Based on knowledge capital value for disease cost accounting of diagnosis related groups.

Background: The National Health Commission and the other relevant departments in China have initiated testing of the Diagnosis Related Groups (DRGs) system in 30 pilot locations since 2019. In the process of DRG payment reform, accounting for the costs of diseases has become a highly challenging issue. The traditional method of disease accounting method overlooks the compensation for the knowledge capital value of medical personnel. Objective: The primary objective of this study is to analyze the cost accounting scheme of China's Diagnosis Related Groups (C-DRG), focusing on the value of knowledge capital. Methods: The study initially proposes a measurement index system for the value of knowledge-based capital, including the difficulty of disease treatment, labor intensity of disease treatment, risk of disease treatment, and operation/treatment time for diseases. The Analytic Hierarchy Process (AHP) is then utilized to weigh the features of medical workers' knowledge capital value. First, pairwise comparisons are conducted in this stage to develop a two-pair judgment matrix of the primary indicators. Second, the eigenvectors corresponding to the maximum eigenvalues of the matrix are calculated to generate the weight coefficient of each feature. The consistency test is carried out after this stage. An empirical analysis is conducted by collecting data, including the full costs of treating three types of diseases-hip replacement, acute simple appendicitis, and heart bypass surgery-from one public medical institution. Results: The empirical analysis examines whether this DRG costing accounting can address the issue of neglecting the value of medical workers' knowledge capital. The methods reconfigure the positive incentive mechanism, stimulate the endogenous motivation of the medical service system, foster independent changes in medical behavior, and achieve the goals of reasonable cost control. Conclusion: In the cost accounting system of C-DRG, the value of medical workers' knowledge capital is acknowledged. This acknowledgment not only boosts the enthusiasm and creativity of medical workers in optimizing and standardizing the diagnosis and treatment process but also improves the transparency and authenticity of DRG pricing. This is particularly evident in the optimization and standardization of the diagnosis and treatment processes within medical institutions and in monitoring inadequate medical practices within these institutions.

A clínica psicanalítica das urgências subjetivas no hospital universitário: construção de um caso clínico / Psychoanalysis of subjective urgencies at a university hospital: construing a clinical case / La clínica psicoanalítica de urgencias subjetivas en el hospital universitario: construcción de un caso clínico

O hospital constitui-se como um contexto em que a urgência subjetiva pode vir a se apresentar de forma frequente, instaurando, para cada sujeito, uma vivência de angústia. O objetivo desta pesquisa foi investigar as possibilidades para uma clínica das urgências subjetivas no contexto de um hospital universitário em Salvador, considerando as vivências em uma residência multiprofissional. Trata-se de uma pesquisa qualitativa de caráter exploratório, em que se realizou revisão teórica sobre o tema e se construiu um caso clínico, sob orientação psicanalítica. A escolha do caso baseou-se na escuta clínica ao longo dos atendimentos e da atuação em equipe multiprofissional, considerando os impasses ao longo do tratamento. Foram utilizados registros documentais produzidos pela psicóloga residente ao longo dos atendimentos, que ocorreram durante três meses. Os resultados apontam para as contribuições da escuta psicanalítica no tratamento das urgências e na atuação em equipe multiprofissional no contexto hospitalar. A subjetivação da urgência permitiu, no caso em questão, um tratamento pela palavra do que havia incidido diretamente no corpo como fenômeno. Conclui-se pela relevância em discutir o tema da urgência e suscitar novas pesquisas, reintroduzindo no contexto hospitalar a questão sobre a subjetividade.(AU)

