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PubMedDate not supplied

Laboratory manager's financial handbook. Cost accounting: the road map to financial success.

Cost accounting is the most basic element of the laboratory's financial management structure. Historically, cost accounting in the nonmedical world referred to accumulating and assigning costs to units of production and departments, primarily for inventory valuation and income determination. In the health industry, microcost accounting is distinguishable from macrocost (management/internal) accounting and serves multiple purposes. Microcost accounting pertains to gathering and providing information for decision making. The range of decisions include managing recurring operations, making nonrecurring strategic decisions, and formulating major organizational policies. Macrocost accounting fulfills the legal requirements of reporting to stockholders, auditors, governmental agencies, and other external parties.

Accounting↗
PubMedDate not supplied

Procedural cost accounting: a survival tactic.

With the recent introduction of PPS and DRGs, nonprofit institutions in our industry have had to make major modifications in their methodology for fiscal soundness. One area that must be addressed is cost accounting and, more specifically, procedure cost accounting. Many hospital department managers have no formal training or education in cost accounting. Likewise, very few physicians receive cost-accounting training in their residency programs. Therefore, in the past, there has been little emphasis on this fiscal procedure. Cost accounting is the recording and classifying of the price paid for anything. The costs associated with a specific procedure are assembled into categories and compiled into a base figure with any additional indirect components or overhead costs taken into account. The resulting figure is then corrected for the institution's collection rate to assure complete recovery of all costs. This method is by no means the answer to every organization's needs; however, it is a starting place for managers. Radiology managers can improve upon this worksheet as their knowledge and understanding of the fiscal side of the hospital continues to grow. With more accurate methods for determining costs, managers can incorporate these into the process. The result will contribute to the final goal, a more efficient and cost effective operation.

Accounting↗
PubMed1987

Patient accounting systems: needs and capabilities.

In the first article of this series, it was stated that most finance executives are not very satisfied with the performance of their current patient accounting systems. What steps can a patient accounting system planner take to help ensure the system selected will garner high ratings from managers and users? Two primarily steps need to be taken. First, the planner needs to perform a thorough evaluation of both near- and long-term patient accounting requirements. He should determine which features and functions are most critical and ensure they are incorporated as selection criteria. The planner should also incorporate institutional planning into that process, such as planned expansion of facilities or services, to ensure that the system selected has the growth potential, interfacing capabilities, and flexibility to respond to the changing environment. Then, once system needs are fully charted, the planner should educate himself about the range of patient accounting system solutions available. The data show that most financial managers lack knowledge about most of the major patient accounting system vendors in the marketplace. Once vendors that offer systems that seemingly could meet needs are identified, the wise system planner will also want to obtain information from users about those vendors, to determine whether the systems perform as described and whether the vendor has been responsive to the needs of its customers. This step is a particularly important part of the planning process, because the data also show that users of some systems are significantly more satisfied than users of other patient accounting systems.

Accounting↗
PubMed2002

Medical Savings Accounts: will they reduce costs?

BACKGROUND: Medical Savings Accounts are an attempt to reduce health care costs by transferring responsibility for expenditures to patients, while providing them with state-supported base amounts to cover some of the costs. We wondered whether such a system would actually be effective, given the fact that medical care expenditures (and illness) are unequally distributed across the population. METHODS: We used the Manitoba Population Health Research Data Respository to assess costs incurred by individual residents of Manitoba for all physician visits and admissions to hospital between 1997 and 1999, and we calculated an average expenditure per person per year over the 3 years. RESULTS: During fiscal years 1997-1999, physician and hospital costs that could be attributed to individual Manitoba residents averaged $730 each year. Most users accounted for very little expenditure. About 40% of the entire population of Manitoba used less than $100 each, and 80% used less than $600. The highest-using 1% of the Manitoba population accounted for 26% of all spending on hospital and physician care, whereas the lowest-using 50% accounted for 4%. When examined by age category, the results were similar. Even in the highest age category, most of the population falls into the low-usage category. If the entitlement under a Medical Savings Account scheme was set at the current average cost of $730 per year, then total spending by government on health care for this healthy group would increase (by $505 million) rather than decrease. If the "catastrophic threshold," above which the insurer would pay costs, was set at $1,000 per year, then the sickest 20% of Manitoba residents would become personally responsible for just over $60 million of current health care costs. The net result is a 54% increase in spending on hospital and physician costs that can be allocated to individuals. INTERPRETATION: Medical Savings Accounts will not save money but will instead, under most formulations, lead to an increase in spending on the healthiest members of the population.

