapy methods, stipulating guarantees and negotiating remunerations. Customer-orientation requires identification of the patient’s different needs and preferences. To satisfy those individually varying demands a sickness fund has to choose carefully its contract partners. A sickness fund’s success depends on the quality of its contracted providers. As selective contracting means that only a chosen number of providers will be contracted, value is created for those by mediating patients with the opportunity of raising both income and utilisation. The value creation by selective contracting can be summarized both for patients as well as for providers as a strong reduction of transaction costs.     

reDefined contribution health care

To combat rising health care costs and a society increasingly unsatisfied with employer-sponsored health care services, reDefined Contribution Health Care suggests a process to create a more consumer-driven health care market. To create this value-sensitive market requires a planned, staged approach that will include immediate actions and work toward fundamental, long-term changes.     

How companies tackle health care costs: Part II.

In this continuing examination of responses to the growing costs of health care, based on a survey of more than 200 large companies, the author discusses the results of employers' efforts to trim these expenses. Most companies have chosen to meet the cost-cutting challenge by changing demand--that is, by redesigning their health insurance policies--and by changing the suppliers of health care services. After a critical analysis of these mechanisms, the author concludes that most of these strategies do little more than shift the costs from one payer to the next. To affect the total cost of the system, she maintains the business sector must use its power to bring about changes in the reimbursement of providers and in the underlying structure of the health care system.     

Hospital Costing: Experience from the VHA

The government administered Veterans Health Administration (VHA) is the largest integrated health care system in the USA. As health care dollars are becoming tighter nationwide, VHA faces the dual challenge of achieving cost reductions and improving quality, while operating in an increasingly competitive marketplace. This places new demands on cost accountability within the agency. This paper identifies the cost accounting procedures currently used by VHA as it responds to internal budgetary curtailment and to external competitive pressures. Understanding the different costing approaches taken by the organization along with their associated problems offers lessons of interest to financial managers within and outside VHA.     

The learning curve and the health care industry

This article will examine the learning curve and its potential impact on the health care industry. Although the learning curve has traditionally been applied to the manufacturing industry, a labor-intensive industry like health care is a prime candidate for the benefits of the learning curve. Specifically, we will look at past research on the learning curve and discuss what effects learning might have on health care costs and outcomes in the current health care environment.