Hospitals are contexts in which subjective urgency can frequently materialize, triggering an experience of anguish for each subject. Hence, this research investigates the possibilities of establishing a subjective urgency clinic at a university hospital in Salvador, considering the experiences in a multidisciplinary residence. A qualitative, exploratory research was conducted by means of a theoretical review on the topic and construction of a clinical case, under psychoanalytical advisement. The case was chosen based on clinical listening during the sessions and performance in a multidisciplinary team, considering the obstacles for long-term treatment. Data were collected from documentary records produced by the resident psychologist during three months. Results point to the contributions of psychoanalytic listening to treating subjective urgencies and to the performance of a multidisciplinary team in the hospital context. In the case in question, subjectivation of urgency allowed a treatment through the word of affecting phenomenon. In conclusion, discussing urgency and conducting further research, are fundamental to reintroduce subjectivity in the hospital context.(AU)

El hospital es un contexto en el que frecuentemente se puede percibir una urgencia subjetiva, estableciendo una experiencia de angustia para cada sujeto. El objetivo de esta investigación fue investigar las posibilidades de una clínica de urgencia subjetiva en el contexto de un hospital universitario en Salvador (Brasil), considerando las experiencias en una Residencia Multiprofesional. Se trata de una investigación cualitativa, de carácter exploratorio, en la que se realizó una revisión teórica sobre el tema y construcción de un caso clínico, con orientación psicoanalítica. La elección del caso se basó en la escucha clínica a lo largo de las sesiones y actuación en un equipo multidisciplinar, considerando los impasses para el tratamiento a largo plazo. Se utilizaron registros documentales elaborados por el psicólogo residente, durante las atenciones, que se realizaron durante tres meses. Los resultados apuntan a las contribuciones de la escucha psicoanalítica en el tratamiento de urgencias y en la actuación de un equipo multidisciplinario en el contexto hospitalario. La subjetivación de la urgencia permitió, en el caso en cuestión, un tratamiento a través de la palabra de lo que había afectado directamente al cuerpo como fenómeno. Se concluye que es relevante discutir el tema de la urgencia y plantear nuevas investigaciones, reintroduciendo el tema de la subjetividad en el contexto hospitalario.(AU)

Process Mapping and Activity-Based Costing of the Intravitreal Injection Procedure.

PURPOSE/AIM OF THE STUDY: To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process. MATERIALS AND METHODS: A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI. RESULTS: The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (-22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24-1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation. CONCLUSIONS: Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors.

Orthopaedic Foot and Ankle Surgeon Industry Compensation Reported by the Open Payments Database.

Background. The current study aims to characterize and explore trends in Open Payments Database (OPD) payments reported to orthopaedic foot and ankle (F&A) surgeons. OPD payments are classified as General, Ownership, or Research. Methods. General, Ownership, and Research payments to orthopaedic F&A surgeons were characterized by total payment sum and number of transactions. The total payment was compared by category. Payments per surgeon were also assessed. Median payments for all orthopaedic F&A surgeons and the top 5% compensated were calculated and compared across the years. Medians were compared through Mann-Whitney U tests. Results. Over the period, industry paid over $39 million through 29,442 transactions to 802 orthopaedic F&A surgeons. The majority of this payment was General (64%), followed by Ownership (34%) and Research (2%). The median annual payments per orthopaedic F&A surgeon were compared to the 2014 median ($616): 2015 ($505; P = .191), 2016 ($868; P = .088), and 2017 ($336; P = .084). Over these years, the annual number of compensated orthopaedic F&A surgeons increased from 490 to 556. Averaged over 4 years, 91% of the total orthopaedic F&A payment was made to the top 5% of orthopaedic F&A surgeons. The median payment for this group increased from $177 000 (2014) to $192 000 (2017; P = .012). Conclusion. Though median payments to the top 5% of orthopaedic F&A surgeons increased, there was no overall change in median payment over four years for all compensated orthopaedic F&A surgeons. These findings shed insight into the orthopaedic F&A surgeon-industry relationship.Levels of Evidence: III, Retrospective Study.

Time-Driven Activity-Based Costing Provides a Lower and More Accurate Assessment of Costs in the Field of Orthopaedic Surgery Compared With Traditional Accounting Methods.