Cost Control↗
PubMed2002

Why good accountants do bad audits.

On July 30, President Bush signed into law the Sarbanes-Oxley Act addressing corporate accountability. A response to recent financial scandals, the law tightened federal controls over the accounting industry and imposed tough new criminal penalties for fraud. The president proclaimed, "The era of low standards and false profits is over." If only it were that easy. The authors don't think corruption is the main cause of bad audits. Rather, they claim, the problem is unconscious bias. Without knowing it, we all tend to discount facts that contradict the conclusions we want to reach, and we uncritically embrace evidence that supports our positions. Accountants might seem immune to such distortions because they work with seemingly hard numbers and clear-cut standards. But the corporate-auditing arena is particularly fertile ground for self-serving biases. Because of the often subjective nature of accounting and the close relationships between accounting firms and their corporate clients, even the most honest and meticulous of auditors can unintentionally massage the numbers in ways that mask a company's true financial status, thereby misleading investors, regulators, and even management. Solving this problem will require far more aggressive action than the U.S. government has taken thus far. What's needed are practices and regulations that recognize the existence of bias and moderate its effects. True auditor independence will entail fundamental changes to the way the accounting industry operates, including full divestiture of consulting and tax services, rotation of auditing firms, and fixed-term contracts that prohibit client companies from firing their auditors. Less tangibly, auditors must come to appreciate the profound impact of self-serving biases on their judgment.

Accounting↗
PubMed1988

Principles and methods of managerial cost-accounting systems.

An introduction to cost-accounting systems for pharmacy managers is provided; terms are defined and examples of specific applications are given. Cost-accounting systems determine, record, and report the resources consumed in providing services. An effective cost-accounting system must provide the information needed for both internal and external reports. In accounting terms, cost is the value given up to secure an asset. In determining how volumes of activity affect costs, fixed costs and variable costs are calculated; applications include pricing strategies, cost determinations, and break-even analysis. Also discussed are the concepts of direct and indirect costs, opportunity costs, and incremental and sunk costs. For most pharmacy department services, process costing, an accounting of intermediate outputs and homogeneous units, is used; in determining the full cost of providing a product or service (e.g., patient stay), job-order costing is used. Development of work-performance standards is necessary for monitoring productivity and determining product costs. In allocating pharmacy department costs, a ratio of costs to charges can be used; this method is convenient, but microcosting (specific identification of the costs of products) is more accurate. Pharmacy managers can use cost-accounting systems to evaluate the pharmacy's strategies, policies, and services and to improve budgets and reports.

Accounting↗
PubMed1996

Cost accounting of radiological examinations. Cost analysis of radiological examinations of intermediate referral hospitals and general practice.

The purpose of this study was to analyse the cost structure of radiological procedures in the intermediary referral hospitals and general practice and to develop a cost accounting system for radiological examinations that takes into consideration all relevant cost factors and is suitable for management of radiology departments and regional planning of radiological resources. The material comprised 174,560 basic radiological examinations performed in 1991 at 5 intermediate referral hospitals and 13 public health centres in the Pirkanmaa Hospital District in Finland. All radiological departments in the hospitals were managed by a specialist in radiology. The radiology departments at the public health care centres operated on a self-referral basis by general practitioners. The data were extracted from examination lists, inventories and balance sheets; parts of the data were estimated or calculated. The radiological examinations were compiled according to the type of examination and equipment used: conventional, contrast medium, ultrasound, mammography and roentgen examinations with mobile equipment. The majority of the examinations (87%) comprised conventional radiography. For cost analysis the cost items were grouped into 5 cost factors: personnel, equipment, material, real estate and administration costs. The depreciation time used was 10 years for roentgen equipment, 5 years for ultrasound equipment and 5 to 10 years for other capital goods. An annual interest rate of 10% was applied. Standard average values based on a sample at 2 hospitals were used for the examination-specific radiologist time, radiographer time and material costs. Four cost accounting versions with varying allocation of the major cost items were designed. Two-way analysis of variance of the effect of different allocation methods on the costs and cost structure of the examination groups was performed. On the basis of the cost analysis a cost accounting program containing both monetary and nonmonetary variables was developed. In it the radiologist, radiographer and examination-specific equipment costs were allocated to the examinations applying estimated cost equivalents. Some minor cost items were replaced by a general cost factor (GCF). The program is suitable for internal cost accounting of radiological departments as well as regional planning. If more accurate cost information is required, cost assignment employing the actual consumption of the resources and applying the principles of activity-based cost accounting is recommended. As an application of the cost accounting formula the average costs of the radiological examinations were calculated. In conventional radiography the average proportion of the cost factors in the total material was: personnel costs 43%, equipment costs 26%, material costs 7%, real estate costs 11%, administration and overheads 14%. The average total costs including radiologist costs in the hospitals were (FIM): conventional roentgen examinations 188, contrast medium examinations 695, ultrasound 296, mammography 315, roentgen examinations with mobile equipment 1578. The average total costs without radiologist costs in the public health centres were (FIM): conventional roentgen examinations 107, contrast medium examinations 988, ultrasound 203, mammography 557. The average currency rate of exchange in 1991 was USD 1 = FIM 4.046. The following formula is proposed for calculating the cost of a radiological examination (or a group of examinations) performed with a certain piece of equipment during a period of time (e.g. 1 year): a2/ sigma ax*ax+ b2/ sigma bx*bx+ d1/d5*dx+ e1 + [(c1+ c2) + d4 + (e2 - e3) + f5 + g1+ g2+ i]/n.

