[Activity based costs of different units in a high complexity Chilean hospital]. / Los costos basados en actividades de Unidades Médico Quirúrgica y de Cuidados Medios en un hospital público.

BACKGROUND: Hospitals must have management tools that allow them to fulfil all their requirements with the allocated resources. AIM: To evaluate the number of bed-days according to the discharge diagnosis in a High Complexity Hospital in Chile. MATERIAL AND METHODS: An activity Based Cost (ABC) calculation was used. The stages were gathering of procedures, identification of the resources used, analysis of discharge diagnosis, definition of cost objects, resource cost drivers, cost of procedures, procedures cost drivers and cost of the cost objects that corresponds to bed-day by each medical specialty. Costs were calculated for Medical-Surgical and Intermediate Care units. RESULTS: There were significant differences in costs according to medical specialty when comparing the costs obtained using the Management information system (WinSig) and ABC. Respiratory, Renal and Circulatory-Cardiovascular specialties accounted for the most expensive bed-days. CONCLUSIONS: This study identified bed-day costs and provides disaggregated information about the causes of cost differences between medical specialties.

Cost objects: How is your ED performing?

BACKGROUND: The aim of this study is to a propose a standardized methodology to identify a list of cost objects that can be used by any ED to compute costs considering that the resulting data must facilitate unit management by improving the information available for decision-making. METHODS: This study considers two stages, first, we analyzed the case-mix of two hospitals collecting their data to define and diagram their processes, activities and to obtain their cost objects, second, we used four additional hospitals to validate our initial findings. RESULTS: We recognized 59 cost objects. Hospitals may have all these cost objects or just a subset of them depending on the services they provide. CONCLUSIONS: Among the main benefits of our cost objects definition are: the possibility of tracing the processes generated by the services delivered by EDs, the economic sense in its grouping, the chance of using any costing methodology, the flexibility with other classification systems such as DRGs and ICDs, and the opportunity of costing for both diseases and treatments. Furthermore, cost comparison among hospitals using our final 59 cost objects list is more accurate and based on comparable units. In different EDs, each cost object will be the result of a similar combination of activities performed. We also present the results of applying this cost objects list to a particular ED. A total of 53 out of 59 cost objects were identified for that particular unit within a calendar year.

Los costos basados en actividades de Unidades Médico Quirúrgica y de Cuidados Medios en un hospital público / Activity based costs of different units in a high complexity Chilean hospital

Background: Hospitals must have management tools that allow them to fulfil all their requirements with the allocated resources. Aim: To evaluate the number of bed-days according to the discharge diagnosis in a High Complexity Hospital in Chile. Material and Methods: An activity Based Cost (ABC) calculation was used. The stages were gathering of procedures, identification of the resources used, analysis of discharge diagnosis, definition of cost objects, resource cost drivers, cost of procedures, procedures cost drivers and cost of the cost objects that corresponds to bed-day by each medical specialty. Costs were calculated for Medical-Surgical and Intermediate Care units. Results: There were significant differences in costs according to medical specialty when comparing the costs obtained using the Management information system (WinSig) and ABC. Respiratory, Renal and Circulatory-Cardiovascular specialties accounted for the most expensive bed-days. Conclusions: This study identified bed-day costs and provides disaggregated information about the causes of cost differences between medical specialties.

Using Discrete Event Simulation to predict KPI's at a Projected Emergency Room.

Discrete Event Simulation (DES) is a powerful factor in the design of clinical facilities. DES enables facilities to be built or adapted to achieve the expected Key Performance Indicators (KPI's) such as average waiting times according to acuity, average stay times and others. Our computational model was built and validated using expert judgment and supporting statistical data. One scenario studied resulted in a 50% decrease in the average cycle time of patients compared to the original model, mainly by modifying the patient's attention model.

A cost management model for hospital food and nutrition in a public hospital.

BACKGROUND: In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. METHOD: This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. RESULTS: The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. CONCLUSIONS: This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.