ハイチのミレバレーで,医療資源の利用を改善するために,時間主導の活動ベースのコストモデル
Morgan Mandigo1, Kathleen O'Neill2, Bipin Mistry3
1Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; University of Miami Miller School of Medicine, Miami, FL, USA.
Lancet (London, England)
|August 28, 2015
まとめ
ハイチで医療費を正確に計測しました この方法は,資源の使用を最適化し,予算の予測を改善し,低リソースの環境で患者のケア効率を改善します.
科学分野:
- 健康経済学
- 医療管理
- 資源の配分
背景:
- 患者のケア資源を最大限に活用するために 資源が限られている環境では 効率性が重要です
- タイム・ドライバド・アクティビティ・ベース・コスト (TDABC) は,臨床および管理プロセスを分析することで正確なコストの見積もりを提供します.
- TDABCは,コストを資源利用時間と関連付けることで,従来のコスト計算方法よりも透明性を高めます.
研究 の 目的:
- TDABCを資源の限られた環境で適用し,正確なサービスコストを計算する.
- 信頼性の高い財政需要の予測を可能にし,品質改善のイニシアチブに情報を提供する.
- 低リソースの環境で医療の提供の効率を最大化すること
主な方法:
- TDABCは,ハイチのHôpital Universitaire de Mirebalais (HUM) で産科および乳がんのケアのための臨床プロセスをマッピングするために多学科チームによって採用されました.
- 人員,設備,施設の直接的なコストは,資源使用時間に基づいて推定されました.
- 間接的な費用は患者のサブグループに分けられ,人件費は人件数単位で計算された.
主要な成果:
- 合併症のない陰道出産の直接費用は62ドル,帝王切開の費用は249ドルでした.
- 診断と乳切除を含む乳がん治療の直接費用は合計1393米ドルでした.
- 間接的なコストは総コストの26%から38%を占め,給与は51%から72%を占める.
結論:
- TDABCを使用した正確な医療サービスのコストは,財務管理と資金決定に不可欠です.
- TDABCは,HUMでの資源利用の最適化とコスト削減の機会を特定しました. 滅菌の合理化やチームワークの改善などです.
- TDABCの適用により,予算の予測が改善され,情報に基づいた資金調達決定が行われ,低リソースの環境で医療の提供とアクセスを改善する価値が示されました.
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