Accounting↗
PubMedDate not supplied

A 'stethoscope' for the physician manager--conditions for clinical accountability in the Nordic setting.

An increasing interest in requiring clinical accountability, i.e. direct economical and managerial involvement of physicians, can be witnessed in the US and the UK, representing two extremes on the axis of private versus public service provision. The development is also taking place in the Nordic countries alongside a 'decentralisation' of financial and managerial decision making to smaller units. The essay discusses possibilities to introduce clinical accountability on the Nordic scene. As a background to the analysis, clinical accountability is defined in terms of production targets, budget limits and preset standards of quality of care. Arguments for not using clinical outcome as result measure are presented. The product analogy is suggested as a means for the physician manager to control both clinical policies and resource management. The conclusion is that the possibilities to introduce clinical accountability in the Nordic countries probably are better than in the US or UK, for the following reasons: physician attitudes, interpreted indirectly by shown interest in management training are not unfavourable; the organisational structure with physicians in a line organisation gives the financially accountable Department Head professional as well as managerial authority; management policy stressing decentralisation increases autonomy and stimulates interest to involve in management; product control information is readily available through reliable information systems. Obstacles are also identified. Finally it is argued that the organisation structure found in Nordic countries enables clinical accountability still preserving clinical freedom in the singular doctor patient relation.

Denmark↗
PubMed1999

Assessing the accuracy of a child's account of sexual abuse: a case study.

OBJECTIVE: The objective of the case study reported in this paper was to examine the accuracy of one child's account of a sexually abusive incident. The availability of an audio recording of the last in a series of abusive incidents enabled us to assess accuracy in greater detail than has hitherto been possible in forensic contexts. METHODS: Information given by the victim during an investigative interview was compared with an audio-taped record of the incident. Content analyses of the interview involved quantitative and qualitative analyses of the victim's account, and a qualitative analysis of the eliciting utterances. A CBCA analysis was performed on the victim's account to assess its purported credibility. RESULTS: Over 50% of the informative details reported by the victim were corroborated by the audio-recorded account (of which 98% were central, i.e., allegation related and 64% were confirmed by more than one source (audio-recording, suspect, witness). A total of 10 CBCA criteria were present in the victim's free-narrative account of the last abusive incident. CONCLUSIONS: Our findings confirm that children can indeed provide remarkably detailed and accurate accounts of their experiences.

Child↗
PubMed2000

Confidential billing accounts for adolescents in private practice.

The purpose of this study was to determine how individual confidential billing accounts for adolescents in private practice would be received, and to assess the impact of these accounts on practice reimbursement. Adolescents wishing to keep confidential any part of the charges for an office visit were offered individual billing accounts. Enrollees agreed to pay whenever and whatever they could. One attempt was made to contact nonpayers at least 3 months after starting their accounts. The mean charge for 40 confidential accounts was $42 (total charges $1489) and all of the charges were for laboratory testing. Participants reimbursed 38% of the total charged ($565/$1489). Confidential accounts were well-received by study participants and may improve access to confidential care.

Adolescent↗
PubMed2005

Accounting for belief bias in a mental model framework: comment on Klauer, Musch, and Naumer (2000).

