Rydlewska-Liszkowska Izabela
Zakład Polityki Zdrowotnej, Instytut Medycyny Pracy im. prof. J. Nofera, Lódź.
Med Pr. 2006;57(6):567-71.
In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials.
在不同的医疗保健系统中，存在着不同的组织方案和筹资活动原则，旨在确保在职人口的健康与安全。无论方案如何以及所提供的医疗保健范围怎样，经济学家都致力于成本的合理化（包括成本削减）。这既适用于将工人医疗保健成本纳入市场产品制造间接成本的雇主，也适用于提供医疗保健服务的医疗机构。在实践中，设定工人医疗保健成本的新方法有助于进行定期成本控制、获取有关成本的详细信息，并使信息更好地适应个别医疗机构的规划和控制需求。对于经济机构和专门从事工人医疗保健的机构而言，传统的成本效益计算侧重于设定单个产品（服务）的成本，只有在成本相对较低且简单产品产量不高时才有用。但是，当产品形成诸如职业医学服务中涉及的众多行动的集合时，基于活动的成本核算（ABC）方法，即代表过程方法，就更为有用。根据这种方法，成本是根据产品生产过程中不同活动所使用的资源来归属到产品的。成本计算通过为给定机构中的特定流程分配所有直接成本来进行。间接成本则根据新产品制造过程中各个任务执行期间所使用的资源来结算。在这种方法中，所谓的产品制造过程/行动图及其相互关系尤为重要。医疗机构成本效益管理方面的进展取决于其管理需求。这方面的当前趋势主要取决于将所有成本参考对象都视为成本对象，并考虑到它们之间的所有相互关系。最终产品、特定任务、资源和活动都可被视为成本对象。ABC方法在设定工人医疗保健领域产品价格方面具有非常高的信息价值。它还有助于在多学科医疗保健方法下评估个别活动的成本以及设定各类产品的成本。ABC方法提供了关于资源消耗的精确数据，如人力或各种材料。
