This research work focuses on the Proposal of an ABC / ABM procedure at the “Mario Muñoz” Military Hospital, based on a study of variables. The proposed system aims to facilitate decision-making by the organization's managers, since the current cost system lacks information to efficiently manage the services demanded by the client.
A broad search for criteria from different authors was carried out on the evolution of Management Accounting, analyzing its main contributions and demonstrating the advantages of ABC / ABM over Traditional Costs.
As a result of the research, important conclusions are reached that contribute to improving the way of managing the resources and activities that are consumed and executed in the processes under study. They also allow these variables to be considered in order to guide the researcher towards where he should go before proposing a procedure for the implementation of a Cost and Management System based on Activities for any Cuban company.
Public health in the country is the right of the people, as are the services provided by the hospital sector, which currently have a more prepared and qualified medical and paramedical staff, the result of constant improvement. In this way, technical scientific advances are made available to the people for the treatment of various diseases. This sector works to achieve excellence in the work they provide and thus increase the quality of life of patients. The evaluation of efficiency in the field of health harbors the conviction of maintaining quality as an inalienable characteristic of the health system in Cuba.
At present, the economic, political and social situation facing the country has not paralyzed the health services provided to the population, since they have increased not only nationally but in a cooperative manner with other countries on different continents. In this last decade of the Revolution, Latin American integration related mainly to the health sector stands out.
This development of medicine leads to improving the insufficiencies in the system, registration and cost control, so the research problem lies in how to improve the insufficiencies in the system, registry and cost control in the Military Hospital " Mario Muñoz ”?
Starting from the Scientific Problem, the following hypotheses are raised:
If an ABC / ABM procedure is proposed, based on a study of variables, then it will be possible to improve the insufficiencies in the system, registration and control of costs at the “Mario Muñoz” Military Hospital.
The General Objective of this work to comply with the proposed Hypothesis is:
Propose an ABC / ABM procedure, based on a study of variables at the “Mario Muñoz” Military Hospital.
From the General Objective, the following Specific Objectives are derived:
- Present the theoretical foundations of the research. Determine the variables that influence the implementation of the ABC / ABM System in the “Mario Muñoz” Military Hospital. Implement the ABC / ABM procedure proposed in the processes under study.
To respond to the objectives set, the research is structured as follows:
- Historical evolution of Management Accounting. Evolution of Management Accounting in Cuba. Doctrinal foundations of ABC / ABM. Characteristics of the Military Hospital "Mario Muñoz Monroy". Proposal and implementation of the ABC / ABM procedure in the Military Hospital "Mario Muñoz Monroy ”.
Background of Management Accounting.
From ancient times, dating from 4500 years before our era (BC), accounting documents are reported in ancient Mesopotamia, which had determinations of wage costs and some of them indicated the existence of merchandise inventories.
In the Middle Ages the union organization was reached as the socioeconomic basis of production, but only with the development of the Industrial Revolution did the improvement of cost systems begin, which is attributed to the technological advance of the time, This led to an increase in production capacity as the principle of specialization of large-scale work was applied, leading to a notable decrease in the unit cost of products.
Although it should be noted, it could not be said that it was already a finished or improved Cost Accounting, since the three elements of cost were not specifically defined.
At that time, only direct materials and direct labor were considered, not addressing in this way the problem of analyzing indirect manufacturing costs. Furthermore, the information provided by these very traditional systems was not used to make competitive or market decisions.
In the 19th century and in the 40s of the 20th century, a higher stage of Industrial Capitalism developed with a greater technological and business boom, and it is where indirect costs begin to be taken into account as the most developed aspect of Cost Accounting. Later in the 1950s, when the costs of establishing responsibility centers were incorporated, Cost Accounting became the center of Management Accounting, considering that the information was more accurate and contributed to decision-making.
As of this last date (1950), the need to articulate a Management Accounting suitable for decision-making became one of the main centers of attention for many researchers and professionals. As a result of this new research trend, in the course of the next twenty years, a series of works appeared that began to shape the meaning of Management Accounting.
The current development of technology has led to the acceleration of Management Accounting, not only from the theoretical point of view, but from the perspective of the adoption and implementation of systems with a philosophy of activities, and with a management approach.
Management Accounting, the main information system of the organization, has to capture, record, process and transmit all the information, internal and external, to address the decision-making process that occurs in the company, informing about all the variables the environment and the organization itself that may have a significant influence on business performance, the process being known as the "set of activities carried out for a specific purpose, pursuing a global object and which can lead to a material or immaterial output".