PURPOSE: To analyze the implementation and benefits of time-driven activity-based costing (TDABC) in the field of orthopaedic surgery. METHODS: We performed a search of PubMed, Google Scholar, and Embase in March 2020, using the following terms: "Time-Driven Activity-Based Costing," "TDABC," "Orthopaedic Surgery," and "Cost." Then we selected the studies that used the TDABC methodology to generate costs for a particular aspect of orthopaedic surgery. The included studies were divided into the following 5 main categories for ease of analysis: joint arthroplasty, trauma, hand, electronic medical record (EMR) implementation, and pediatric. We analyzed the overall ability of TDABC in the field of orthopaedic surgery, compared to the standard costing methods. RESULTS: We included a total of 19 studies that implemented the TDABC methodology to generate a cost, which was compared to traditional accounting methods. The orthopaedic subspecialty with the most amount of TDABC implementation has been the field of joint arthroplasty. In these studies, the authors have noted that TDABC has provided a more granular breakdown of costs and has calculated a lower cost compared with traditional accounting methods. CONCLUSION: TDABC is a powerful cost analysis method that has demonstrated benefit over the activity-based costing (ABC) approach in determining a lower and more accurate cost of orthopaedic procedures. Furthermore, the TDABC method generates an average cost reduction of $10,000 and $12,000 for total hip arthroplasty and total knee arthroplasty, respectively. CLINICAL RELEVANCE: TDABC can allow health care administration to better determine and understand the cost drivers of particular orthopaedic procedures at their institutions. With improved estimates on the true cost of an activity, hospital administrators and department chairs can adjust to ensure cost-effective, patient-centered health care.

Divergências metodológicas dos Tribunais de Contas e seus efeitos sobre as regras de despesa com pessoal / Divergencias metodológicas de las Cortes de Cuentas y sus efectos en el gasto con funcionarios públicos / Courts of accounts divergent methodologies and its impacts on personnel expenditure rules

Resumo O presente artigo expõe as divergências entre as metodologias adotadas pelos Tribunais de Contas e as apresentadas no Manual de Demonstrativos Fiscais (MDF), elaborado pela Secretaria do Tesouro Nacional (STN), para o cálculo das despesas com pessoal, segundo a Lei Complementar no 101, de 4 de maio de 2000, ou Lei de Responsabilidade Fiscal (LRF). Avalia-se, portanto, como as divergências metodológicas influenciam no cumprimento dos limites das despesas com pessoal dos próprios Tribunais de Contas, a partir dos Relatórios de Gestão Fiscal (RGFs) referentes aos terceiros quadrimestres dos anos de 2016 a 2018, comparando com o disposto no MDF e com as informações inseridas no Sistema de Informações Contábeis e Fiscais do Setor Público Brasileiro (Siconfi). Demonstrar-se-á que alguns Tribunais de Contas ultrapassariam os limites de despesa com pessoal se fosse adotada a metodologia do MDF, o que indica a necessidade de convergência de regras para evitar que a contabilidade criativa de alguns órgãos de controle externo contribua para o desequilíbrio fiscal do ente federativo.

Resumen El presente artículo expone las divergencias metodológicas entre las Cortes de Cuentas de los entes subnacionales brasileños y la Secretaría del Tesoro Nacional, del Ministerio de Economía, acerca de los gastos presupuestarios con funcionarios públicos, según la Ley de Responsabilidad Fiscal. Presenta cómo las divergencias metodológicas permiten que las Cortes de Cuentas cumplan sus límites de gastos con sus funcionarios, a partir de demostrativos fiscales de 2016 a 2018, comparándolos con la metodología del Manual para Demostrativos Fiscales publicado por el Ministerio de Economía. Se propone demostrar que las Cortes de Cuentas excederían los límites de gastos con empleados si fueran aplicados los patrones del gobierno central, lo que indica la necesidad de convergencia para evitar que la contabilidad creativa de algunas Cortes contribuya al desequilibrio fiscal subnacional.

