The International journal of health planning and management
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Int J Health Plann Manage · Jan 2001
Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider.
This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. ⋯ A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.
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Int J Health Plann Manage · Jan 2000
ReviewReconsidering clinical accountability. An examination of some dilemmas inherent in efforts to bolster clinician accountability.
The paper critically appraises current efforts to bolster the accountability of clinicians. The paper opens with an examination of the values, meaning and rules which underpin different accountability systems. Against this background we canvass conceptual, practical and ethical issues which need to be addressed if efforts to extend the accountability of clinicians are to meet with success.
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Int J Health Plann Manage · Apr 1999
Public sector hospitals and organizational change: an agenda for policy analysis.
An important feature of health care systems in recent years is the change in the organizational position and relations of public sector hospitals. Health sector reforms have led to increasing heterogeneity in the organizational location and status of public sector hospitals and new organizational forms of public-private relations are being developed by and for hospitals. These changes can have important implications for health and health care. ⋯ It firstly outlines key elements of health sector reform and relates these to two dimensions of organizational change for hospitals: increasing heterogeneity and forms of public-private relations. The paper provides a descriptive format for classifying forms of hospital organizational change and proposes a framework of six questions for analysing these organizational forms. This may be used to assess the appropriateness of specific policies to particular country situations and to develop more open debate around hospital organizational forms.
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This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are decomposed into vertical, horizontal and 'reranking' segments for each of the four financial sources. ⋯ There is some horizontal inequity and 'reranking', which mainly comes from the county council taxes, since those tax rates vary for each county council. The implication is that, to some extent, people with equal incomes are treated unequally.
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Int J Health Plann Manage · Apr 1998
ReviewThe evolution of health care reforms in Greece: charting a course of change.
An examination of Greece's experience with health care reform planning over the past half century reveals a remarkable consistency in reform themes pursued by planners. However, few of the plans resulted in legislation, and of the legislation that was passed even fewer were implemented. The present paper traces out reform plans since the early 1950s and argues that legislative and implementation failures have been due to a lack of political will, insufficient attention to consensus-forming mechanisms, and inadequate consideration of the technical, administrative, and institutional feasibility of reform plans. ⋯ Macroeconomic constraints, and consensus on broader economic policies focusing on the EU convergence requirements have produced a consensus regarding the imperative of change in the health sector, and have given rise to mechanisms which facilitate the task of implementation. The most recent health care reform act (of 17 July 1997) is less radical than many of its predecessors, but includes issues that had entered the health care reform agenda as early as 1952, as well as the more current issues of health care reform agenda as early as 1952, as well as the more current issues of health sector rationalization. Implementation of the most recent legislative act has already begun.