Cost Centers Research Articles

Cyber-Physical Loops as Drivers of Value Creation in NDE 4.0.

Across so many industries, non-destructive evaluation has proven its worth time and again through quality and safety assurance of valuable assets. Yet, over time, it became underappreciated in business decisions. In most cases, the data gathered by NDT is used for quality assurance assessments resulting in binary decisions. And we seem to miss out on value of the information content of NDE which goes way deeper and can help other stakeholders: such as engineering, management, inspectors, service providers, and even regulators. Some of those groups might not even be aware of the benefits of NDE data and its digitalization. Unfortunately, the NDE industry typically makes the data access unnecessarily difficult by proprietary interfaces and data formats. Both those challenges need to be addressed now by the NDE industry. The confluence of NDE and Industry 4.0, dubbed as NDE 4.0, provides a unique opportunity for the NDE/NDT Industry to not only readjust the value perception but to gain new customer groups through a broad set of value creation activities across the ecosystem. The integration of NDE into the Cyber-Physical Loop (including IIoT and Digital Twin) is the chance for the NDE industry to now shift the perception from a cost center to a value center. This paper provides an overview of the NDE ecosystem, key value streams, cyber-physical loops that create value, and a number of use cases for various stakeholders in the ecosystem.

Calculation of the Visit Costs of Various Services Provider Groups: Improvement of Payment Mechanisms

Background: Initiatives to improve the quality of health services and reduce costs currently have centered around payment mechanisms. In Iran, like many other countries, the outpatient visit costs are paid via fee for service, while real-time visits and other details of provided services are not considered in the tariff setting process. This study attempted to calculate the visit costs of various service provider groups and compared them with tariffs. Methods: In this cross-sectional research, the essential data about different costs were collected from providers' offices, standard time of each visit was achieved from Iran's Ministry of Health and Medical Education, current visit time of service providers was calculated based on health insurance companies' data across the country. After calculating the standard and current visit costs through the activity-based costing technique, main determinants of costs (major cost centers) were specified for use in probably future weighted tariffs in fee for service payment mechanism. Results: The greatest difference between standard and the current number of visits was found in the Sub-specialist physician group (6784 in a year), and the greatest difference was between standard and current cost of visits in sub-specialist psychiatrists (126703 IRR). Staffing and rental cost centers account for the highest share of total visit cost (87 %). Conclusion: This study demonstrated a significant difference between the current and standard visit costs with tariffs. Therefore, it is essential that policymakers improve the payment mechanism by modifying the visit tariffs for medical service providers. One suggestion in this way is using domestic relative value units according to costing research results.

Resource Utilization Using Micro-Costing Method and Cost Effectiveness Analysis of Treatment of Acute Promyelocytic Leukemia with Generic Arsenic-Trioxide