Abstract This article describes how Brazilian Courts of Accounts at the subnational level diverge with the National Secretariat of Treasury of the Ministry of Economy, on how to measure the personnel expenditure cap, a rule according to the Fiscal Responsibility Law of 2001. Since the Courts of Accounts can decide how to measure the personnel expenditure rule in their jurisdictions, the article describes how those decisions, presented in the Fiscal Management Report from 2016 to 2018, diverge with the federal standards described in the Manual of Fiscal Reports (MDF) and compiled in the System of Public Sector Fiscal and Accounting Information (Siconfi). It concludes that some Courts of Accounts would exceed the personnel expenditure cap if they adopted the federal standards described by the central government, which indicates the existence of fiscal accountability practices with a contagious effect upon subnational entities under its jurisdiction, increasing the risks of fiscal imbalances in the federation.

Influência do afeto no julgamento e decisão contábil / Influence of affection on judgment and accounting decision

Para avaliar a influência do afeto no julgamento e tomada de decisão contábil, realizou-se uma pesquisa experimental. A amostra compreendeu 115 alunos do curso de graduação em Ciências Contábeis, separados em dois grupos: afeto positivo (58) e afeto negativo (57). Todos os participantes foram requisitados a resolverem um caso de julgamento contábil para tomada de decisão. Ao entrarem na sala, foram orientados pela atriz/empresária, que teve a incumbência de gerar afeto positivo ou negativo para cada um dos grupos em momentos distintos. A atriz simulou ser uma empresária e os participantes os contadores que teriam que lhe ajudar. Para a análise dos dados, realizou-se os testes qui-quadrado e Mann-Whitney. Os resultados revelam que o afeto positivo influencia no julgamento e tomada de decisão contábil, quando o nível de dificuldade é maior para a resolução de determinado problema, o que faz com que os participantes analisassem a questão com mais atenção na identificação da melhor decisão diante do problema apresentado. A partir dos resultados, organizações contábeis poderão direcionar recursos para práticas que melhorem as relações de seus contadores com seus clientes, pois tais relações podem influenciar o comportamento no ambiente de trabalho e afetar o julgamento e tomada de decisão.

To assess the influence of affection on judgment and accounting decision-making, an experimental survey was conducted. The sample comprised 115 undergraduate students in Accounting Sciences, separated into two groups: positive affect (58) and negative affect (57). All participants were asked to resolve an accounting judgment case for decision making. Upon entering the room, they were guided by the actress/businesswoman, who had the task of generating positive or negative affection for each of the groups at different times. The actress pretended to be a businesswoman and the participants were accountants who would have to help her. For data analysis, chi-square and Mann-Whitney tests were performed. The results reveal that positive affect influences judgment and accounting decision-making when the level of difficulty is greater in solving a certain problem, which makes participants analyze the issue more carefully in identifying the best decisionin the face of the problem. introduced. Based on the results, accounting organizations will be able to direct resources to practices that improve their accountants' relationships with their clients, as such relationships can influence behavior in the workplace and affect judgment and decision making.

The roots of budgetary and financial accounting in Brazil / Las raíces de la contabilidad presupuestaria y patrimonial en Brasil / Raízes da contabilidade orçamentária e patrimonial no Brasil

Abstract This article presents evidence of Italian influences on the Brazilian Public Sector Accounting in the early twentieth century, using the analytically structured history approach and the institutional theory. The study presents the institutional work developed by accountant Carlos de Carvalho in employing a new accounting methodology at the time. The article proposes a new perspective on the literature on the history of accounting in Brazil, suggesting that the emergence of budgetary and financial accounting was due to the innovation of local practices in a municipality of the state of São Paulo, and then expanded to the entire state, influenced by the Italian legal doctrine. Therefore, the use of dual accounting in Brazil during the early twentieth century was first disseminated in practice and transformed into legislation afterward. The Italian roots that influenced this movement are present in the current model, which is being reviewed by the current process of convergence to international IPSAS standards.