Thus, it can be stated that Management Accounting is subjecting the internal production and control systems to a deep renovation and, consequently, the management systems of companies, in which the idea that minimization is being abandoned of costs constitutes the axis of competitiveness.
Already in the sixties and seventies, some companies began to envision the first changes from a Traditional Accounting to a Management Accounting.
Evolution of Management Accounting in Cuba.
On the threshold of the third millennium, Cuba is in the process of perfecting its accounting regulation, with the aim of providing it with greater flexibility in its design, trying to strengthen the role of accounting information as a real tool for transformation. systematic information in action by business management, simultaneously meeting the growing demands of external users.
The need for the evolution of Accounting in the country is conditioned to a great extent by the convenience of homogenization with the most widespread and applied accounting practice in today's globalized world, an essential element for economic integration, as clearly shown in the requirements of business improvement.
According to the existing economic system in Cuba, Cuban accounting regulation has a totally public nature. The standardization of Cuban Accounting is based on legal provisions issued by various State bodies and its Central Administration, as well as other State entities that have been issued by other State entities through Laws, Decree-Laws, Decrees and other provisions of the National Assembly of People's Power (Cuban Parliament), the Council of State and the Council of Ministers; Resolutions and Instructions of the Ministry of Finance and Prices, the governing body of Accounting in the country, resolutions and instructions of the Branch Ministries for compliance with the companies and subordinate or sponsored agencies; complementary provisions of the Cuban Banking; among others.
It should be noted that accounting regulation is supported, both in its own conception and in its implementation and systematic development, in the country's academic and scientific organizations in the professional sphere of Accounting, where Universities play an active and leading role, becoming the driving force behind investigations in the different branches of Accounting within the country.
The accounting practice has a rich history that began at the end of the 19th century, consolidating in 1927 with the beginning of Higher Studies in Accounting at the historic University of Havana and during the Pseudo-Republic it managed to reach its greatest splendor in the decade of the 1950s, coinciding with the emergence of Management Accounting.
In the period prior to 1959, Cuban accounting standardization was highly influenced by North American accounting practice, which is extended to universities, where both in terms of Financial Accounting, as well as Cost and Management Accounting, bibliographies of Cuban and North American authors; which is still present in university classrooms, with the difference that these authors are currently combined with a wide range of books and articles from various corners of the world.
Starting in 1959, the changes that occurred in national life weakened North American influence, and in the 1960s, due to the primacy of conceptions later recognized as erroneous, the monetary-mercantile relations between companies disappeared and accounting virtually with them., which is limited to economic control.
Cuban accounting practice was reborn in 1975, but now it is very affected by the accounting conceptions that prevailed in the former socialist countries of Eastern Europe, as Cuba was one of the member countries of the Council for Mutual Economic Assistance (CAME). From that moment on, successive changes began in Cuban Accounting, which can be framed in three successive stages of improvement:
1st stage (1977-1986): Establishment of an Accounting system implemented by means of a document containing the economic content of the accounts to be used and the aspects for which it was debited and credited; Information System; Rules and procedures; and illustrative examples.
2nd stage (1987-1992): Transformations occur aimed at simplifying the National Accounting System (SNC), accounts and subaccounts are abolished, functions are decentralized and models and annexes of the Information System are rationalized.
3rd stage (1993-current): Great flexibility of Cuban accounting practice, communication with foreign partners by adopting terminology homologous with international accounting practice, the process of Business Improvement begins in which the various branches of Accounting play an important role.
It can be said that the Cuban General Accounting Model does not yet represent a result, but rather a process of evolution in full swing.
Need for the Emergence of the Activity-Based Cost and Management System (ABC / ABM)
The use of an Activity Costs System acquired special relevance in a controversial and dynamic environment such as the final stage of the 20th century, given the conditions in which business managers needed information that would allow them to make decisions regarding the combination and design of products, as well as in technological processes, elements linked to the profitability of the organization on a global scale.
The analysis of cost management starts in principle from the processes that occur in the company, since these are derived in various activities that guarantee the product / service that the client demands.
Doctrinal Foundations of ABC / ABM
The ABC / ABM System arises with the purpose of improving the management and calculation of the cost of any cost objective (Cooper and Kaplan, 1988), in order to facilitate relevant and timely information in decision-making. In this sense, the origin of the management and the incurrence of these appear first in the execution of the activities that are carried out to obtain a good or service.
The ABC / ABM bases its philosophy on the fact that activities consume resources and that products or services consume activities (Cooper and Kaplan, 1988), allowing the cost of activities to be related to any cost objective.