K. C. Klauer, J. Musch, and B. Naumer (2000; see record 2000-02818-008) presented a general multinomial model of belief bias effects in syllogistic reasoning. They claimed to map a particular mental model account of belief bias (J. V. Oakhill, P. N. Johnson-Laird, & A. Garnham, 1989; see record 1989-38845-001)) onto this model and to show empirically that it is incorrect. The authors argue that this mental model account does not map onto the multinomial model and that it can account for the data presented by Klauer et al. (Experiments 1-4). The authors further argue that additional data Klauer et al. presented in support of a new model of their own (Experiments 5-8) are explained by this mental model account. The mental model account is, therefore, refuted neither by Klauer et al.'s theoretical analysis nor by any of the results they presented. Furthermore, the account can accommodate more recent findings on belief bias in a more satisfactory way than can alternative models that have been proposed.

Culture↗
PubMedDate not supplied

The role of litigation in human research accountability.

This essay examines and analyzes the recent and dramatic series of personal injury lawsuits instituted against those individuals and institutions that conduct and monitor human research. It discusses the social engineering functions of tort litigation, outlines the legal elements and viability of lawsuits against those who conduct and monitor human research, and evaluates and predicts what role tort litigation will play in fulfilling the goals of accountability in the context of human research and human research regulation. In general, tort law engenders two forms of accountability: retrospective and prospective. Retrospective accountability is backward looking, focusing on harms that have already occurred, their culprits, and the reimbursement of individuals for their injuries. Prospective accountability is forward looking in that it encourages actors and institutions to fulfill responsibilities toward individuals in order that harm does not occur, or at least that the risk of harm is decreased. This article argues that research litigation is not, and will probably never become, an effective means of ensuring retrospective accountability in regard to research injuries and ethical violations. Paradoxically though, the current wave of research litigation may serve an important and even key role in encouraging and ensuring prospective accountability.

Compensation and Redress↗
PubMed2004

Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services.

This paper examines the concept and practice of community participation in World Bank-supported health sector reforms in Asia, and how far such participation has strengthened accountability with regard to provision of sexual and reproductive health (SRH) services. It argues that the envisaged scope of community participation within a majority of reforms in Asia has been limited to programme management and service delivery, and it is occurring within the boundaries of priorities that are defined through non-participatory processes. Setting up of community health structures, decentralization and community financing are three important strategies used for promoting participation and accountability within reforms. The scant evidence on the impact of these strategies suggests that marginalized groups and sexual and reproductive rights based groups are poorly represented in the forums for participation, and that hierarchies of power between and amongst health personnel and the public play out in these forums. Community financing has not lead to enhanced service accountability. As a result of the above limitations, community participation in health sector reforms has rarely strengthened accountability with respect to provision of comprehensive SRH services. In this context, rights (including sexual and reproductive) based groups and researchers need to engage with design, monitoring and evaluation of health sector reforms, both from inside as participants and outside as pressure groups. Participation contracts enhancing powers of civil society representatives, quotas for participation (for women, other marginalized groups and rights-based organizations), and investment in capacity building of these stakeholders on leadership and sexual reproductive rights and health are pre-requisites if participation is to lead to health and SRH service accountability. Community participation and service accountability hence requires more and not less investment of resources by the state.

Asia↗
PubMed1992

Controlled substance dispensing and accountability in United States anesthesiology residency programs.

Controlled substance dependence (CSD) among anesthesiology personnel, particularly residents, has become a matter of increasing concern. Opinions vary as to the effectiveness of controlled substances (CS) accountability in deterring, identifying, or confirming CSD. A survey of program directors of American anesthesiology training programs was conducted in the summer of 1990 to determine the level of CS dispensing and accountability within their programs. The survey demonstrated that CS dispensing and accountability varied considerably among programs, among hospitals associated with individual programs, and within geographically distinct anesthesia delivery areas within the separate hospitals. Nevertheless, most institutions were moving toward improved methods of CS dispensing and providing more and better CS accountability. The presence of significant CSD, particularly among anesthesiology residents, was reconfirmed. We were unable to correlate the level of accountability of CS with the incidence of CSD. It remains to be seen to what extent CS accountability will continue to develop and whether CSD prevalence will then be changed.

Anesthesia Department, Hospital↗
PubMed2000

Community accountability among hospitals affiliated with health care systems.

