Mecozzi Bernardino, Pancione Luigi, De Intinis Giuseppe, Gullstrand Ragnar, Gualtieri Alfonso, Giraudo Paolo
Direttore Generale ASL 3, Torino, Italy.
Radiol Med. 2003 Mar;105(3):215-29.
To calculate the itemised and overall costs (including staff, technical equipment, and materials) of the services of a radiology department in order to ensure clearer communications between the service providers and clients concerning the service and its costs. The analysis was carried out in the radiology department of a city general hospital.
An Activity Based Cost Analysis was used to study the production process for each type of service delivered, considering all the direct and indirect costs. These calculations resulted in an itemised list of costs per service that included all of the cost components of a radiological examination, overcoming the limits of cost accounting based on specific factors only (e.g. physician time used). The contents of the itemised cost analysis - human resources, equipment and consumables, gathered from the staff were compared with the actual consumption data for a 4-month period of normal activity. The evaluation was completed by an analysis of the quality perceived by clients relative to the levels and costs of the service.
Itemised cost analyses were obtained and verified for 72 categories of services defined by similar types and costs. Thanks to this process-oriented approach, costs could also be differentiated by patient referral group (in-patient, out-patient, emergency department) to compare the impact on the organisation of the three patient categories. Emergency department and in-patient services were found to have a greater impact than out-patient services, and the latter proved more cost-effective than the other two. Emergency department services were found to be considerably less cost-effective due to the fact that the service is guaranteed 24 hours a day / 7 days a week, but seldom fully exploited. While confirming that the Regional charges are inadequate, our analysis supplied all the data needed to precisely evaluate the cost drivers and to update the charges to reflect the actual costs. As regards quality, the patients judged the processes positively, but as a result of their growing expectations they expressed a need for more information.
This itemized cost analysis has proved to be an excellent tool for communicating service costs, and can be used effectively as a benchmarking instrument to verify the cost-effectiveness of similar services, especially if integrated with an in-depth quality analysis (to be carried out by all clients). The results obtained have allowed us to determine the impact of service delivery processes on patients from various referral categories and to develop an up-to-date internal price list that better reflects the actual costs compared to current charges.
计算放射科服务的明细成本和总成本（包括人员、技术设备和材料），以确保服务提供者和客户之间就服务及其成本进行更清晰的沟通。该分析在一家城市综合医院的放射科进行。
采用基于活动的成本分析方法，研究每种提供的服务类型的生产过程，考虑所有直接和间接成本。这些计算得出了每项服务的明细成本清单，其中包括放射检查的所有成本组成部分，克服了仅基于特定因素（如医生使用时间）的成本核算的局限性。从工作人员那里收集的明细成本分析内容——人力资源、设备和耗材，与正常活动4个月期间的实际消耗数据进行了比较。通过分析客户对服务水平和成本的感知质量来完成评估。
针对72种按相似类型和成本定义的服务类别获得并验证了明细成本分析。由于这种面向过程的方法，成本也可以按患者转诊组（住院患者、门诊患者、急诊科患者）进行区分，以比较这三类患者对机构的影响。发现急诊科和住院患者服务的影响大于门诊患者服务，且后者被证明比其他两者更具成本效益。由于该服务每周7天、每天24小时提供保障，但很少得到充分利用，因此发现急诊科服务的成本效益相当低。在确认区域收费不足的同时，我们的分析提供了精确评估成本驱动因素并更新收费以反映实际成本所需的所有数据。在质量方面，患者对流程给予了积极评价，但由于他们的期望不断提高，他们表示需要更多信息。
这种明细成本分析已被证明是一种传达服务成本的优秀工具，并且可以有效地用作基准工具来验证类似服务的成本效益，特别是如果与深入的质量分析（由所有客户进行）相结合。所获得的结果使我们能够确定服务提供流程对来自不同转诊类别的患者的影响，并制定一份更新的内部价格清单，与当前收费相比，该清单能更好地反映实际成本。
