Abstract
We describe a cost-accounting method developed in the department (state) of Valle del Cauca, Colombia, and analyze some results of an intensive study of six months' costs at the hospital-health center in Candelaria. Data on total and average costs of services in all programs are used to examine certain questions of efficiency, especially those showing possible gains from the substitution of paramedical personnel and medical students for staff physicians. Our data for specific programs indicate possible opportunities for cost savings with the substitution of personnel, although the lack of data on outcomes suggests caution in such an interpretation. We also demonstrate the importance of distinguishing between changes that occur in the volume of services used and those factors that affect total costs when analyzing average costs. The more inclusive methods we employed yielded values markedly different from those found by more conventional cost-accounting approaches. Both the general method used and the specific findings illustrate the desirability of extending this approach to other health care institutions to assist administrators and planners in decision making.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
República de Colombia, Ministerio de Salud Publica, Instituto Nacional Para Programas Especiales de Salud and Asociacíon Colombiana de Medicina:Estudio de Instituciones de Atención Médica: (a)Informe General y Anexo (1971); (b)Recurso Institucional (1973). Bogotá, D.E., The Instituto.
Programa de Investigación y Desarrollo de Sistemas de Salud: Several planning reports. Cali, The Programa, various dates.
Aguirre A: Community medicine at the University of Valle. In Lathem W, Newbury A (eds.):Community Medicine: Teaching, Research, and Health Care. New York, Appleton-Century-Crofts, 1970, Pp 51–61.
Velázquez G: Community medicine as an experiment in health care. In Lathem W, Newbury A (eds):Community Medicine: Teaching, Research, and Health Care. New York, Appleton-Century-Crofts, 1970. Pp 121–131.
Discussion. In Lathem W, Newbury A (eds.):Community Medicine: Teaching, Research, and Health Care. New York, Appleton-Century-Crofts, 1970. Pp 131–139.
DANE:Censo Nacional de Población, Año 1973.
Correal P, Hernandez R:Plan de Salud del Centro Hospital Universitario de Candelaria: 1.962–1.972. Cali, División Ciencia de la Salud, Universidad del Valle, 1969.
Gross PF:Health Planning in Colombia—Towards a Rational Framework for the Selection, Acquisition, Processing and Retrieval of Data for Planning. (working document for World Health Organization, 1970).
USAID, Mission to Colombia:An Analysis of the Colombian Public Health Sector. Bogotá, D.E., The Mission, 1972.
Butter I, Moore GT, Robertson RL, et al: Effects of manpower utilization on cost and productivity of a neighborhood health center.Milbank Mem Fund 50:421–452, 1972.
Robertson RL, Moore GT, Butter I, et al: Costs and financing policies at a neighborhood health center.Inquiry 10:36–48, 1973.
Sorensen JE, Phipps DW:Cost-Finding and Rate-Setting for Community Mental Health Centers. DHEW Publication No HSM 72-9138, 1972.
Universidad del Valle, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Publica:Boletin (4a Trimestre, 1.965). Cali, The Departamento, 1965.
Wray JD, Aguirre A: Protein-calorie malnutrition in Candelaria, Colombia: I. prevalence; social and demographic causal factors.J. Trop Pediatr 15:76–98, 1969.
Bryant J:Health & the Developing World. Ithaca, NY, Cornell University Press, 1969.
Universidad del Valle, División de Salud and Municipio de Cali, Secretaria de Salud Municipal:Programa de Investigación en Modelos de Prestación de Servicios de Salud (PRIMOPS): Diseño del Modelo (Projecto No 1, Documento No 1). Cali, The División, 1972.
Leontief W: Theoretical assumptions and nonobserved facts.American Economic Review 61:1–7, 1971.
República de Colombia, Ministerio de Salud Publica, Pediseño de Sistema Nacional de Salud:Manual Instructivo para la implantacion del Control de Costos en los establecimientos del Sector Salud (Documento RSSC-12; Anexo 2 al Documento RSSC-10). Bogotá, D.E., The Ministerio, 1973.