In the theoretical field, there are certain works that focus on criticizing the basic principles of the ABC / ABM System, but most researchers such as: Tamarit, 2002; Caldera, 2003; Castelló and Lizcano, 2003; Pérez, 2003; Bescos, 2004; Baujín and Vega, 2005; Pérez, 2007, consider that these systems are superior to traditional cost calculation and management methods, due to the contributions that the system makes to decision-making.
Among the contributions made by this system can be noted:
| Table # 2: Contributions of the ABC / ABM System. Source: self made. | ||
| YEAR | AUTHOR | INPUT |
| 1992 | Castelló | Improve cost calculation accuracy for any cost objective. |
| 1994 | Ama | Improve profitability determination of any cost objective. |
| 1998 | Serra | Avoid potential cross-subsidies between cost targets. |
| 1991 | Brimson | The outputs are superior to those obtained with conventional systems. |
| 1991 | Brimson | It allows the calculation of information on past or future costs through so-called activity-based budgets. |
| 1988 | Cooper and Kaplan | The information provided in front of decision making is more relevant than that generated by conventional cost systems. It allows to know the causes that originate the costs, the information obtained will be more understandable to evaluate the management. |
The ABC / ABM cost helps organizations obtain better information about their processes and activities by continuously improving the efficiency of operations. With this system we work on the rationalization and optimization of the development of its personnel, its capital and its other assets.
That is why Cuban companies need to adopt activity-based cost and management systems (ABC / ABM), within them a fundamental sector is the hospital sector, specifically the “Mario Muñoz” Military Hospital, in the city of Matanzas in which this research focuses on.
Characteristics of the "Mario Muñoz" Military Hospital.
The "Mario Muñoz" Clinical - Surgical - Teaching Military Hospital is one of the many health facilities in our country with the primary objective of guaranteeing preventive-curative medical care and rehabilitation to the universe of the territory, with the highest quality required.
Description of the current Cost System of the Military Hospital ”Mario Muñoz”
The cost system currently used by the hospital is considered a traditional system, associated with work orders. However, the perspective is to implement the ABC / ABM System in the future, as a management and cost system for decision making.
Each cost center provides the accounting department with a monthly list of the tasks performed in that period. This relationship, together with the expenses that appear in the income statement at the end of the month, is supplied to a software that determines the final cost of each of the centers that the hospital has.
The fundamental deficiency of this system lies precisely in the distribution or allocation of indirect costs. In addition, the accounting staff analyzes them by accounting and not by management in each cost center, which limits decision-making in the hospital from the point of view of management, quality and reduction of the cost of services.
In the same way, the use of a single distribution base to assign indirect costs distorts the information for decision making.
Due to this, an ABC / ABM procedure is proposed for the “Mario Muñoz” Military Hospital that consists of three phases and eight stages that are explained below: (See figure # 2)
Phase I: Analysis of the variables that influence the implementation of the ABC / ABM System in the “Mario Muñoz” Military Hospital
For the selection of the variables that most influence the implementation of the ABC / ABM System, the coefficient of competence for the Selection of Experts was applied (Annex # 1).
The fundamental objective of the method used is to determine the order of importance of the variables selected in the object of practical study.
One of the main problems is deciding who are the experts or connoisseurs of the subject being analyzed; that is, who to consider experts (See Annex # 2) for the investigation.
An expert is understood as both the individual himself and a group of people or organizations capable of offering conclusive assessments of a problem in question and making recommendations with a maximum of competence.
In preparing the list of experts, a study of their quality is made and their workplace is considered, as well as their real possibility of collaboration.
Together with the information provided by the surveys (Annex # 3), statistical parameters were used to characterize each variable and thus know the degree of influence of these in the implementation of the ABC / ABM System (Annex # 4). These parameters are:
- Arithmetic mean: Also, it is usually called average. It is the sum of all the data in the sample, divided by the volume of the sample. It is the "balance or center of gravity" point of the data.
- Mode: If it exists, it is the data or data, which have the highest absolute frequency. In a data set for there to be a mode, there must be at least one piece of data that is repeated a number of times greater than the others appear. Therefore, fashion may or may not exist, and if it exists it may or may not be unique.
- Median: It is the (unique) value that the center of said data occupies. Therefore, if the sample element whose value is the median is excluded, the primary data can be redistributed into two subgroups, which will be made up of equal amounts of data.
- Variation Coefficient: Indicates the degree of dispersion of the variables. If it is less than 12 there is no dispersion between them and if it is greater than 13, there is dispersion.
- Kurtosis and Skewness coefficients: They allow to know the distribution presented by the sample, so that it follows a normal behavior, they must be in the range of -2 to
For the calculation of these parameters, the statistical package Statgraphics 5.1 was used.