Resumen El artículo presenta evidencias de la influencia italiana sobre la contabilidad del sector público en Brasil a principios del siglo XX. El análisis aplica la metodología de la historia estructurada y el aspecto sociológico de la teoría institucional. Se narra el trabajo institucional desarrollado por el contador Carlos de Carvalho al emplear una nueva metodología contable en ese momento. Este estudio reposiciona la literatura histórica sobre contabilidad en Brasil, puesto que propone que el surgimiento de la contabilidad presupuestaria y patrimonial se debió a la innovación de las prácticas locales en un municipio influenciado por los métodos empleados en la contabilidad dual italiana de la época, difundida y estandarizada en la ley. Las raíces italianas que influyeron en este movimiento permanecen presentes en el modelo actual, que está siendo revisado por el proceso actual de convergencia hacia las normas internacionales IPSAS.

Resumo Este artigo trata da influência italiana na contabilidade do setor público no Brasil do início do século XX. A análise aplica a metodologia de história estruturada e a vertente sociológica da teoria institucional. Narra-se o trabalho institucional desenvolvido pelo contador Carlos de Carvalho ao empregar uma nova metodologia contábil. Este estudo reposiciona a literatura sobre história da contabilidade no Brasil, pois propõe que a contabilidade dual (orçamentária e patrimonial) iniciou sua evidenciação conjunta em um município (São Carlos-SP), mas só alcançou sua integração no Estado de São Paulo sob a influência doutrinária e legal italiana. Seu uso foi difundido primeiro e transformado em lei depois. As raízes italianas da inovação contábil do início do século XX no Brasil continuam presentes no modelo atual, que vem sendo revisto pelo processo de convergência às normas internacionais de contabilidade do setor público (international public sector accounting standards [IPSAS]).

Limits of Brazilian public accounting and control systems to address the systemic corruption problem: lessons from the Swedish and Italian cases / Análisis de los límites de los sistemas de contabilidad y control para enfrentar el problema de la corrupción sistémica en Brasil: lecciones de los casos de Suecia e Italia / Análise de limites dos sistemas de contabilidade e controle para o enfretamento do problema da corrupção sistêmica no Brasil: lições dos casos da Suécia e da Itália

Abstract This article seeks to understand the reasons for the persistence of corruption in the Brazilian federal government, despite strong public accounting and financial control systems in the country. More than two-thirds of the states in the world, including Brazil, face the challenge of plundering public finances by political, economic, and bureaucratic elites. In this context, the exclusive use of the dominant approach of economic theories for the structuring of public control systems is limited. It is more appropriate to consider corruption as a problem of collective action. Hence, the theoretical reference chosen includes Bourdieu's theory of practice and Tocqueville's and Ostrom's collective action theories, as they have been understood respectively by Mungiu-Pippidi and Rothstein. The methodological strategy adopted is an exploratory analysis of the cases of contemporary day Brazil, based on the lessons learned from nineteenth-century Sweden, and Italy in the 1990s. The results indicated that overcoming systemic corruption requires more than control systems. It demands, at least, a trigger to disrupt the perverse social imbalance, institutional capacity to offer normative effectiveness and a cohesive and active civil society.

Resumen El artículo se propone a comprender las razones de la persistencia de la corrupción en el gobierno federal brasileño, aunque este ya cuente con comprensivos sistemas de contabilidad pública y control financiero. Más de dos tercios de los estados del mundo, incluso Brasil, enfrentan un alto nivel de desvío de dinero público por parte de las élites políticas, económicas y burocráticas. En este tipo de contexto, es muy limitado el uso exclusivo del abordaje dominante de las teorías económicas para la estructuración de los sistemas de control público. El artículo argumenta ser más apropiado buscar soluciones derivadas del enfoque de las teorías de acción colectiva. Él utiliza la teoría de la práctica de Bourdieu y las teorías de la acción colectiva de Tocqueville y Ostrom, conforme adoptadas por Mungiu-Pippidi y Rothstein, respectivamente. La estrategia metodológica es un análisis exploratorio del caso brasileño, a la luz de las lecciones de Suecia en el siglo XIX, e Italia en la década de 1990. Los resultados indican que superar la corrupción sistémica puede requerir más que establecer sistemas de contabilidad y de control fuerte. Es necesario, por lo mínimo, un gatillo que desestabilice el equilibrio social perverso existente, cierta capacidad institucional para conferir efectividad normativa y una sociedad civil activa y cohesiva.