Feldstein PJ: Cost analyses and data needed for a better appreciation of choices in the provision of medical care. In Densen PM, et al (eds):University Medical Care Programs: Evaluation. DHEW Publication No HSM 72-3010, 1972. Pp 117–124.
Lee SS: Compilation of ideas from a discussion. In Densen PM, et al (eds):University Medical Care Programs: Evaluation DHEW Publication No HSM 72-3010, 1972. Pp 125–131.
Roemer MI:Evaluation of Community Health Centres. (Public Health Papers, No 48). Geneva, World Health Organization, 1972.
Abel-Smith B: Health priorities in developing countries: the economist's contribution.Int J Health Serv 2:5–12, 1972.
McCaffree KM: The cost of mental health care under changing treatment methods.Am J Public Health 56:1013–1025, 1966.
Berki SE:Hospital Economics. Lexington, Mass, D.C. Heath and Co, 1972. Pp 85–120.
Hall T: La formacion y la utilizacion del personal paramedico.Educacíon Médica y Salud 1:282–298, 1967.
Beltrán O: Utilización de nuevos tipos de personal para la extensión de servicios de salud (paper for Conferencia Panamericana Sobre Planificacion de Recursos Humanos en Salud). Ottawa, Government of Canada, 1973.
Yankauer A, Connelly JP, Feldman JJ: Pediatric practice in the United States: With special attention to utilization of allied health worker services.Pediatrics 45:521–554, 1970.
Boaz RF: Manpower utilization by subsidized family planning clinics: An economic criterion for determining the professional skill mix.J Hum Resources 8:191–207, 1972.
Boaz RF: Free standing subsidized family planning clinics: The manpower cost of patient service.Inquiry 10:14–25, 1973.
Golladay FL, Miller M, Smith KR: Allied health manpower strategies: Estimates of the potential gains from efficient task delegation.Med Care 11:457–469, 1973.
Zeckhauser R, Eliastam M: The productivity potential of the physician assistant.J Hum Resources 9:95–116, 1974.
Babson JH:Disease Costing. Manchester, Manchester University Press, 1973.
República de Colombia, Departamento del Valle, Servicio de Salud:Sistema de Control de Costos: Manual. Cali, The Servicio, 1973.
Berrera A, et al:Costos Unitarios Historicos 1971–1972 en Algunas Instituciones de Atención Médica en Bogotá. D.E. Bogotá, D.E., Servicio de Salud and Universidad de Los Andes, 1973.
Lewis CE: The state of the art of quality assessment—1973.Med Care 12:799–806, 1974.
República de Colombia, Departamento Administrativo Nacional de Estadistica.
Programa de Investigación y Desarrollo de Sistemas de Salud: Data collected from miscellaneous sources, including Servicio Seccional de Salud-Valle.
República de Colombia, Ministerio de Salud Publica and Asociacion Colombiana de Facultades de Medicina:Estudio de Recursos Humanos para la Salud y la Educación en Colombia: Métodos y Resultados. Bogotá, D.E., The Ministerio, 1969.
Sparer G, Anderson A: Costs of services at neighborhood health centers—a comparative analysis.N Engl J Med 286:1241–1245, 1972.
Herzlinger RE, Moore GT: Management control systems in health care.Med Care 11:416–429, 1973.
Additional information
Dr. Robertson is with the Department of Economics, Mount Holyoke College, South Hadley, Massachusetts 01075. Mr. Barona is an economist with the Departmento de Administración Industrial, Universidad del Valle, Cali, Colombia, and Mr. Pabón is an engineer with the Departamento de Administración Industrial, Universidad del Valle.
Rights and permissions
About this article
Cite this article
Robertson, R.L., Barona, B. & Pabón, R. Hospital cost accounting and analysis. J Community Health 3, 61–79 (1977). https://doi.org/10.1007/BF01319144
Issue Date:
DOI: https://doi.org/10.1007/BF01319144