Augusta and Atlanta, Ga. From the School of Medicine and the Section of Plastic Surgery, Medical College of Georgia, and Georgia Institute of Technology.
Plast Reconstr Surg. 2011 Jun;127(6):2487-2495. doi: 10.1097/PRS.0b013e3182131d0c.
In this article, the authors present a microeconomic analysis of the effects of the administrative status on plastic surgery units within academic medical centers, comparing the departmental versus subdepartmental status. The objectives are to introduce decision-making tools of microeconomics and use them to explore the potential effects of administrative status on academic plastic surgery services.
Real financial data over a decade were used to construct total cost (TC), average total cost (ATC), and total revenue (TR) curves. From these, the authors derive the efficiency scale and express the fiscal performance by examining profitability, and the commonly used ATC curve. Mathematical modeling is then used to examine the effects of departmental versus subdepartmental status, assuming that (1) a plastic surgery unit exists in a competitive market; and (2) TR > TC for the plastic surgery unit to self-sustain in the long term. The variables considered are total clinical production (Q), gross collection rates (GCR), personnel cost, and departmental tax.
The sustainability (Q against GCR) is a hyperbolic curve with Q × GCR = TC at break-even. The TC/TR = f(TR) curve resembles the ATC curve. Sectional versus departmental status for a plastic surgery service in an academic medical center depends greatly on the shape of their TC/TR = f(TR) curve.
With most competing clinical units within the same academic medical center having departmental status, and most competing private surgeons having no institutional "taxes," the essential requirement for academic medical center plastic surgery services is to ensure that their TC/TR = f(TR) curve is comparable to that of their competitors.
本文作者对学术医学中心内整形外科学术单位的行政地位的影响进行了微观经济学分析，比较了部门和分部地位。目的是介绍微观经济学的决策工具，并利用这些工具探讨行政地位对学术整形手术服务的潜在影响。
使用十多年的真实财务数据构建总成本（TC）、平均总成本（ATC）和总收入（TR）曲线。在此基础上，作者得出了效率规模，并通过检查盈利能力和常用的 ATC 曲线来表达财政绩效。然后，使用数学模型来检验部门和分部地位的影响，假设（1）整形手术单位存在于竞争市场中；（2）TR > TC，以确保整形手术单位在长期内能够自我维持。考虑的变量包括总临床产量（Q）、总收款率（GCR）、人员成本和部门税。
可持续性（Q 对 GCR）是一条双曲线，在盈亏平衡点处 Q × GCR = TC。TC/TR = f（TR）曲线类似于 ATC 曲线。学术医学中心整形服务的分部与部门地位在很大程度上取决于其 TC/TR = f（TR）曲线的形状。
由于大多数在同一学术医学中心内竞争的临床单位都具有部门地位，而大多数竞争的私人外科医生都没有机构“税”，因此学术医学中心整形手术服务的基本要求是确保其 TC/TR = f（TR）曲线与竞争对手的曲线相当。