Resumo O artigo busca entender as razões para a persistência da corrupção no governo federal brasileiro, apesar de este nível de governo já contar com robustos sistemas de contabilidade pública e de controle financeiro. Mais de dois terços dos estados do mundo, incluindo o Brasil, enfrentam elevado nível de desvio de dinheiros públicos por parte de elites políticas, econômicas e burocráticas. Neste tipo de contexto, o uso exclusivo da abordagem dominante das teorias econômicas para a estruturação dos sistemas de controle público é muito limitado. O artigo defende que é mais adequado buscar soluções derivadas de abordagem das teorias de ação coletiva. Para isso utiliza a teoria da prática de Bourdieu e as teorias de ação coletiva, de Tocqueville e Ostrom, conforme acolhidas respectivamente por Mungiu-Pippidi e Rothstein. A estratégia metodológica é de análise exploratória do Brasil atual, à luz das lições da Suécia do século XIX e da Itália da década de 90. Os resultados indicam que a superação da corrupção sistêmica requer mais do que a constituição de sistemas de contabilidade e de controle fortes. Exige, no mínimo, um fator desencadeante que desestabilize o equilíbrio social perverso vigente, capacidade institucional para conferir eficácia normativa, além de uma sociedade civil coesa e ativa.

Overseas influences on the development and recent innovations on public sector accounting and finance in Latin America / Influencias extranjeras en el desarrollo e innovaciones recientes en contabilidad y finanzas del sector público en América Latina / Influências estrangeiras no desenvolvimento e inovações recentes em contabilidade e finanças do setor público na América Latina

Abstract The idea for this special issue was to contribute to the international literature on public sector accounting from a Latin-American perspective, exploring which forces influence Public Sector Accounting and Finance (PSA&F) artifacts and concepts in Latin America, and how they occur. There is evidence that later influences from countries such as Italy, the United Kingdom, the United States, and New Zealand played a role in PSA&F developments in Latin-America. However, the roots and the associated effects (e.g., recent innovations, resistances, decoupling) of PSA&F are still unanswered questions. Such 'recent innovations' on public financial management processes include but are not limited to accrual accounting, convergence towards IPSAS, risk assessment, auditing, and budgeting. This special issue contains four articles capturing different perspectives of influences and mechanisms of PSA&F in the region.

Resumen La idea original de esta edición especial fue contribuir a la literatura internacional sobre contabilidad del sector público desde una perspectiva latinoamericana, explorando las influencias extranjeras en los artefactos y conceptos de contabilidad y finanzas del sector público (C&FSP) en América Latina y cómo ocurren dichas influencias. Existen evidencias de que las influencias de países como Italia, Reino Unido, Estados Unidos de América (EE.UU.) y Nueva Zelanda jugaron un papel en el desarrollo de C&FSP en América Latina. Sin embargo, estas raíces de C&FSP y los efectos asociados (por ejemplo, innovaciones recientes, resistencias, disociación) siguen siendo cuestiones abiertas. Estas innovaciones recientes en los procesos de gestión de las finanzas pública incluyen, entre otros, contabilidad de acumulación, convergencia a las normas internacionales de contabilidad del sector público (IPSAS - international public sector accounting standards), evaluación de riesgos, auditoría y presupuestación Esta edición especial consta de cuatro artículos que capturan diferentes perspectivas sobre las influencias en los mecanismos de C&FSP en la región.

