Moreno Karen, Sanchez Eduardo, Salvador-Carulla Luis
Department of Business Administration, Public University of Navarre, Navarre, Spain.
J Ment Health Policy Econ. 2008 Jun;11(2):79-88.
The care of the severe mentally ill who need intensive support for their daily living (dependent persons), accounts for an increasingly large proportion of public expenditure in many European countries.
The main aim of this study was the design and implementation of solid methodology to calculate unit costs of different types of care. To date, methodologies used in Spain have produced inaccurate figures, suggesting few variations in patient consumption of the same service.
An adaptation of the Activity-Based-Costing methodology was applied in Navarre, a region in the North of Spain, as a pilot project for the public mental health services. A unit cost per care process was obtained for all levels of care considered in each service during 2005. The European Service Mapping Schedule (ESMS) codes were used to classify the services for later comparisons. Finally, in order to avoid problems of asymmetric cost distribution, a simple Bayesian model was used.
As an illustration, we report the results obtained for long-term residential care and note that there are important variations between unit costs when considering different levels of care. Considering three levels of care (Level 1-low, Level 2-medium and Level 3-intensive), the cost per bed in Level 3 was 10% higher than that of Level 2.
The results obtained using the cost methodology described provide more useful information than those using conventional methods, although its implementation requires much time to compile the necessary information during the initial stages and the collaboration of staff and managers working in the services. However, in some services, if no important variations exist in patient care, another method would be advisable, although our system provides very useful information about patterns of care from a clinical point of view.
Detailed work is required at the beginning of the implementation in order to avoid the calculation of distorted figures and to improve the levels of decision making within the Health Care Service. IMPLICATIONS FOR HEALTH CARE POLICY AND FORMULATIONS: As other European countries, Spain has adopted a new care system for the dependent population. To finance this new system, reliable figures must be calculated for each type of user in order to establish tariffs or public prices. This study provides a useful management tool to assist in decision making.
The methodology should be implemented in other regions of Spain and even in other countries in order to compare our results and validate the cost system designed.
在许多欧洲国家，为日常生活需要密集支持的重症精神病患者（依赖他人者）提供护理的公共支出占比越来越大。
本研究的主要目的是设计并实施可靠的方法来计算不同类型护理的单位成本。迄今为止，西班牙使用的方法得出的数字不准确，表明同一服务的患者消费几乎没有差异。
在西班牙北部的纳瓦拉地区应用了基于活动成本核算方法的一种改编方法，作为公共精神卫生服务的试点项目。2005年期间，针对每项服务所考虑的所有护理级别得出了每个护理流程的单位成本。使用欧洲服务映射时间表（ESMS）代码对服务进行分类以便后续比较。最后，为避免成本分配不对称问题，使用了一个简单的贝叶斯模型。
作为示例，我们报告了长期住院护理所获得的结果，并指出在考虑不同护理级别时单位成本存在重要差异。考虑三个护理级别（1级 - 低、2级 - 中、3级 - 高），3级的每张床位成本比2级高10%。
使用所述成本核算方法获得的结果比使用传统方法提供了更有用的信息，尽管其实施在初始阶段需要花费大量时间来收集必要信息，并且需要服务部门的工作人员和管理人员协作。然而，在某些服务中，如果患者护理没有重要差异，另一种方法可能更可取，尽管我们的系统从临床角度提供了有关护理模式的非常有用的信息。
在实施开始时需要进行详细工作，以避免计算出失真的数字并提高医疗服务中的决策水平。对医疗保健政策和制定的影响：与其他欧洲国家一样，西班牙为依赖人群采用了新的护理系统。为了资助这个新系统，必须为每种类型的用户计算可靠的数字，以便确定收费标准或公共价格。本研究提供了一个有用的管理工具来协助决策。
应在西班牙的其他地区甚至其他国家实施该方法，以便比较我们的结果并验证所设计的成本系统。