We have previously reported on the challenges of treating AML in India, the major challenge being the cost of treatment (Chepsy et al. BJH 2015). With conventional treatment of AML it is recognized that the major part of this cost is not related to the cost of the individual chemotherapeutic drugs, but rather from the high cost of supportive care to take patients through repeated cycles of prolonged neutropenia induced by conventional chemotherapy. In contrast with arsenic trioxide (ATO) based regimens in acute promyelocytic leukemia (APL), when expensive patented ‘innovator’ ATO was used, the reported 3 year direct pharmacy cost of drugs was higher with an ATO+ATRA regime compared with a conventional ATRA+chemotherapy regimen (Euro 46,700 Vs 6,700), though the cost of supportive care was a third of conventional therapy (Kruse M et al. PLoS One. 2015). There is limited data on the cost effectiveness of using generic ATO, as available in India, in the treatment of APL (10 mg vial costs US $7 in India versus US $ 676 in North America)In a single center, retrospective study, 30 newly diagnosed APL (ND-APL) patients, treated with ATO and 16 relapsed APL (R-APL) patients, treated on a phase II trial with a ATO based regimen followed by an autologous stem cell transplant (regimens as previously reported by us; Mathews et al. Blood 2012 and Mathews et al. Blood 2016 abstract) were evaluated. In the absence of patients being treated at our center with a conventional ATRA+chemotherapy regimen (APL-CT) the cost of treatment for APL with such a regimen was assumed to be similar to the cost that would be incurred to treat a non-M3 AML patient at our center with a conventional AML chemotherapy schedule. Incremental cost effectiveness ratio was calculated using weighted costs with weighing factor obtained from survival data for 60 patients from our database for APL ATO group and from the AIDA 2000 trial for APL-CT group.A three phase micro-costing method (figure 1) used four cost centers involved in providing patient care: (i) chemotherapy administration (ii) supportive care (iii) treatment of complications (iv) laboratory services. For each of these cost centers there were four cost drivers: (i) drugs / reagents (ii) personnel (iii) ward (iv) instruments / overheads. The actual cost of cost drivers was found out by micro-costing and summed up to obtain the unit cost of each cost center (m). Each time a patient used a cost center this unit cost would be incurred. Next, the frequency of utilization (n) of each cost center was found out from the patient database and multiplied by the unit cost of the cost center to obtain the total cost of treatment in each protocol (m x n) (For illustration and international comparison all cost were converted to US$).In ND-APL patients, the mean cost of induction and consolidation was $5078.5±1581 and $902±212 respectively while in APL-CT it was $9812.1±3239 and $11803.1±4872 respectively (exchange rate 1 US$=61.87 Indian rupees). Our data illustrated that APL-CT group incurred higher costs mainly due to the greater duration of in-patient care that was required in this group and since they had higher rate of infectious complications (Table 1). During maintenance phase, in ND-APL, there were no in-patient stays and the entire chemotherapy was given on outpatient basis and the average cost was $2074±146 and the cost of following up these patients for an additional three years was $704.6±289. The mean lifetime cost of treatment of ND-APL using ATO was $8759.2±2078 while using APL-CT was $24393±5528. In R-APL patients, the total cost of re-induction and consolidation was $3498±1220 and $2274±372 respectively. The mean cost of an autologous-SCT was $4318±159. The average lifetime cost of treatment of relapsed APL patients using ATO based regimen followed by an autologous SCT was $12269.7±4915. The weighted cost per living for ATO and CT was estimated to be $12426 and $28330 respectively. The incremental cost effectiveness ratio showed ATO to be cheaper by $13359 for each life saved compared to conventional chemotherapy.ATO based regimen in ND-APL and R-APL are associated with significant reduction in resource utilization and costs of treatment and is also cost-effective as compared to conventional ATRA+chemotherapy. With the world still debating the best treatment for APL, generic ATO based regimen offers a significant opportunity for resource constrained countries to treat all patients with a diagnosis of APL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The economic impact of infection requiring hospitalization on venous leg ulcers

ObjectiveTo determine the impact of infection (INF) on medical resource utilization (MRU) and cost of care in patients with venous leg ulcers (VLU). MethodsWe performed a retrospective case-control study of 78 patients followed for a minimum of 12 months with C6 VLUs treated by vascular surgeons, at our wound center. To eliminate minor episodes of INF or incorrectly diagnosed episodes, only patients who had an inpatient admission specifically for INF comprised the INF group, whereas all other admissions were excluded for this group. MRU was defined as the number of clinic visits, Visiting Nurse Association (VNA) visits, and inpatient admissions. The actual cost for treatment was determined using financial data provided by both the hospital and physician organization billing units. The total cost over the 1-year follow-up period comprised individual cost centers: inpatient and outpatient facility fees, physician fees, and visiting nurse services. Mean MRU and cost data were compared using the two-sample t-test between INF and NON-INF. ResultsOf the 78 patients with C6 VLU, 9 (11.5%) had at least one inpatient admission for INF related to their VLU in the 1-year treatment period, with an additional five recurrent admissions for a total of 14 admissions, whereas 69 NON-INF had three NON-INF-related admissions. There was no difference between INF and NON-INF for usual risk factors, but INF had a greater proportion of congestive heart failure (44%; 13%, P < .02). Regarding MRU, both the number of outpatient wound center visits (INF 16.89 ± 6.41; NON-INF 9.46 ± 7.7, P = .008) and VNA blocks (INF 3.89 ± 2.93; NON-INF 1.94 ± 2.24, P < .02) were greater for INF. Total costs for INF ($27,408 ± $10,859) were threefold higher than those for NON-INF ($11,088 ± $9343, P < .0001) and subsequent VNA costs were doubled for INF ($9956 ± $4657) vs NON-INF ($4657 ± $5486, P = .01). ConclusionsINFs in patients with VLU led to an overall increase in MRU and cost of care, with the INF cohort requiring more inpatient admissions, outpatient visits, and VNA services than NON-INF. Given the major impact INF has on cost and MRU, better treatment modalities that prevent INF as well as identifying risk factors for INF in patients with VLU are needed.

