Hospital costs allow a dynamic integration between the healthcare and administrative part, the decisions that can be made after the results obtained are far-reaching and have to do with the efficiency in the expense of supplies, improvement in the quality and provision of the service, ability to negotiate with the entities with which you contract, in short the benefits are many for proper decision-making. Hospital costs must have essential characteristics so that they are actually useful and show different aggregate values to the financial results, such as: Integrality Opportunity DynamismWith hospital costs, you must have a total organization that allows you to see the institution as a true system where all the parts interrelate with each other so that quality results are obtained, which must be the feedback for continuous improvement. The Assistance, Administrative and Logistics areas must work with the strictly necessary personnel and the minimum of supplies so that quality does not detract from the good service that the institution must provide.
Costs represent for managers of health institutions a managerial tool when making important decisions, but the great drawback is that hospitals and / or clinics are called public or private, is not having an adequate cost structure, or the information is not updated as time goes by, therefore mistakes are made when delivering results, the costs managed appropriately constitute confidence building to make decisions.
To get the best results you need collaboration and some other ingredients that must be taken into account such as.
1. Administrative and Management Support.
2. Search the profile of a leader
3. The cost system needs to be dynamic
4. The entity is required to interact as a true system
5. Health indicators
Administrative and managerial support
If you do not have a support from Management, it is recommended not to start working, as this work would be a waste of time, you should also think and look to the future and ask this question. Essentially who or who are the people who need cost information? The answer is obvious. Costs are a management tool and managers need information at any given time.
One problem that is evident in almost all health institutions in the administrative part is that managers do not know what to do with the information presented to them at the financial level called Costs, Accounting or Budget, hinting that there is a lack of training in the financial issue, for this reason it is possible that many times more thought is given to healthcare (essential for the fulfillment of the objective of the health institution), and not financially, it should be noted that the two should be considered as a marriage and should Having the knowledge of both to manage in an effective way, the financial information is often taken only for the fulfillment of the requested requirements and many times it is signed by the managers without being certain of the content of the same,This practice is quite dangerous, especially in the public sector, knowing the implications that signing without analyzing can bring. (Law 734 of 2002), it is convenient to have certainty and comprehensiveness of administrative, financial and healthcare knowledge.
Seek the profile of a leader to carry out the proposed objectives with the development and implementation of the cost system that involves the entire hospital community:
It should be noted that the costs are not only carried out by a single person, the leader, this character is the facilitator to obtain all the information, capture it, develop it, obtain results, analyze it and present it to the directors of the institution.
When setting up the cost system, you should always be in the mood to get ahead in the project, because in addition, in the course of time and its implementation, there are infinite difficulties that must be overcome to move forward. In this process, one of the greatest difficulties is adversity with coworkers, especially due to the resistance they present to changes, and in this process, changes always occur and additionally, all areas are asked for a lot of information to concatenate everything related to the cost system.
It should also be understood that nobody has the last word on costs and that every day in our daily work we are collecting information that will serve to comply with and develop health costs, one of the reasons to be aware of possible changes day by day. it is the frequency or dynamics of our regulations.
According to what has been noted, it is important that the cost system is flexible and dynamic, adapting to the changes that occur both internally and externally, therefore, and preferably, the leader must be proactive in the face of daily challenges.
The cost system needs to be dynamic
This is to imply that to the extent that management decisions, or emerging standards, affect the provision of services, the cost leader must be willing to make the necessary changes in the system to adjust it to the decision made or adjustment to the issued standard, for example: When a new service is opened, when a service is closed, when payroll or contracted personnel are increased or decreased.
The entity is required to interact as a true system
System definition: A system is a set of organized and related parts or elements that interact with each other to achieve a goal. Systems receive (input) data, energy or matter from the environment and provide (output) information, energy or matter.
It is necessary that communication flow effectively and that information needs are adjusted for a good feeding of the cost system, additionally it serves as a complement to the needs of the Institution's Quality Assurance System in Health Services and It must work together with the indicators of management, productivity, hospitalization, morbidity, mortality, etc.
Health indicators
It is essential that the indicators are worked in a coherent and inherent way to the information that the cost office must produce, this generates that the information is analyzed and countersigned for decision making at important moments of the entity.
