Abstract
Health care reform aims to improve Health System performance by achievement of one of the four objectives: reducing costs by increasing the efficiency of health care provision. Performance improvement implies acceptance of innovations in all Health care activities including health care financial management. Successful implementation of health care financing reform requires previous costs and activities analysis in health institutions. In the work we performed comparative analysis of the costs of 27 health institutions by applying innovative system for health care services costs analysis and control. Initialy spreadsheet system was made, by using internationaly recognised 'Step Down' methodology, for cost control and analisys in the hospitals and was adapted for Primary health care institutions. Results achieved: The dominant cost for employees salaries, on average around 80%, does not depend on the size of Primary health institution (Dom zdravlja); Significant differences in the percentage values of the cost of medicines, medical supplies, diagnostic services; There is an obvious difference percentage values of technical maintenance costs as a result of uneven percentage of the number of non-medical employees, differences in infrastructure organization, the difference in the condition and type of equipment, the difference in the type of space heating and type of fuel for heating, patients transportation obligations especialy of home treatment services and polyvalent patronage. There is a big difference in average cost per outpatient examination, as a consequence of uneven number of services performed, especialy in the dentistry services. There is a significant difference in the number of preventive health examinations performed which has a direct impact on the cost of these inspections. The main conclusion of the analysis done indicates that in the actual situation of disparities, in terms of costs, can joperdize implementation of Primary health care financing using 'Capitation' as model.
Highlights
Reforma zdravstvenog sistema podrazumeva prihvatanje inovacija u upravljanju finansijama zdravstvene ustanove
Dobijeni rezultati pokazuju da: Dominantni trošak za lična primanja, prosečno oko 80%, ne zavisi od veličine doma zdravlja; Evidentne razlike u procentnim vrednostima troškova za lekove, medicinski potrošni materijal, dijagnostičke službe; Postoji evidentna razlika procentne vrednosti troškova tehničkog održavanja kao posledica neujednačenog procenta broja zaposlenih nemedicinskih radnika, razlika u infrastrukturnoj organizaciji, razlika u stanju i vrsti opreme, razlika u načinu grejanja prostora i vrsti goriva za grejanje, obaveze prevoza bolesnika i specifičnost službe kućnog lečenja i polivalentne patronaže; Postoji velika razlika u troškovima po uprosečenom ambulantnom pregledu, kao posledica neujednačenog broj izvršenih usluga
Osnovni zaključak urađene analize ukazuje na činjenjicu da je u uslovima prikazane neujednačenosti troškova problematično primeniti sistem finansiranja kapitacijom
Summary
Reforma zdravstvenog sistema podrazumeva prihvatanje inovacija u upravljanju finansijama zdravstvene ustanove. U radu je izvedena uporedna analiza troškova 27 domova zdravlja primenom inovativnog tabelarnog sistema za analizu i kontrolu troškova korišćenjem „Step Down“ metodologije. Kada govorimo o potrebi za inovativnim pristupom u oblasti zdravstvene zaštite, tu ne mislimo samo na proces lečenja bolesti nego i na druge procese koji omogućavaju funkcionisanje zdravstvenog sistema. Upravljanje finansijama u zdravstvenim ustanovama u Srbiji u uslovima ograničenog priliva sredstava zahteva novi menadžerski pristup koji podrazumeva da generalni direktor mora da poseduje „finansijsku pismenost“ koja će mu omogućiti da upravlja finansijama u pravom smislu te reči, primenom menadžerskih alata koji omogućavaju analizu, planiranje i kontrolu finansija na brz i jednostavan način. U ovom radu prikazan je inovativni pristup u upravljanju finansijama doma zdravlja primenom tabelarnog sistema za analizu i kontrolu troškova
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