TRANSFORMATION OF THE ORGANIZATIONAL AND ECONOMIC MECHANISM IN THE PROCESS OF FORMING A CONTROLLING SYSTEM

The article discusses various approaches to the interpretation of the concept of “organizational and economic mechanism”, and also formed the author’s presentation of this concept. The authors provide the composition of the main elements of the organizational and economic mechanism with a brief description of each of them. Demonstrated the relationship between controlling and the organizational and economic mechanism. The main possibilities and effects that are achieved with the formed controlling system are highlighted. In the controlling system, tasks are identified that can be solved by the organizational and economic mechanism. As part of the transformation of the organizational and economic mechanism in the formation of the controlling system, the authors, in accordance with the goals of detailing and specifying the costs and revenues of the organization, supplemented the composition of the elements of the organizational and economic mechanism with “zones of responsibility”. The authors formulated the definition of areas of responsibility, an example is given for cost centers, and also clearly demonstrated the place of areas of responsibility in the management structure of an organization.

Development of a balanced scorecard as a strategic performance measurement system for clinical radiology as a cost center

ObjectivesTo develop a goal-oriented indicator system based on the balanced scorecard (BSC) concept, which takes into account the perspectives of the referring physician and patient and emphasizes the focus on the internal processes of the radiology department.MethodsDevelopment of a BSC occurred in six steps: (Step 1) strengths/weaknesses and opportunities/risks (SWOT-) analysis of the radiology department, (Step 2) setting-specific objectives (model, core values, key objective) followed by the development of 4 perspectives, (Step 3) and definition of strategic issues oriented to the value-added chain of the processes of the radiology department. (Step 4) Creation of a “Strategy Map” with regard to the perspective and their cause–effect relationships. (Step 5) Development of an automated key performance indicator (KPI) cockpit for the monitoring, reporting, and management scorecard.ResultsA total of 10 success factors were identified using SWOT analysis. The core values include high quality in clinical, teaching, and research areas. The radiological value-added chain is composed of three processing steps. 1. registration, 2. examination, and 3. reading/X-ray demonstration. Three action programs were derived: 1. increase competency (e.g., specialist standard), 2. improve referring physician/patient satisfaction, 3. increase productivity. Daily process monitoring was added to the management cockpit as a monitoring scorecard. The scorecard comprises 18 KPIs and is automatically updated every month. The annual management scorecard comprises 10 KPIs.ConclusionsThe BSC makes it possible to implement a strategy for radiology that is strongly oriented toward the requirements of the referring physicians and the demands of patients.

How to survive in an era of lower office space demand , higher supply and shorter leases

The COVID-19 epidemic has brought with it dramatic changes in the commercial real estate industry. Many corporates decided to transit into hybrid working, allowing their staff to work remotely at least part of the week, which is likely to lead to lower demand for office space even in the mid and long term. This situation is exacerbated for office building landlords by the explosion in subleasing activity and is even tougher for retail space landlords, leading to a parallel increase in supply of office space. Adding to that the growing demand for higher flexibility from tenants and likely decrease in length of an average office lease, we see a perfect storm requiring office building landlords to take serious actions to remain relevant and succeed in the new market reality. Improving the safety of their buildings and perception of safety via better direct communication with building’s end users, providing more robust services and utilising technology to streamline operations and to enable more flexibility will be vital to landlords’ and asset managers’ success in the coming years. The likely increase in vacancy rates will not hit all office buildings equally; there will be winners and losers in the new reality. This situation can also become a catalyst for the whole industry to move from being a cost centre and become a value provider for tenants, enabling them to drive talent attraction and retention while keeping their workforce safe and informed.

