基于粗糙集与分类回归树的“病例组合”分类研究

论文根据粗糙集和决策树技术两种理论的互补性,研究一种新的“病例组合”分类模型：将粗糙集与分类回归树相结合的“病例组合”分类模型。该模型既具有粗糙集的一些优点：通过属性约简,可以成功地剔除知识库中的冗余属性,发现知识中隐藏的关联和规则,帮助人们做出正确简洁的决策;又具有决策树的分类精度高,有良好的学习能力和简单的树形结构。     

Accounting and Medicine: An Exploratory Investigation into Physicians’ Attitudes Toward the Use of Standard Cost-Accounting Methods in Medicine

Research studies demonstrate wide variation in how physicians diagnose and treat patients with similar medical conditions and suggest that at least some of the variation reflects inefficiencies and unnecessary medical costs. Health care researchers are actively examining ways to reduce variations in practice through standardization of medicine to reduce the cost of treatment and ensure the quality of outcomes. The most widely accepted form of this standardization is Evidence Based Best Practices (EBBP). Furthermore, financial health care providers such as hospitals and managed care organizations are investigating methods to tie resource usage to medical protocols in their efforts to monitor and control health care costs. Such proposals are contentious because they report on physicians’ medical practice behaviors (such as the number of tests ordered, use of specific therapies, etc.) and such reports could potentially be used to influence their clinical behaviors. The intent of this exploratory study was to examine physicians’ perceptions about linking a standard costing system to EBBP guidelines. The authors interviewed nine practicing physicians asking each physician to respond to the question, ‘As a physician working in a hospital environment, what are your reactions to and concerns with combining standard costing techniques with EBBP?’ The interviews were in-depth and free form in nature. The physicians’ responses were recorded and analyzed using Grounded Theory Methodology. Using this methodology the field data was categorized into two major themes. The most important theme centered on ethics and the second theme was concerned with the implementation and use of a standard cost system in regard to EBBP. If physicians’ worries about ethical dilemmas and implementation issues are not resolved, then it is likely that doctors would be unwilling to participate in any efforts to develop or use a standard cost-reporting system in medicine. While this study was exploratory in nature, it should provide future guidance to accountants, health care researchers and health care providers about physicians’ issues with the use of standard costing methods in medicine.     

Analysing the Institutional Logic of Late DRG Adopters

Abstract: This study investigates how institutional logics that are prevalent in an organizational field influence change in management accounting. More precisely, we examine the institutional logics of late DRG adopters through which organizations attempt to address the pressures imposed by the institutional field of health care. Specific attention is also paid to the way in which organizations operate at different institutional levels and what kinds of interrelationships exist between these levels. Such developments may at least partially explain why the implementation and adoption of DRG–based accounting systems in Finnish health care took almost twenty years.     

Gaming,Accountability and Trust: DRGs and Activity‐Based Funding in Norway

This paper examines a particular performance management instrument in Norway: DRGs used in conjunction with activity‐based funding of hospitals. We ask whether this system creates opportunities for undesirable gaming practices, how accountability arrangements deal with gaming, and how trust and institutional logic may help to explain anomalies and their resolve. From an instrumental and cultural perspective, we examine six Norwegian cases of gaming and two governmental assessments of coding and activity‐based funding. Current solutions do provide gaming opportunities, in a highly complex accountability setting. Accountability arrangements highlight tensions between trust and distrust, rather than resolving the balance between individual goals and collective norms.     

EFFECTS OF NEW CONTROL SYSTEMS IN SWEDISH HEALTH CARE ORGANIZATIONS

Organizations that are radically changing their control systems provide interesting arenas for studies of the effects of such systems. Research on public organizations have shown reforms in some cases to have effects but in other cases they have had no effects. The aim of our study is to describe the introduction and effects of a new control system in the Swedish health care sector. Basically a traditional budget system is replaced with a system according to which hospitals are paid for services made. We found that the new system had functional but also some dysfunctional effects. The major functional effect was an increased productivity. This was possible due to an earlier low level of productivity. However, increased productivity demands capacity reductions given a certain production level. Such decisions must be taken by politicians but they are, however, very reluctant to reduce capacity, which may cause serious disturbances in the system and dysfunctional consequences.