In addition to the above, the Kendall method was used to evaluate the criteria of the experts, which is detailed in Annex # 5.
The research will be based on the study of the psychosocial variables of the Tamarit model, (2002) as it is considered one of the most researches on the subject. Variables:
| Table # 3: Variables that influence the implementation of the ABC / ABM System. Source: own elaboration from Tamarit, (2002) | |
| Variables | |
| Related to the organization | Related to the behavior of individuals. |
| - Size of the organization.
- Potential degree of cost distortion. - Available resources. - Information sources. - Existing cost system. - Organizational structure. - Business strategy. - Corporate culture. - Support from senior management. - Training. - Participation of all members of the organization. - Clarity and consensus of the objectives of the system. - Relationship of ABC / ABM with other management systems. - Relationship of the organization with the workers. |
- Perception of ABC / ABM according to the characteristics of the individuals.
- Perception of the information provided by the ABC / ABM System. - Perception of the usefulness of the ABC / ABM System.. - Perception of the impact of ABC / ABM in the organization. - Attitude towards the system. |
The results that were obtained are:
Figure # 3: Selection of variables related to the implementation of the ABC / ABM System. Source: self made.
The 9 variables that most influence the implementation of ABC / ABM according to the experience and the criteria of the experts, are:
- a) support from senior management; b) business strategy; c) relationship of the organization with workers; d) business culture; e) attitude towards the system; f) perception of the usefulness of the system; g) relationship of ABC / ABM with other management systems; h) clarity and consensus of the objectives of the system; i) perception of the information provided by the system.
Explained Phase I, we proceed to explain the next phase of the procedure.
Phase II: Management of processes and activities
This phase is developed, with the aim of obtaining the processes that are executed in the hospital, determining the sub-processes that are inherent to it and the activities that correspond to it, considering the stages described in the previous figure.
Stage 1: Analysis of the processes
It comprises a management stage, where the advisors and users of the system participate jointly. In it, the selected experts participate, who have knowledge in management systems and have a general command of the entity's processes.
The experts list all the processes and activities that take place in the various areas of the hospital, derived from the application of the brainstorming method.
| Table # 4: Military Hospital Processes. Source: own elaboration from consulted bibliography | |
| - Economic management | - Urgent and Emergency Care |
| - Quality Management | - Diagnostic means |
| - Human Capital Management | - Production and Services |
| - Material Supply | - Technical Supply |
| - Development Management | - Defending |
| - Hospitalization | - External Consultation |
Once the processes have been selected, we proceed to the second stage of Phase II.
Stage 2: Design or strategic redesign of processes
At this stage people participate who can provide important criteria given the degree of experience accumulated in the activity they carry out. It is a stage that involves the majority of workers, since all areas that carry out activities inherent to the selected processes participate.
Resulting in the following processes:
| Table # 5: Relevant processes of the Military Hospital. Source: own elaboration from consulted bibliography | |
| - Human Capital Management | - Diagnostic means |
| - Hospitalization | - Material Supply |
| -Attention to Emergencies and Emergencies (Guard Corps) | - External Consultation |
Once the processes are known, the analysis of the activities carried out in the hospital is carried out.
Stage 3: Analysis of activities
For the analysis of the activities, the classification of Porter (1985) will be used, in primary activities and support activities. The importance of having the activities well identified makes it possible to achieve a better management of resources in each activity carried out. In addition, it facilitates the feedback process regarding the relevant processes selected in the hospital.
| Table # 6: Guard Corps Activities (PO-1) | |
| Injections and aerosols cubicle activities (A) | Activities of the local clean minor surgery (C) |
|
1. Heal septic wounds.
2. Heal non-septic wounds. 3. Heal superficial wounds. 4. Heal tearing wounds. |
| Table # 7: External Consultation Activities (PO-2) | |||||||||||||||||||||||
| Nursing activities (E) | Podiatry activities (P) | ||||||||||||||||||||||
| 1. Give spray.
2. Give injection. 3. Cure dog bite. 4. Heal surgical wound. 5. Heal fingernail. |
|
||||||||||||||||||||||
|
From the analysis of the activities, the classification of the activities in the fourth stage is established.
Stage 4: Hierarchy of activities by levels
The hierarchy of activities is nothing more than the grouping of homogeneous activities at different levels according to their behavior in the process. The activities should be grouped by levels: unit level; batch level; product level; client level and finally hospital level.
All the activities listed in the previous stage are grouped at the client (patient) level.