MO571PRACTICE PATTERNS ON THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM IN THE UNITED STATES: RESULTS FROM A MODIFIED DELPHI PANEL

Abstract Background and Aims The 2017 Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) guidelines inform clinical practice for the management of secondary hyperparathyroidism (SHPT) internationally; however, many recommendations lacked high or moderate clinical evidence as defined by KDIGO. An expert panel was convened to establish clinical consensus for the current management of SHPT in the United States (US). Method The panel comprised 10 US healthcare providers (HCPs; [6 nephrologists, 1 surgeon, 1 nurse practitioner, 1 pharmacist, 1 dietician]) and 1 patient. HCP panelists participated in a modified Delphi process over 3 phases, addressing 126 questions based on a review of the literature and published guidelines. The threshold for consensus was 66%. In phases 1 and 2, panelists anonymously completed electronic surveys considering a ‘typical’ patient with SHPT unless otherwise specified. In phase 1, panelists answered 126 questions based on their own knowledge and experiences. In phase 2, panelists were reminded of their answers to closed-ended questions that did not achieve consensus in phase 1 and were asked if they would change their responses in light of the most common response. For open-ended questions, they were asked if they agreed with summary statements that captured the most common answers. Phase 3 was an unblinded virtual meeting where panelists reviewed the consensus reached in phases 1 and 2, and through active discussion, resolved those questions that had not reached consensus. The patient completed a separate electronic survey, which complemented key points in the HCP survey, and provided perspective during the virtual meeting. Results All 11 panelists completed the entire modified Delphi process. Sixty-three out of 126 (50%) and 116/126 (92.1%) questions reached consensus or addressed practice-specific information not requiring consensus by the end of phase 1 and 2, respectively; all questions reached consensus by the end of phase 3, including modification of 2 questions and the addition of 1 question. The panel unanimously agreed that SHPT treatment is often started too late and suggested additional markers for early identification of patients requiring treatment are needed. Serum levels of calcium, phosphate, and parathyroid hormone (PTH) should be monitored starting at CKD stage G3a at intervals of every 6 months, 3–6 months for CKD G3b, and at least every 3 months at CKD G4 and above. Thresholds for interventions could not be defined in absolute terms for all patients due to patient-and practice-specific factors. However, in patients on dialysis, serum levels of phosphate &amp;gt; 5.5 mg/dL (1.8 mmol/L) and calcium &amp;gt; 9.5 mg/dL (2.4 mmol/L), warrant increased monitoring and consideration of therapeutic interventions. Serum intact PTH &amp;gt; 300 pg/mL (32 pmol/L) typically indicates a need for SHPT treatment, with a consensus preferred target of 150–300 pg/mL (16–32 pmol/L); patients on dialysis were considered out of PTH target at ≥ 8 times the upper limit of normal (&amp;gt; 520 pg/mL [55 pmol/L] intact PTH). HCPs were concerned about vascular calcification in all patients with CKD 3a–G5D. The panel reached consensus on the use of several SHPT interventions, including a consensus preference for the intravenous calcimimetic etelcalcetide over the oral calcimimetic cinacalcet in appropriate in-center dialysis patients requiring PTH-lowering therapy; cinacalcet was agreed to be first-line therapy in appropriate patients on home dialysis (Table 1). Factors such as formularies and dialysis center protocols were recognized to influence therapeutic choices. Conclusion Ten US HCPs reached consensus on many aspects of SHPT management, further defining therapeutic strategies and highlighting the need to be proactive. While the panel expressed evidenced-based preferences for certain therapies, factors such as cost and dialysis center protocols may affect decision making.

Establishing a health economics and value unit at the Children’s Cancer Hospital–Egypt: Introducing a practical approach for evidence-based decision making.