The shift from local, community-based hospitals to more complex, multilevel delivery systems raises questions about the community accountability exercised by hospitals. A national sample of community hospitals is the basis of this study, which examines the ways that community accountability is exercised by the governing boards of hospitals affiliated with health care systems and how such institutions compare with hospitals not affiliated with a health care system. Results indicate that hospitals display community accountability in a variety of ways. Boards of system-affiliated hospitals exercise community accountability most strongly in their information monitoring and reporting activities, whereas free-standing hospitals exercise community accountability through the structural and compositional attributes of their boards. Further, hospitals affiliated with different types of systems vary in the style and degree of accountability they demonstrate.

Ethics, Institutional↗
PubMed2006

Accountability sought by patients following adverse events from medical care: the New Zealand experience.

BACKGROUND: Unlike Canada's medical malpractice system, patients in New Zealand who are dissatisfied with the quality of their care may choose between 2 well-established medicolegal paths: one leads to monetary compensation and the other to nonmonetary forms of accountability. We compared the forms of accountability sought by patients and families in New Zealand who took different types of legal action following a medical injury. This study offers insights into the forms of accountability sought by injured patients and may help to inform tort-reform initiatives. METHODS: We reviewed compensation claims submitted to the Accident Compensation Corporation (ACC), New Zealand's national no-fault insurer, following injuries associated with admission to a public hospital in 1998 (n = 582). We also reviewed complaint letters (n = 254) submitted to the national Health and Disability Commissioner (HDC) that same year to determine the forms of accountability sought by injured patients. We used univariable and multivariable analyses to compare sociodemographic and socioeconomic characteristics of patients who sought nonmonetary forms of accountability with those of patients who claimed compensation. RESULTS: Of 154 injured patients whose complaints were sufficiently detailed to allow coding, 50% sought corrective action to prevent similar harm to future patients (45% system change, 6% review of involved clinician's competence) and 40% wanted more satisfying communication (34% explanation, 10% apology). The odds that patients would seek compensation were significantly increased if they were in their prime working years (aged between 30 and 64 years) (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.14-2.41) or had a permanent disability as a result of their injury (OR 1.75, 95% CI 1.14-2.70). When injuries resulted in death, the odds of a compensation claim to the ACC were about one-eighth those of a complaint to the HDC (OR 0.13, 95% CI 0.08-0.23). INTERPRETATION: Injured patients who pursue medicolegal action seek various forms of accountability. Compensation is important to some, especially when economic losses are substantial (e.g., with injury during prime working years or severe nonfatal injuries). However, others have purely nonmonetary goals, and ensuring alternative options for redress would be an efficient and effective response to their needs.

Data Collection↗
PubMed2005

Basic processes in reading: a critical review of pseudohomophone effects in reading aloud and a new computational account.

There are pervasive lexical influences on the time that it takes to read aloud novel letter strings that sound like real words (e.g., brane from brain). However, the literature presents a complicated picture, given that the time taken to read aloud such items is sometimes shorter and sometimes longer than a control string (e.g.,frane) and that the time to read aloud is sometimes affected by the frequency of the base word and other times is not. In the present review, we first organize these data to show that there is considerably more consistency than has previously been acknowledged. We then consider six different accounts that have been proposed to explain various aspects of these data. Four of them immediately fail in one way or another. The remaining two accounts may be able to explain these findings, but they either make counterintuitive assumptions or invoke a novel mechanism solely to explain these findings. A new account is advanced that is able to explain all of the effects reviewed here and has none of the problems associated with the other accounts. According to this account, different types of lexical knowledge are used when pseudohomophones and nonword controls are read aloud in mixed and pure lists. This account is then implemented in Coltheart, Rastle, Perry, Langdon, and Ziegler's (2001) dual route cascaded model in order to provide an existence proof that it accommodates all of the effects, while retaining the ability to simulate three standard effects seen in nonword reading aloud.

Data Interpretation, Statistical↗
PubMed1999

Governing police practice: limits of the new accountability.

The advent of public-sector managerialism has brought with it a new principle of police accountability in Western democracies such as Australia and Britain. The new accountability gives emphasis to managerial rather than legal or public-interest standards, favours external oversight combined with self-regulation rather than centralized control, and promotes risk management rather than rule enforcement. This article makes use of the experience of an Australian police force to show that the new accountability has not been successful in holding police accountable, while elements of the old accountability have re-emerged to dominate public debates. It is argued that in the area of police governance, the neo-liberal state does not necessarily pursue a coherent strategy of 'acting at a distance' (cf. Miller and Rose 1990), partly because of the inability of accountability technologies to deliver substantially the promised policy outcomes and partly because of the sensitivity of its political arm to the public's moral outrage against corruption (cf. Garland 1996).

Australia↗