Resumo A ideia original para esta edição especial foi contribuir com a literatura internacional sobre contabilidade do setor público sob uma perspectiva latino-americana, explorando as influências estrangeiras nos artefatos e nos conceitos de contabilidade e finanças do setor público (C&FSP) na América Latina e como ocorrem tais influências. Há evidências de que as influências vindas de países como Itália, Reino Unido, Estados Unidos da América (EUA) e Nova Zelândia desempenharam um papel nos desenvolvimentos de C&FSP na América Latina. No entanto, tais raízes de C&FSP e os efeitos associados (p. ex., inovações recentes, resistências, dissociação) ainda são questões em aberto. Essas inovações recentes nos processos de gestão financeira pública incluem, entre outras, contabilidade por competência, convergência para as normas internacionais de contabilidade do setor público (international public sector accounting standards [IPSAS]), avaliação de riscos, auditoria e orçamento. Esta edição especial consiste em quatro artigos que capturam diferentes perspectivas das influências nos mecanismos de C&FSP na região.

Public sector accounting reform in Latin America and Epistemic Communities: an institutional approach / Reformas de la contabilidad del sector público en Latinoamérica y comunidades epistémicas: una perspectiva institucional / Reforma contábil do setor público na América Latina e comunidades epistêmicas: uma abordagem institucional

Abstract Latin American countries have undergone a growing interest in international accounting standards. Several countries are making progress in the adoption of international standards driven by different internal factors as well as external dynamics. The role of experts in the design of public policies associated with international standards has been studied by the epistemic community theory, which is the theoretical framework used in this study to address the influence of different international organizations on the adoption of IPSAS in Brazil and Colombia. This paper discusses the isomorphic institutional pressure exerted over the governments of these two countries in order to meet an international standard considered to be adequate. Meanwhile, the emerging trend towards the adoption of IPSAS in Latin America continues to grow, although some obstacles to achieving the goals defined in the reform arise.

Resumen Los países de América Latina han experimentado un creciente interés por las normas internacionales de contabilidad. Varios países están avanzando en la adopción de estándares internacionales, impulsados por diferentes factores internos y dinámicas externas. El papel de los expertos en la definición y recomendación de las políticas públicas asociadas con los estándares internacionales ha sido estudiado por la teoría de las comunidades epistémicas. El artículo retoma este marco teórico para abordar la influencia de diferentes organismos internacionales en la adopción de IPSAS en Brasil y Colombia. Discute la presión institucional isomórfica sobre los gobiernos de estos dos países para converger a un estándar internacional que es visto como adecuado. La tendencia emergente hacia la adopción de IPSAS en los países latinoamericanos crece, aunque existen importantes obstáculos para alcanzar las metas definidas en la reforma.

Resumo Os países da América Latina têm experimentado um crescente interesse pelas normas internacionais de contabilidade. Vários países estão avançando na adoção de padrões internacionais, impulsionados por diferentes fatores internos e dinâmicas externas. O papel dos especialistas na definição e recomendação de políticas públicas associadas a padrões internacionais tem sido estudado pela teoria de comunidades epistêmicas. O artigo retoma este arcabouço teórico para abordar a influência de diferentes organizações internacionais na adoção das IPSAS no Brasil e na Colômbia. Discute a pressão institucional isomórfica sobre os governos desses dois países para convergir para um padrão internacional considerado adequado. A tendência emergente para a adoção de IPSAS nos países da América Latina está crescendo, embora existam obstáculos significativos para alcançar as metas definidas na reforma.

Activity-Based Costing and Time-Driven Activity-Based Costing for Assessing the Costs of Cancer Prevention, Diagnosis, and Treatment: A Systematic Review of the Literature.