e18859 Background: Health Economics is a multi-disciplinary practice that recently gained recognition in healthcare management systems. Value-based healthcare (VBHC) focuses on improving patient outcomes while using fewer healthcare resources. Integrating the principles of health economics and VBHC are essential to better inform decision-making based on evidence, especially in resource-limited settings, that need ultimate efficiency in managing resources. Egypt has the highest second estimated number of incident childhood cancer cases in the Eastern Mediterranean Region (EMR), based on GLOBOCAN 2020. Thus, childhood cancer in Egypt is an urging priority due to the large number of patients, limited resources, and poor outcomes. There is a need to optimize resource use and promote value in care delivery for childhood cancer care in Egypt, based on real-world evidence. Methods: This work aims to highlight the role of establishing a health economics and value (HEV) unit at the Children’s Cancer Hospital 57357 –Egypt (CCHE), to improve care and outcomes for children with cancer efficiently. CCHE is a not-for profit pediatric oncology center, treating around 50–60% of childhood cancers across Egypt free of charge. Results: The HEV unit was established in 2017 as a sub-function of the upper management at the hospital. The core mission of the unit is to translate health economics and VBHC concepts into practice to promote evidence-based decision-making, through applying the following functions and activities: monitoring trends in childhood cancer survival, resource use, and costs; applying health economic evaluation tools such as cost-effectiveness analysis (CEA) and multi-criteria decision analysis (MCDA); applying time-driven activity based costing (TDABC); implementing VBHC on a disease- and a hospital-level; monitoring costs and benchmarking. Some of these functions/activities reflect on operational processes such as integrating the CEA tools within the hospital procedures to maximize value of money spent; and restructuring hospital-wide cost centers for accurate costs reporting. Capacity building is also an important pillar in the unit’s framework, where the unit team conducts internal and external training sessions and workshops to spread the knowledge about health economics, VBHC, and evidence-based healthcare. Conclusions: The HEV unit at CCHE presents a unique model of applying health economics and value-based healthcare at a micro level in a pediatric oncology center in Egypt. This is a novel approach for healthcare management in Egypt and making informed decisions based on real-world evidence.

An Income Model Using Historical Data, Power-Law Distributions and Monte Carlo Method for University Technology Transfer Offices

Engineering education pushes the creation of new technology to solve community problems. The process of technology transfer promotes educational innovation in universities, a vital process that can improve citizens’ quality of life in cities and rural communities. As a result, university technology transfer offices (TTOs) have to create strategies that motivate students and researchers to generate technology. Thus, a primary challenge that TTOs face is to know and communicate the income potential compared to their much more predictable and limited expense budgets. Institutional budgeting for a TTO’s growth would be simplified if the office were on a solid financial footing, i.e., breaking even or making a financial return. Many offices assume that income is unpredictable, that it is a lottery, luck, and more stakes in the fire improve the odds of hitting a winner, etc. These common assumptions or beliefs provide only a vague insight into how to move an intellectual property (IP) portfolio strategy forward. How can a TTO be assessed for quantitative value and not just be a cost center adding qualitative value? This paper illustrates the first steps to understanding how to project potential income versus a much more predictable expense budget, which would allow universities to improve their technology transfer strategy and results. As a result, TTOs would operate under a more sustainable IP portfolio strategy, promote educational innovation in universities, and generate a more significant community impact.

Hospitalization Expenditure of COVID-19 Patients at the University of the Philippines-Philippine General Hospital (UP-PGH) with PhilHealth Coverage

Objective. This research aimed to determine the in-patient expenditure of COVID-19 adult patient s and their out-of-pocket (OOP) payments at the University of the Philippines-Philippine General Hospital (UP-PGH) after the new PhilHealth case rate coverage was instituted last 15 April 2020. It also intended to present the preliminary data on the expenses incurred by COVID patients during the initial phase of the pandemic in the country.&#x0D; Methods. This study was a retrospective chart review of admitted COVID-19 patients aged 19 years old and above from 15 April to 14 August 2020 at UP-PGH that availed of PhilHealth COVID-19 case rate benefits package (C19C1-C4). Data were analyzed to extract overall expenses, out-of-pocket (OOP) charges, cost centers utilization, and other hospitalization expenditure sources.&#x0D; Results. Of the 691 COVID-19 patients included during the study period, 55.72% were male, mostly belonging to the 61-70 age range with a median age of 58. The average in-hospital stay was 14.20 days, and 76.99% were under charity services, with the moderate (42.84%) and mild (25.33%) pneumonia cases accounting for 68.17% of the admissions. Total hospital expenses clustered around Php51,000 to 200,000 (~USD 1,041 to 4,156), most spending between Php101,000 to 150,000 (~USD 2,078 to 3,118). The top three cost centers and expenditure sources were pharmacies, personal protective equipment (PPE) usage, and laboratory. The average OOP payment for patients less than 60 years old was higher, ranging from Php 25,899 to Php 44,428.63 (USD 538 to USD 924.44) compared to patients older than 60 (Php4,005.60 to Php 32,920.20 ~ USD 83.35 to 684.98). The most OOP charges were for the age group 19-30, amounting to Php 44,428.63 (USD 924.44).&#x0D; Conclusion. Preliminary findings of this study gave an actual representation of the expenses of COVID-19 patients, which can guide future utilization of the national health insurance during unexpected pandemics. Early price regulation of new therapeutic interventions, diagnostic tests, and medical supplies, e.g., PPEs, disinfectants, air filters, are measures that can be implemented.