The update, monitoring and control of the indicators must have an orientation towards the analysis and use of the information, this will allow the modification or elimination of activities that guarantee the improvement of the quality of the health services, aimed at complying with the norms and standards defined for the empowerment.
Steps to follow to structure costs
Before starting the work, the concepts must be clear and the methodology to be used for the implementation of the cost system must be known. The information to be considered includes:
• Cost manual
• Concept of indicators
• Formation of the cost committee
• Justification of costs for the entity
• Realization of the internal project of the costs
• Carrying out a work schedule or program
• Field work (functional units and cost centers)
Cost manual
It should be borne in mind that the cost manual must have a specific design for obtaining health costs, this manual must contain at least the basic cost concepts, the description of the methodology to be followed, and finally and after collection. From the information the cost calculation is carried out, the latter concept must involve the values of labor, supplies and general expenses, all of them involved in production.
To achieve the results it is convenient that the costs are clear (easy to understand), simple and real, it is convenient to note that for the realization of the costs they must or require the participation of all, since there must be a constant interrelation between the administrative, the assistance and logistics part of the institution.
Indicators concept
When talking about the concept of indicators, the concept of integrated management control must be taken into account, that is, the organizational scheme, equivalent to the set of norms, principles, plans, standards, goals and mechanisms of verification and evaluation adopted by the IPS, all this translated into a series of indicators integrated into a dashboard that must be managed by management for better decision-making. Additionally, all the indicators compared to the cost results make up a tool that generates what we could call the power of information, since these well-managed results are the instrument for decision-making.
Hospital indicators are mandatory and for this you can consult the page of the Ministry of Health and the regulations that contain them.
Formation of the Cost Committee
With the cost system it is expected to give a participation to each and every one of the hospital's dependencies, where a close link between the administrative and financial dependencies with the areas in charge of the provision of health services must operate, which is why it is The creation of the Cost Committee, in which people from the administrative, assistance and logistics areas participate, is an opportunity that cannot be ruled out and that is in pursuit of the goals that are to be achieved for the implementation of costs.
Cost Justification for IPS
The reasons for the implementation of a cost information system can include the following:
• Requirement of Law 100 of 1993
• The Financial Statements must contain the ordered and uniform information of the income, costs and expenses of each institution that provides health services, which must be presented to the General Accounting Office of the Nation, the National Superintendence of Health and the Ministry of Health..
• The information generated as a result of the cost system is a fundamental tool for decision making.
Carrying out the internal project of cost implementation
The realization of this project will justify the implementation, with a factor that is very decisive and that is that as the "project" report is presented, it will be observed that if the entity is judicious, economically it will not represent a great value, in Regarding the locative part and the tools that will be used for the implementation, what should be considered is that the information in fieldwork, data collection, typed of the ordered and logical information, constant updating of the system, are tasks that in fact, they need quite a bit of time and additionally, a knowledgeable, enthusiastic person with all the support of the directives is needed to carry out what is intended in this case is the implementation of the cost system.
Carrying out a work schedule or program
The work schedule must be carried out in a matrix that determines the following variables.
• Exercise
• Description
• Product
• Mechanism
• Responsable
As an example.
By functional unit is understood, the set of specific production processes, the procedures and activities that compose it, which are executed within a technically defined sequence and limits, where it is possible to visualize, analyze and intervene in the overall sale process. or production of the service.
In the income of the institution providing the health service, they represent the values received or caused, as a result of the activities carried out in fulfillment of its administrative function or state mission, through the provision of health and related services, therefore they are classified into functional units.
The functional units are made up of the cost centers, these are one location in each functional unit, in such a way that there will be as many locations as there are cost centers, therefore there cannot be equal locations in different functional units. On this basis, the identification of cost centers will be made up of the code that identifies it according to the needs of the institutions.
The functional units are established according to the organization of each entity and the services they provide, among others we can mention the following:
Functional Emergency Unit
External Consultation Functional Unit
Hospitalization and Hospitalization Functional Unit
Operating Unit and Delivery Room
Diagnostic Support Functional Unit
Therapeutic Support Functional Unit
Marketing Functional Unit (Pharmacy)
Other Health Services
It should be noted that this is only an example, the organization can be established according to the criteria of the person in charge of costs or their criteria and approval in the Cost Committee.
