Danneskiold-Samse B, Alban A, Pedersen K M
Dansk Sygehus Institut, Kbenhavn.
Ugeskr Laeger. 1990 Jan 29;152(5):298-303.
The costs of an activity is frequently the most conspicuous part in decision making when changes in health care services are considered. It is thus essential to be aware of the principles and considerations underlying the composition of costs. The concept of cost is not restricted to expenditures that have to be paid. It involves the notion of opportunity cost i.e. the cost of a service is the satisfaction or benefit foregone in not being able to use the resources involved to obtain some other service which is also desirable and therefore also provides satisfaction. Strictly, this relates to the best alternative way of using the resources. In order to estimate the costs of an activity, all costs, whether direct or indirect, tangible or intangible, ought to be taken into account. The fact that they may be difficult to measure a value is no excuse for ignoring them. In a cost analysis the result has to be assessed in the light of the types of costs employed and the aim of the analysis. Average cost is very often used, but is seldom the relevant costs. What is normally of concern is the cost of some change. Only by using marginal costs i.e. those costs that actually do change is it possible to obtain a true picture of resource consequences of that change. Regardless of the type of cost it is necessary to consider on whom the costs fall and to whom the benefits accrue. These may not be the same.
在考虑医疗服务变化时，一项活动的成本往往是决策中最引人注目的部分。因此，了解成本构成背后的原则和考虑因素至关重要。成本的概念并不局限于必须支付的支出。它涉及机会成本的概念，即一项服务的成本是因无法使用所涉及的资源来获得其他同样令人向往且能带来满足感的服务而放弃的满足感或收益。严格来说，这涉及使用资源的最佳替代方式。为了估算一项活动的成本，所有成本，无论是直接成本还是间接成本，有形成本还是无形成本，都应予以考虑。难以衡量其价值这一事实绝不是忽视它们的借口。在成本分析中，必须根据所采用的成本类型和分析目的来评估结果。平均成本经常被使用，但很少是相关成本。通常关注的是某种变化的成本。只有使用边际成本，即实际发生变化的成本，才有可能真实了解该变化对资源的影响。无论成本类型如何，都有必要考虑成本由谁承担以及收益归谁所有。承担成本者和受益方可能并不相同。