Impact of environmentally friendly technologies on costs and cost-effectiveness of a dairy cattle confinement system

Our goal was to assess the economic impact of some environmentally friendly technologies on the production costs and cost-effectiveness of a dairy cattle confinement system, estimating environmental costs and their representativeness in both effective and total operating costs, as well as in the total cost. We assessed the cost-effectiveness of the cost center of milk production and identified the components that most affect final costs, estimating a break-even point (kg milk year-1) as well. The data were collected in a freestall full-confinement system of a dairy cattle farm located in southern Minas Gerais State (Brazil), from January 2016 to December 2017. The cost of milk production was estimated using a method based on the operating and total costs from a cost center involving lactating and dry dairy cows. The cost center of milk production showed to be economically feasible, showing positive gross and net margin results, as well as positive profitability and cost-effectiveness. Total environmental operating cost was on average R$ 0.015 per kg milk, which represented 1.985% of the total operating cost. Effective environmental operating cost was on average R$ 0.0059, which corresponded to 0.7788% of the total operating cost. Finally, total environmental cost was on average R$ 0.0317, representing 3.3280% of the total cost. The most representative items of the effective operating cost were in descending order: animal feed, workforce, animal health, animal production hormone (bovine somatotropin; bST), vehicle maintenance, machines and equipment, maintenance of improvements, electricity, and freestall bedding sand. Average break-even point was 1,104,038.54 kg milk year-1 or 3,024.76 kg milk day-1, while average production was 4,271,383.00 kg milk year-1 and 11,702.42 kg milk day-1.

IMPLEMENTATION HUMAN RESOURCE MANAGEMENT IN IMPROVING COMPETITIVE ADVANTAGE of PT CSI

This researchXaims to analyzeXthe implementation of the integration process of the company's strategic plan and HRD strategic plan in increasing competitive advantage in PT CSI. The research dataXis collectedXfrom in-depth interviews and secondary data as well as primary data from HRD in 2019. Qualitative research methods with approaches case studies are used in this study. The results of the study found that the implementation of Human Resource Management has not been oriented towards comprehensive investment. It is proven that HRD is still considered a cost center, even though there has been an integration and adaptation of the entire process of increasing competitive advantage. HRD companies have been involved in the planning process. The day-to-day practice of Human Resource Management does not appear to fully describe the integration with the needs of organizational strategy. The results also show that at the practical level HRD has a two-way relationship with policy makers, meaning that the problems and impacts that arise in HR management are considered in the strategic plan formulation process.

Staff Family Day in the Pediatric Intensive Care Unit

Staff Family Day in the Pediatric Intensive Care Unit

The Cost of Hip and Knee Revision Arthroplasty by Diagnosis-Related Groups: Comparing Time-Driven Activity-Based Costing and Traditional Accounting

BackgroundTraditional hospital cost accounting (TA) has innate disadvantages that limit the ability to meaningfully measure care pathways and quality improvement. Time-driven activity-based costing (TDABC) allows a meticulous account of costs in primary total joint arthroplasty (TJA). However, differences between TA and TDABC have not been examined in revision hip and knee TJA (rTJA). We aimed to compare total costs of rTJA by the diagnosis-related group (DRG), measured by TDABC vs TA. MethodsOverall costs were calculated for rTJA care cycles by DRG for 2 years of financial data (2018-2019) at our single-specialty orthopedic institution using TA and TDABC. Costs derived from TDABC, based on time and resources used, were compared with costs derived from TA based on historical costs. Proportions of implant and nonimplant costs were measured to total TA costs. ResultsSeven hundred ninety-three rTJAs were included in this study, with TA methodology resulting in higher cost estimates. The total cost per DRG 468, rTJA with no comorbidities or complications (CC), DRG 467, rTJA with CC, and DRG 466, rTJA with major CC, estimated by TDABC was 69%, 67%, and 49% of the estimation by TA, respectively. Implant and nonimplant costs represented different proportions between methodologies. ConclusionConsiderable differences exist, as TA estimations were 31%-51% higher than TDABC. The true cost is likely a value between the estimations, but TDABC presents granular and patient-specific cost data. TDABC for rTJA provides valuable bottom-up information on cost centers in the care pathway and, with targeted interventions, may lead to a more optimal delivery of value-based health care.