BACKGROUND: A review of the literature on economic analyses in cancer (prevention, diagnosis, and treatment) using activity-based costing (ABC) or time-driven activity-based costing (TDABC) for measuring costs and to examine how these approaches have been applied to assess and manage cancer costs. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a search for studies that used ABC or TDABC to calculate the cost of cancer in prevention, diagnosis, and treatment. Only English- and Portuguese-language articles were retrieved from Medline, Lilacs, ScieLO, and Embase (January 1990 to August 2016). RESULTS: In total, 421 studies were evaluated. However, only 27 papers were included. The first publications were from the early 2000s, but most of the studies were published in 2016 (n = 10). Most of the studies were carried out in the United States (n = 6) and Belgium (n = 6). Cancer treatment was the major focus of all studies (n = 20), followed by screening programs evaluations (n = 4) and diagnosis (n = 3). Among treatment modalities, economic analysis of radiotherapy was the most common topic of study. Retrospective clinical data represented 57.6% of the studies. More than 50% of the studies presented unspecified economic analysis. The hospital perspective was the most prevalent perspective among the studies (46.1%). CONCLUSIONS: ABC and TDABC economic analyses are a promising area of studies in oncology costs.

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.

Clinicopathological case: progressive somnolence and dementia in an accountant: when the shine rubs off the gold standard.

A 63-year-old accountant developed progressive somnolence, cognitive decline, gait disturbance and cerebellar dysfunction with autonomic features. This report documents the clinicopathological conference at the 39th Edinburgh Advanced Neurology Course 2017.

Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals.

STUDY OBJECTIVE: Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10-20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases. DESIGN: Observational study. SETTING: State of Texas hospital discharge abstract data for 1st quarter of 2016, 4th quarter of 2015, 1st quarter of 2015, and 4th quarter of 2014. PATIENTS: Discharged from an acute care hospital in Texas with at least 1 major therapeutic ("operative") procedure. MEASUREMENTS: Counts of discharges for each procedure or combination of procedures, classified by ICD-10-PCS or ICD-9-CM. MAIN RESULTS: At the average hospital, most surgical discharges were for procedures performed at most once a month at the hospital (54%, 95% confidence interval [CI] 51% to 55%). At the average hospital, approximately 90% of procedures were performed at most once a month at the hospital (93%, CI 93% to 94%). The percentages were insensitive to the quarter of the year. The percentages were 3% to 6% greater with ICD-10-PCS than for the superseded ICD 9 CM. CONCLUSIONS: There are many different procedure codes, and many different combinations of codes, relative to the number of different hospital discharges. Since most procedures at most hospitals are performed no more than once a month, activity-based cost accounting with a sample size sufficient to be useful is impractical for the vast majority of procedures, in contrast to analysis by surgeon and/or subspecialty.

Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery.

STUDY OBJECTIVE: Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital. DESIGN: Observational study. SETTING: State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. PATIENTS: Inpatients discharged with a major therapeutic ("operative") procedure. MEASUREMENTS: For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month. MAIN RESULTS: Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P<0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights. CONCLUSIONS: Approximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them.

Tracing a Path to the Past: Exploring the Use of Commercial Credit Reporting Data to Construct Residential Histories for Epidemiologic Studies of Environmental Exposures.

Large-scale environmental epidemiologic studies often rely on exposure estimates based on linkage to residential addresses. This approach, however, is limited by the lack of residential histories typically available for study participants. Our objective was to evaluate the feasibility of using address data from LexisNexis (a division of RELX, Inc., Dayton, Ohio), a commercially available credit reporting company, to construct residential histories for participants in the California Teachers Study (CTS), a prospective cohort study initiated in 1995-1996 to study breast cancer (n = 133,479). We evaluated the degree to which LexisNexis could provide retrospective addresses prior to study enrollment, as well as the concordance with existing prospective CTS addresses ascertained at the time of the completion of 4 self-administered questionnaires. For approximately 80% of CTS participants, LexisNexis provided at least 1 retrospective address, including nearly 25,000 addresses completely encompassed by time periods prior to enrollment. This approach more than doubled the proportion of the study population for whom we had an address of residence during the childbearing years-an important window of susceptibility for breast cancer risk. While overall concordance between the prospective addresses contained in these 2 data sources was good (85%), it was diminished among black women and women under the age of 40 years.

Comparison of cost determination of both resource consumption accounting and time-driven activity-based costing systems in a healthcare setting.

Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting. Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA. Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA. Conclusion Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs. What is known about the topic? TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA. What does this paper add? There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting. What are the implications for practitioners? This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.