Once the activities are classified, we proceed to the fifth and final stage of this second phase, where the cost drivers that show the greatest cause-effect relationship with respect to the activity will be identified.
Stage 5: Choice of cost drivers
An inducer or cost generator constitutes the cause of its origin, that is, the variable that causes the level of cost reached.
A characteristic of the proposed procedure is that the same cost driver can be used for various activities, as long as the grouped activities are homogeneous.
The cost driver for the activities listed in the previous stage is the NUMBER OF PATIENTS
Once the cost drivers for each activity have been identified and selected, it turns out to continue with Phase III of the proposed procedure.
Phase III. Determination of the cost of the processes
This phase begins from the sixth stage of the procedure and is fundamentally related to the determination of the cost of the different stages that continue and that are part of the total cost of the services that clients demand in the entity under study.
Stage 6: Calculation of the cost of the activities
To calculate the cost of the activities, the direct material (MD), direct labor (MOD) and the indirect variable manufacturing costs (CIFv) will be added, this will result in the cost of the activity, not including time (CAs / t).
To obtain the cost of the activity including time, the cost previously calculated will be multiplied by the duration of the activity in hours (TD) and the cost of the activity per patient including time (CAi / t) will be obtained.
In this sense, the primary documents help and support decision-making through the information they provide from the existing record and control of said activity. At this stage, only the cost of the primary activities is calculated, since there are no support activities in the areas under study. (See annex 6)
| Table # 9: Calculation of the cost of the activity per patient. Source: self made. | |
| (CAs / t) | (CAi / t) |
| MD + CIFv + MOD | CAs / tx TD |
Stage 7: Allocation of the cost of activities to the operational processes of the Hospital
In this stage occurs the allocation of the cost of support activities to the primary activities of the different processes and the allocation of the activities of the relevant processes to the operating processes of the hospital under study.
In turn, it is important to point out that the unidentified costs and expenses of the primary and support activities inherent to the selected processes will be treated as costs and expenses for the period as mentioned above.
| Guard Corps | |
| Exercise | cost |
| PO-1-A | $ 22.80 |
| PO-1-C | 77.45 |
| Total of process PO-1 | $ 100.25 |
| External Consultation | |
| Exercise | cost |
| PO-2-E | $ 22.32 |
| PO-2-P | 60.21 |
| Total of process PO-2 | $ 82.53 |
| Diagnostic Physiotherapy | |
| PO-3 | $ 295,333 |
| PO-4 | $ 3424.77 |
Finally, in the 9th Stage, the cost of the hospital's operational processes is determined.
Stage 8: Calculation of the total cost of operational processes
To determine the cost of operational processes, the allocation of the cost of the primary activities of the strategic processes and support to the operational processes of the hospital should be considered. In this sense, the costs that are finally assigned to said operational processes constitute the final objective of each process, which will allow to subsequently evaluate the activities that were not profitable and that must be improved in the shortest possible time and that is reflected in the sequence to follow for the determination of said calculation.
| Processes | cost |
| Total PO-1 | $ 100.25 |
| Total PO-2 | 82.53 |
| Total PO-3 | 3 720,103 |
| Total cost | $ 3,902,883 |
CONCLUSIONS
- The study of the evolution of Management Accounting, allowed to analyze the development of accounting science, the reason for the expiration of traditional cost systems and the need for the rise of new systems. To study the doctrinal foundations of the ABC / ABM System, facilitated the development of an ABC / ABM procedure for the areas under study at the “Mario Muñoz” Military Hospital. The ABC / ABM System is a system that integrates detailed cost analysis, with a more focused management approach. efficient when analyzing the processes and activities that really incur costs and add value to the patient. The Hospital's current cost system limits timely decision-making by not providing all the necessary information on the management of its areas.Through the results obtained in the investigation, it was possible to know the variables that most influenced the proposed ABC / ABM procedure, which facilitated working on those that constituted barriers in the search for information.
RECOMMENDATIONS
- For the application of this system, training and advisory courses must be planned and carried out for the entity's staff, which will allow the proposed ABC / ABM procedure to be put into practice in the shortest possible time. Disseminate the results of the investigation in different ways with a view to its theoretical and practical consolidation in the rest of the hospital areas. That the research carried out be used as a methodological document for all hospital personnel, in order to achieve a greater culture about the System. Integrate the ABC / ABM Software to the proposed procedure so that the information and results are obtained in the shortest possible time, enabling it to reach all areas of the hospital for the decision-making process.
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When the subject to be addressed requires it, internal experts (belonging to the organization) and / or external experts, belonging to academic institutions, are included.
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