How Much Should We Pay to Deliver Comprehensive Mental and Social Health Services? Experiences from Iran.

Objective: Comprehensive mental and social health services is the new benefit package which had been aimed to provide mental health services to people who suffer from mental disorders. The aim of this study was to estimate the cost of plan and its drivers to provide evidence for decision-making by national policymakers. Method : We used the bottom-up costing approach to estimate the cost of plan. We identified the cost centers, services delivery process, and facilities. Data were collected via different sources and tools such as the new financial system, registration forms, and performance reporting forms. We categorized the cost into 4 groups and selected appropriate measures to estimate the cost. We estimate the total and unit cost for 3 levels in 2 scenarios by considering the 2017 prices. Results: Screening resulted in 8.9% new detection with a different incidence in urban and rural areas (urban: 16.5%; rural: 2.7%). Also, 61 842 million IRR was spent for the screening, diagnose, treatment, and rehabilitation of detected people in 2017. Personal cost is responsible for 90.6% and primary screening for 66.4% of the total cost. Conclusion: For the development of the program (from screening to rehabilitation) 530 513 IRR should be spent per capita. The cost of detection per client can vary due to differences in disease prevalence, especially treatment and rehabilitation costs. It is suggested to consider the variation of the prevalence in expanding the plan to the whole country. Integrating the services in primary health care lead to huge cost saving.

Учет затрат в производстве товарного выпуска

Th is article discusses the organization, accounting and cost management of a manufacturing enterprise. To do this, the relationship between accounting accounts and cost centers, items and elements is shown. Particular attention is paid to the compilation of the consolidated calculation and the consolidated budget, as well as the construction of the balance of commodity output.

Costing total hip arthroplasty in a South African state tertiary hospital

Background. Most South Africans depend on the public sector for health services. There is an increasing demand for arthroplasty in the public sector, but a paucity of academic data regarding its cost. Objectives. To: ( i ) identify the factors that determine the cost of an uncomplicated primary hip arthroplasty; and ( ii ) make recommendations on cost optimisation. Methods. This was a cross-sectional study. Patients who met the inclusion criteria had their hospital financial records reviewed from October 2015 to March 2017. Six cost centres were utilised: inpatient admission, theatre and anaesthesia, ambulatory, prosthesis, physiotherapy and blood bank. The data were statistically analysed. Results. Fifty-five patients met the study inclusion criteria. Data were stratified into categories. Analysis of variance (ANOVA) was used to test the data, and significant differences were found in the prosthesis, inpatient admission and ambulatory cost centres at a 95% significance level. The least significant difference was used to test the ANOVA results that paired significant categories. No cost centre showed significance over the other categories. Data for the six cost centres were compared with the current literature and industry best practice. Eight recommendations are made. Conclusions. The study showed that clinicians need to be aware of procedural costing in the current financial climate. There are still opportunities to optimise cost containment in the state sector.

Assessing the Maturity of Corporate Social Responsibility Practices: An Applied Study on Telecom Companies in KSA

Corporation social responsibility (CSR) practices are, nowadays, inescapable and more needed than ever considering the growing environmental institutional requirements as well as performance indicators that are increasingly including CSR issues to evaluate companies. CSR should not be considered as cost center, it is a vital source of company value and reputation. Actually, companies operating in KSA are not an exception of this CSR matter. This paper aims mainly to evaluate and analyze the maturity of CSR practices through an empirical study for Telecom companies in KSA, namely STC, Zain and Mobily. From a deepen literature review, four main CSR practices have been identified, namely: economic, ethical, legal and philanthropic practices. A questionnaire has been developed to test and validate research hypothesis. The results show a high level of CSR practices, except for the philanthropic practices.

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania.

Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals. Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components. The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants. Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.